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WoundManagementWoundManagement
ThePlanfortonight…-WoundsondutyClassificationWoundmanagement-TissueViabilityStagesofwoundhealingWoundmanagement
ThePlanfortonight…WoundDefinition‘Adisruptionoftheintegrityandfunctionofthetissuesinthebody’
(Baharestani2004)WoundDefinitionFirstAidClassificationofwoundsWoundscanbeclassifiedinto7differenttypesdependingontheobjectthatproducesthewoundandthemannerwhichithasbeeninflicted.EachwoundtypecarriesspecificrisksassociatedwithsurroundingtissuedamageandinfectionCANYOUREMEMBERWHATTHEYARE?!!!!FirstAidClassificationofwoTypesofwoundINCISEDCausedbyacleancutfromasharpedgedobject.BloodvesselsarecutstraightacrosssobleedingmaybeprofuseStructuressuchastendons,nervesorarteriesmaybedamagedTypesofwoundINCISEDTypesofwoundLACERATIONCausedbycrushingorrippingforcesMaybleedlessprofuselythanincisedwoundsLikelytobemoretissuedamageMoreoftencontaminatedwithgermssoinfectionriskishighTypesofwoundLACERATIONTypesofwoundABRASIONSuperficialwoundinwhichthetopmostlayersoftheskinarescrapedoffleavingarawtenderareaCausedbyslidingfallsorfrictionburnsCancontainembeddedforeignparticlesthatmayresultininfectionTypesofwoundABRASIONTypeofwoundsCONTUSIONCausedbyabluntbloworpunchrupturingthecapillariesbeneaththeskincausingbloodtoleakintothetissuesresultinginbruising.SeverecontusionmayindicatedeeperdamagesuchasinternalinjuryorfractureTypeofwoundsCONTUSIONTypeofwoundPUNCTURESuchasstandingonanailorbeingprickedbyaneedle.Smallentrysitebutadeeptrackofinternaldamage.Asgermsanddirtcanbecarriedfarintothebody,theinfectionriskishighTypeofwoundPUNCTURETypeofwoundSTABCausedbyalongorbladedinstrumentusuallyaknifepenetratingthebody.StabwoundstothetrunkmustalwaysbetreatedseriouslyduetodangersofinjurytovitalorgansorlifethreateninginternalbleedingTypeofwoundSTABTypeofWoundGUNSHOT2woundsCausedbyabulletormissilewhichmaycauseseriousinternalinjuryEntrywoundmaybesmallandneatExitwoundmaybelargeandraggedTypeofWoundGUNSHOTWoundmanagementWoundmanagementWoundhealingTheprocessbywhichtissuedamagedordestroyedbyinjuryordiseasearerestoredtonormalfunctionWoundhealingTheprocessbywhStagesofwoundhealingINFLAMMATORYUpto3daysaftertheinitialwoundRedness,swelling,heatPROLIFERATIONDays3-24Constructionofthewound,developmentofnewgranulationtissueMATURATION24daysafterwound-1yearEpithelialcellsmigrateovernewtissue,becomeslessvascularAfter3monthsthetensilestrengthisonly50%ofnormaltissueStagesofwoundhealingINFLAMMFactorsaffectingwoundhealingCardiovasculardisordersPeripheralVascularDisease,ChronicHeartDiseaseTherapiesRadiotherapy,ChemotherapyMalnutritionPsychological&socialfactorsIncreasingageImmunedisordersRheumatoidarthritis
EndocrinedisordersAnaemia,DiabetesInappropriatewoundmanagementFactorsaffectingwoundhealinWoundManagement-WhatthebooksaysWashyourhandsandapplyglovesCleanthewoundwithrunningwaterifthewoundisdirty.PatdrywithgauzeCoverwithadhesivedressing.WoundManagement-WhatthebookOptimumhealingenvironmentCellsmigrateoverviabletissueandwoundsheal3timesfasterinamoistenvironment(Winter1962)Woundtemperaturebelow37degreesdelaysmitoticactivityforupto4hours(Torrance1986)WhitecellswillnotfunctioninalowtemperatureincreasingpotentialforclinicalinfectionOptimumhealingenvironmentCelTocleanornottoclean?!!!GOAL‘Toremoveanyhindrancetothemaintenanceorrestorationofhealing,achievedwithminimalphysicaldiscomfortandpsychologicaldistresstothepatient.‘THEREFORE…ifthereisnodebrisinthewound,thewoundisnotbleedingorthewoundisnotdirty-thereisnoneedto‘clean’it.Tocleanornottoclean?!!!GOSterilesalinesolution0.9%.
V’sTapWaterTHEREISNOEVIDENCETOUSEONEORTHEOTHERSaline0.9%isanisotonicsolutioncompatiblewithsimilarosmoticpressuretolivingcellssoshouldnotcausecelldamageduringwoundirrigation.Easyapplicationinthemiddleofafieldhowever,ideallythesolutionshouldwarmedtobodytemperature.Warmedtapwaterisjustaseffectiveandmuchcheaper!Sterilesalinesolution0.9%.
Howtocleanawound?Warmtapwaterorwarmedsterilesalinesolution0.9%canbeusedwithgauze.Letthewaterrunoffthewoundintoanappropriatereciprocal.Usecleanswabsforeachstroke.Alwaysensurethewoundiscompletelydrytopreventmaceration.Disposeinyellowclinicalwastebag.Howtocleanawound?WarmtapCottonWool-DONOTUSE!ItisnotrecommendedtouseCottonwooltocleanasitcanredistributebacteriawithinwoundsanddrivefibresintothetissuesThesethenmayactasfociforinfection.CottonWool-DONOTUSE!HowtotellifawoundisinfectedLocalisedrednessLocalisedpainLocalisedheatSwellingDiscoloureddischargeIncreasedexudateMalodourCasualtyfeelingunwellHowtotellifawoundisinfeAntisepticsTheroutineuseofantisepticsinwoundcleansingisnotrecommendedasitmaybedetrimentaltowoundhealing,thebacteriamaydeveloparesistance,andtheremaybeapotentialtoxiceffectonviabletissue.AntisepticsTheroutineuseofBURNS-specialistarea Superficial(1stdegree)
Canbemanaged.Anythingelse,sendtohospitalPartialthickness Fullthickness(2nddegree) (3rddegree)BURNS-specialistarea SuperSuperficialBurnManagementApplycoldwatertolocalisedsuperficialburnMaintainmoistenvironmentandminimiseriskofinfectionbycoveringwithclingfilm,tegaderm,hydrocolloidReviewanewburnafter24/48hourstoreassessSuperficialburnsusuallyhealin7-14daysIfdelayedconsiderinfectionandrefertosecondarycare.Oncehealedadvisetoprotectnewlyhealedtissue.Useofemollientmaysoothandeaseitching.UsehighfactorsunblockforfirstyearwhilstnewskinmaturesSuperficialBurnManagementAppBlistersHaveprotectivefunctionIfnotlargeandwillnotobstructdressingormovement-leaveintactLargeblistersmayneedtobedrainedbutdonot‘deroof’asmayincreaseriskofinfectionBlistersHaveprotectivefunctiSo...HowtopickanidealwounddressingItsmorethanapplyingaplaster!So...HowtopickanidealwounDressingRequirements-
InSummary!Moisture–Winter(1962)foundthatepithelialcellsmigrateoverviabletissueandwoundshealthreetimesfasterinamoistenvironmentThermalinsulation–anydropintemperaturebelow37degreesdelaysmitoticactivityforuptofourhours(Torrance1986).Leucocyteswillnotfunctioninalowtemperaturewound–increasingthepotentialforclinicalinfectionHighlyabsorptive–exudatecanbeharmfultogoodskin.Chronicwoundexudatecandelayhealing(Phillipsetal1998)DressingRequirements-
InSumFreeofcontaminants–cottonwool,remainsofdressings,necrotictissueareforeignbodiesandarefociforinfectionLow-adherent–adherentdressingsmayteardriedexudateoffthewoundbed,causingtraumatonewlyformingtissues.NewlyformingcapillariescangrowthroughgauzeloopsandwillbetornwhenthegauzeisremovedNon-toxic/harmful–manyantisepticshavebeenfoundtodamagehealthytissuePatientfactors–acceptabletothepatientandtheneedtobatheorshowerforexample.Takingintoconsiderationknownsensitivities,fragiletissuetypeorethicalconsiderations (AdaptedfromHamptonandCollins2004)Freeofcontaminants–cottonDressingsavailabletoHCPsLowAdherentVapourpermeablefilmAntimicrobialOdourAbsorbentAlginateFoamHydrocolloidLarvalTherapyDressingsavailabletoHCPsLoAnyQuestions?AnyQuestions?WoundManagementWoundManagement
ThePlanfortonight…-WoundsondutyClassificationWoundmanagement-TissueViabilityStagesofwoundhealingWoundmanagement
ThePlanfortonight…WoundDefinition‘Adisruptionoftheintegrityandfunctionofthetissuesinthebody’
(Baharestani2004)WoundDefinitionFirstAidClassificationofwoundsWoundscanbeclassifiedinto7differenttypesdependingontheobjectthatproducesthewoundandthemannerwhichithasbeeninflicted.EachwoundtypecarriesspecificrisksassociatedwithsurroundingtissuedamageandinfectionCANYOUREMEMBERWHATTHEYARE?!!!!FirstAidClassificationofwoTypesofwoundINCISEDCausedbyacleancutfromasharpedgedobject.BloodvesselsarecutstraightacrosssobleedingmaybeprofuseStructuressuchastendons,nervesorarteriesmaybedamagedTypesofwoundINCISEDTypesofwoundLACERATIONCausedbycrushingorrippingforcesMaybleedlessprofuselythanincisedwoundsLikelytobemoretissuedamageMoreoftencontaminatedwithgermssoinfectionriskishighTypesofwoundLACERATIONTypesofwoundABRASIONSuperficialwoundinwhichthetopmostlayersoftheskinarescrapedoffleavingarawtenderareaCausedbyslidingfallsorfrictionburnsCancontainembeddedforeignparticlesthatmayresultininfectionTypesofwoundABRASIONTypeofwoundsCONTUSIONCausedbyabluntbloworpunchrupturingthecapillariesbeneaththeskincausingbloodtoleakintothetissuesresultinginbruising.SeverecontusionmayindicatedeeperdamagesuchasinternalinjuryorfractureTypeofwoundsCONTUSIONTypeofwoundPUNCTURESuchasstandingonanailorbeingprickedbyaneedle.Smallentrysitebutadeeptrackofinternaldamage.Asgermsanddirtcanbecarriedfarintothebody,theinfectionriskishighTypeofwoundPUNCTURETypeofwoundSTABCausedbyalongorbladedinstrumentusuallyaknifepenetratingthebody.StabwoundstothetrunkmustalwaysbetreatedseriouslyduetodangersofinjurytovitalorgansorlifethreateninginternalbleedingTypeofwoundSTABTypeofWoundGUNSHOT2woundsCausedbyabulletormissilewhichmaycauseseriousinternalinjuryEntrywoundmaybesmallandneatExitwoundmaybelargeandraggedTypeofWoundGUNSHOTWoundmanagementWoundmanagementWoundhealingTheprocessbywhichtissuedamagedordestroyedbyinjuryordiseasearerestoredtonormalfunctionWoundhealingTheprocessbywhStagesofwoundhealingINFLAMMATORYUpto3daysaftertheinitialwoundRedness,swelling,heatPROLIFERATIONDays3-24Constructionofthewound,developmentofnewgranulationtissueMATURATION24daysafterwound-1yearEpithelialcellsmigrateovernewtissue,becomeslessvascularAfter3monthsthetensilestrengthisonly50%ofnormaltissueStagesofwoundhealingINFLAMMFactorsaffectingwoundhealingCardiovasculardisordersPeripheralVascularDisease,ChronicHeartDiseaseTherapiesRadiotherapy,ChemotherapyMalnutritionPsychological&socialfactorsIncreasingageImmunedisordersRheumatoidarthritis
EndocrinedisordersAnaemia,DiabetesInappropriatewoundmanagementFactorsaffectingwoundhealinWoundManagement-WhatthebooksaysWashyourhandsandapplyglovesCleanthewoundwithrunningwaterifthewoundisdirty.PatdrywithgauzeCoverwithadhesivedressing.WoundManagement-WhatthebookOptimumhealingenvironmentCellsmigrateoverviabletissueandwoundsheal3timesfasterinamoistenvironment(Winter1962)Woundtemperaturebelow37degreesdelaysmitoticactivityforupto4hours(Torrance1986)WhitecellswillnotfunctioninalowtemperatureincreasingpotentialforclinicalinfectionOptimumhealingenvironmentCelTocleanornottoclean?!!!GOAL‘Toremoveanyhindrancetothemaintenanceorrestorationofhealing,achievedwithminimalphysicaldiscomfortandpsychologicaldistresstothepatient.‘THEREFORE…ifthereisnodebrisinthewound,thewoundisnotbleedingorthewoundisnotdirty-thereisnoneedto‘clean’it.Tocleanornottoclean?!!!GOSterilesalinesolution0.9%.
V’sTapWaterTHEREISNOEVIDENCETOUSEONEORTHEOTHERSaline0.9%isanisotonicsolutioncompatiblewithsimilarosmoticpressuretolivingcellssoshouldnotcausecelldamageduringwoundirrigation.Easyapplicationinthemiddleofafieldhowever,ideallythesolutionshouldwarmedtobodytemperature.Warmedtapwaterisjustaseffectiveandmuchcheaper!Sterilesalinesolution0.9%.
Howtocleanawound?Warmtapwaterorwarmedsterilesalinesolution0.9%canbeusedwithgauze.Letthewaterrunoffthewoundintoanappropriatereciprocal.Usecleanswabsforeachstroke.Alwaysensurethewoundiscompletelydrytopreventmaceration.Disposeinyellowclinicalwastebag.Howtocleanawound?WarmtapCottonWool-DONOTUSE!ItisnotrecommendedtouseCottonwooltocleanasitcanredistributebacteriawithinwoundsanddrivefibresintothetissuesThesethenmayactasfociforinfection.CottonWool-DONOTUSE!HowtotellifawoundisinfectedLocalisedrednessLocalisedpainLocalisedheatSwellingDiscoloureddischargeIncreasedexudateMalodourCasualtyfeelingunwellHowtotellifawoundisinfeAntisepticsTheroutineuseofantisepticsinwoundcleansingisnotrecommendedasitmaybedetrimentaltowoundhealing,thebacteriamaydeveloparesistance,andtheremaybeapotentialtoxiceffectonviabletissue.AntisepticsTheroutineuseofBURNS-specialistarea Superficial(1stdegree)
Canbemanaged.Anythingelse,sendtohospitalPartialthickness Fullthickness(2nddegree) (3rddegree)BURNS-specialistarea SuperSuperficialBurnManagementApplycoldwatertolocalisedsuperficialburnMaintainmoistenvironmentandminimiseriskofinfectionbycoveringwithclingfilm,tegaderm,hydrocolloidReviewanewburnafter24/48hourstoreassessSuperficialburnsusuallyhealin7-14daysIfdelayedconsiderinfectionandrefertosecondarycare.Oncehealedadvisetoprotectnewlyhealedtissue.Useofemollientmaysoothandeaseitching.UsehighfactorsunblockforfirstyearwhilstnewskinmaturesSuperficialBurnManagementAppBlistersHaveprotectivefunctionIfnotlargeandwillnotobstructdressingormovement-leaveintactLargeblistersmayneedtobedrained
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