wound management: continued

wound management: continued

1. emergency treatment

   • pressure cuffs and tourniques
     • pressure cuffs
       • apply proximal to appendicular wounds
       • inflate 20-30mmHg higher than for normal bp
       • should be on a max of 6 hours
     • tourniques
       • not recommended unless limb is being amputated
       • narrow tournique (penrose drain) use for 3-5 mins at a time
       • wide band (5-10cm wide) safe for max of 30mins

2. assessment of bacterial infection

   • swab wound after lavage (washing out)
     • prescence of beta-haemolytic strepcocci or 10^5 organisms/g
   • rapid slide test
     • swab 1-2cm deep in wound with sterile cotton bud, rub swab over 1-2cm of microscope slide, bacteria present = don't close wound
       • if staining gram-ve bacteria doesn't take up stain so stays pink

3. control of contamination

   • need to clean contaminated wound within 6 hours
   • be sterile (gloves, hats, gowns etc.)
   • cover wound with gel, saline covered swab, vaseline etc
   • clip hair away
   • flush with sterile salene, tap water, lactated ringers, 0.05% chlorhexidine (hibi), 0.01-1% povidine-iodine
   • take bacterial swab for culture
   • apply sterile dressing and bandage

4. debridement - getting rid of debris

   • wet to dry in SA (not equine) - cheap
   • hydrosurgery - bursts of water (new used in equine) more effective than surgical removal
   • vac therapy - animals wears it for 24hrs, vacuum that sucks it out
   • autolytic debridement (body gets rid)
   • surgical removal

5. Documentation

   • wound mapping
     • dimentions
     • shape/outline
     • type
     • areas of infection, inflammation or necrotion
   • progression
     • areas of granulation
     • areas of epithelisation
     • take photos

6. closure

   • dependant on
     • level of contamination
     • viability of wound tissues
   • primary
     • immediate closure
   • delayed primary
     • 2-5 days post injury
   • secondary
     • after 5 days post injury
   • second intention healing
     • healing through granulation