1 / 170

Wound Management

Wound Management. Andrew Stiell U of C Family Medicine R2 October 1st, 2009. Thanks. Dr Ian Rigby Carole Rush. Objectives. Review a few basic topics Interactive Game Discuss your cases. Quiz: From when is the earliest evidence we have of a surgical technique being done?.

lowell
Download Presentation

Wound Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Wound Management Andrew Stiell U of C Family Medicine R2 October 1st, 2009

  2. Thanks • Dr Ian Rigby • Carole Rush

  3. Objectives • Review a few basic topics • Interactive Game • Discuss your cases

  4. Quiz:From when is the earliest evidence we have of a surgical technique being done?

  5. Quiz:From when is the earliest evidence we have of a surgical technique being done ? • 1200’s • 500 • 500 BC • 1200 BC • 12 000 BC

  6. Quiz:From when is the earliest evidence we have of a surgical technique being done ? • 1200’s • 500 • 500 BC • 1200 BC • 12 000 BC

  7. Trapanation (burr hole) • 12 000 BC • Used tools to make hole into skull • Used to treat trauma, seizure, migraines, psychiatric disorder • 50% survival

  8. Skin • Largest organ in our body • 16-21 square feet • 1-4mm thick

  9. Skin • Largest organ in our body • 16-21 square feet • 1-4mm thick • Lots going on: (per square inch) • 650 sweat glands • 20 blood vessels • >1,000 nerve endings

  10. Skin - Function • Barrier from pathogens

  11. Skin - Function • Barrier from pathogens • Sensation

  12. Skin - Function • Barrier from pathogens • Sensation • Heat regulation (radiation, convection, conduction)

  13. Skin - Function • Barrier from pathogens • Sensation • Heat regulation (radiation, convection, conduction) • Barrier to fluid loss (evaporation)

  14. Skin - Function • Barrier from pathogens • Sensation • Heat regulation (radiation, convection, conduction) • Barrier to fluid loss (evaporation) • Storage (water & lipids)

  15. Skin - Function • Barrier from pathogens • Sensation • Heat regulation (radiation, convection, conduction) • Barrier to fluid loss (evaporation) • Storage (water & lipids) • Vitamin D production

  16. Skin - Function • Barrier from pathogens • Sensation • Heat regulation (radiation, convection, conduction) • Barrier to fluid loss (evaporation) • Storage (water & lipids) • Vitamin D production • Communication (mood, physical status)

  17. Skin - Anatomy

  18. Skin - Anatomy

  19. Skin- Healing

  20. Healing terminology • Closed • Open • Delayed • Primary intention • Secondary intention • Third intention

  21. Skin Healing- Open vs Closed Closed: • less inflammation • less contracture • less scar width • less future contamination Open: - less chance of infection

  22. Skin Healing • Open or Delayed Closure: • Already infected (by soil, organic matter or feces) • Extensive tissue damage (high-velocity missile injuries, explosion injuries of hand or complex crush injuries) • Human Bite wounds • Animal Bites

  23. Skin Healing- Delayed Closure

  24. Some Rules: • In each section go in order starting with the lowest question available • Do not have to answer in the form of a question • Dr Rigby gets the final say on if answers are correct as he is giving out the prize

  25. Ooh It Burns! $100 What is the most common age to suffer a burn? (decade)

  26. Ooh It Burns! $100Answer Ages 0-10 and 20-29

  27. Burns • Most common in ages 1-2 yo & 20-29yo • Males > Females • In small children almost all burns are scald burns. • Adults flame burns are most common • Most common contributing factor is EtOH

  28. Burns

  29. Burns • Don’t forget child abuse • Immersion scald burns • Stocking pattern • Back of hands & feet, buttock and legs • Accidental • Spill burns • Head, trunk, palmer surface of hands & feet

  30. Ooh It Burns! $200 How do we classify burns?

  31. Ooh It Burns! $200Answer 1st, 2nd, 3rd & 4th degree burns Partial vs Full thickness

  32. Burns - severity • 1)Temperature • 2)Time of exposure • Capacity to hold heat • Viscosity • Clothing

  33. Burns - depth • 1st Degree • 2nd Degree • Superficial Partial Thickness • Deep Partial Thickness • 3rd Degree • Full Thickness • 4th Degree • -Full Thickness

  34. Burns - depth • 1st Degree • Minor epithelial damage • Red, tenderness & pain • No blistering • Heals over several days • Eg. sunburns

  35. Burns - depth • 2nd Degree Superficial Partial Thickness • Epidermis and superficial papillary dermis • Fluid-filled blisters • Pink, moist, soft and very tender • Heal in 2-3wks w/o scarring Deep Partial Thickness • Deeper into dermis • Red & blanched white • Thick walled blisters • Decreased 2pt discrimination • Heal in 3-6 wks • Increased risk of scar

  36. Burns - depth • 3rd Degree Full Thickness • Destroy Epidermis and Dermis • Capillary network destroyed • White or leathery • Numb • Requires skin grafting • Eg. Immersion scalds,flames, chemical electrical

  37. Burns - depth • 4th Degree Full Thickness + destruction of subcutaneous tissue • Involves fascia, muscle & bone • Require extensive debridement and reconstruction • Eg. Prolonged exposure to immersion scalds, burns, chemical and electrical

  38. Burn Zones?

  39. Burns - Zones • 1) Coagulation / Necrosis • Contact with source • Dead/Dying cells b/c loss of blood flow • White or charred • 2) Stasis / Ischemia • Red and may blanch initially • @ 24hrs no circulation, petechial hemorrhages • Becomes white as it is necrotic • 3) Hyperemia • Blanches, has circulation • Becomes deep red • Starts healing at 1 week

  40. What should you do if you are out camping, many hours from help, and your friend suffers a burn?

  41. What should you do if you are out camping many hours from help and your friend suffers a burn? • A) Do not remove burned clothing • B) Immerse in cool water x30min • C) Immerse in cool water x1hr • D) Cover with dry dressing • E) A & C • F) B & D

  42. What should you do if you are out camping many hours from help and your friend suffers a burn? • A) Do not remove burned clothing • B) Immerse in cool water x30min • C) Immerse in cool water x1hr • D) Cover with dry dressing • E) A & C • F) B & D

  43. Burns-Dressing • In the field prior to transport • Remove burned clothing • Skin washed with cool water • Immerse in cold water x30min if cannot be transported • >30 min only cool 9% of TBSA to prevent hypothermia • Do not use ice as it can cause frostbite injury • Cover with dry dressing

  44. Burns-Dressing (in the ED) • Minor Burns(Outpatients) • Cleansed with sterile saline • Blisters?? To pop or not to pop? • Clean and debride If follow up is later (1week) • Synthetic dressings (Aquacel Ag dressing): maintain moist environment If follow up is next day • Strips of sterile fine-mesh gauze soaked in saline which are covered by fluffed 4x4 coarse gauze • Flamazine cream (Antibacterial ointment is often not used because require frequent changes needed) • F/u at wound clinic 1-3 days for dressing change

  45. Burns-Dressing (in the ED) • Major Burns (Inpatients) • Cleanse with sterile saline • Maintain sterile environment If waiting for hydrotherapy - Cover with clean sheet or towel If too unstable for hydrotherapy - Plastics will apply Flamazine and gauze • Debridement of blisters (except palms and soles) • Aggressive debridement usually deferred unless involving joints • Silver stains the face, therefore polysporin is used

  46. Burns - fluids Why do we have such big fluid losses? 1) Increased evaporation b/c loss semi-impermiable barrier 2) Systemic inflammatory causing vessels to have increased permeability -Fluid gets pushed in to burned tissues 3)Tissue destruction causes capillary permeability • Fluid gets goes in to adjacent tissue to the burn wound

  47. Ooh It Burns! $300 Name 2 criteria for burn referral/transfer?

  48. Ooh It Burns! $300Answer Transfer Guidelines for Patients with Severe Burns Any burn >10% of BSA in pts <10 or >50 Burns involving >20% of total BSA in any patient Full-thickness burns involving >5% of total BSA Significant burns of hands, face, feet, genitalia, perineum, or major joints Significant electrical injury Significant chemical injury Significant inhalation injury, trauma, co morbidities

More Related