Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4...

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Louis Pilati MD FACEP HUM Medical Director Wound Healing and Hyperbaric Medicine Center Located at Sycamore Medical Center Overview On Wound Care and Hyperbaric Medicine

Transcript of Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4...

Page 1: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Louis Pilati MD FACEP HUM

Medical Director

Wound Healing and Hyperbaric Medicine Center Located at Sycamore Medical Center Overview On Wound Care and Hyperbaric Medicine

Page 2: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Wound Healing

and

Hyperbaric Medicine Center

Page 3: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Educational Background

Medical School – Wright State University School of Medicine

Specialty Emergency Medicine (Board Certified)

Subspecialty Training – Hyperbaric & Undersea Medicine (Board Certified) – Diving Medical Officer US Navy – Wound Care Specialist

Page 4: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Our Wound Healing Center

How is it different from other centers?

_ Over 15 years of experience Opened in June 1999 – Dedicated Physician 5 days/week and a staff

that is wound care certified – Treatment Options

Hyperbaric Chambers (12 Person Chamber) Casting Technicians ONLY UHMS Certified Facility with Distinction

in Ohio

Page 5: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Why Use a Wound Center

Studies show when wounds are evaluated weekly and treated aggressively 68% will heal in the first 30 days

This reduces cost of care and better patient satisfaction

Wound centers provide education and provide patients with adjunctive modalities to aid in there healing

Page 6: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

How to we approach the

Problem Wound?

Page 7: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Every Wound Should Heal ?

Page 8: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

PROBLEM WOUND

FAIL TO RESPOND AND PROGRESS TO MEDICAL AND SURGICAL MANAGEMENT IN THE EXPECTED TIME FRAME

GREATER THEN 30 DAYS USUALLY IN A COMPROMISED HOST

Page 9: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

COMPROMISED HOST

SYSTEMIC – ADVANCED AGE – DIABETES – INFECTION – EDEMA – CIRCULATORY DEFICIT – MOTION, PRESSURE

LOCAL – IMMUNOSUPPRESSION – FOREIGN BODIES – NECROTIC TISSUE – DEAD SPACE – RADIATION – NUTRITIONAL DEFICIT

Page 10: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Main causes Ask yourself what is the underlying pathophysiology of the wound

Edema ( Venous, Post-op swelling) Circulation ( Vascular) Pressure ( Bed Ridden, Diabetic Foot Ulcer) Other(Dermatological, Cancers, Foreign Body)

Page 11: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 12: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Initial Wound Care Visit

Review past and current history Complete patient history Complete Physical exam Address complicating factors

Vascular Edema Pressure Nutrition Systemic condition

Consider consults Determine etiology and initiate treatment

Page 13: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Treatment Must Address: Nutrition/ Hydration

Medical

– Glucose control Social Needs

– Trauma – Smoking

Rehabilitation

Long Term Education

Debridement

Infection Control

Pressure Relief

Edema Reduction Revascularization

Oxygen

Page 14: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Approach Problem Wound Involves:

Problem Wound

Treatment

Reassessment Evaluation

Education

Page 15: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Venous Disease

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Page 17: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Cellulitis vs. Venous Stasis

Not all swollen draining legs are cellulitis Most can be managed with compression and

+/- antibiotics

Page 18: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 19: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 20: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 21: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 22: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 23: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
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Edema Control

Elevation of extremities Multilayer Compression Wrap Profore and Unna boots Graded compression stockings External sequential compression pumps

Page 25: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Edema Control

Fibrinogen and peri-capillary cuffing Decreases nutrients and oxygen tensions Pro-inflammatory proteinacious mixture Matrix metalloproteinases (MMP) Controlling edema is a major goal in

promoting chronic wounds to heal.

Page 26: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Multilayer Compression Wraps

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Lymphedema Pumps

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Compression Stockings

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Circ-Aids

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Pressure Relief

Decubitus Ulcers Repositioning Foam or air mattresses

Planter Foot Ulcers Complete bed rest Total contact casting Custom bivalved othosis DH Walker boot Others

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Alternating Air Flow mattress

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Roho Cushion

Page 33: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 34: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 35: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 36: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 37: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 38: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 39: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 40: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 41: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 42: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 43: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 44: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Limb Salvage

Page 45: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Nutrition

Albumin level of < 3.5 Pre-Albumin levels > 15

Page 46: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Infection and Biobourden

Stimulates an inflammatory response Deprives tissues of nutrients and oxygen

Page 47: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

MRSA Beta- Hemolytic Strep Staph Aureus Pseudomonas Later: E. Coli, Proteus and Klebsiella Deeper Wounds: Anaerobes Most become Polymicrobial over time

Page 48: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Probe the wound for the presence of bone and tendon

Looking for foreign material Deep tissue cultures Sed Rate CBC C-Reactive Protein MRI Bone Scan Plain Flim

Page 49: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

How to Limit Bioburden and

Bacteria Counts Local wound cleaning

Irrigation with 4- 15 psi

Excision of necrotic tissue and Biofilm

Page 50: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Types Of Debridement

Surgical/ Sharp Debridement Mechanical (wet to dry) Enzymatic Autolytic Biological

Page 51: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Debridement

Page 52: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Hyperbaric Oxygen

Page 53: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

What is Hyperbaric Oxygen

Hyperbaric medicine is the process whereby a patient breaths 100 % oxygen in a chamber at pressure levels greater then sea level.

This system increases the amount of dissolved oxygen in plasma.

Page 54: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Mono Place

Page 55: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 56: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 57: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Approved Indications for

Hyperbaric Oxygenation

Emergency & Routine

Page 58: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Emergency Indications

Air or Gas Embolism Decompression Sickness Carbon Monoxide

Poisoning Gas Gangrene

Crush Injuries Necrotizing Fasciitis Thermal Burns

Page 59: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Appropriate Wound Etiology

(Routine) Refractory Osteomyelitis Necrotizing Soft Tissue Infections Gas Gangrene Compromised Skin Grafts and Flaps Crush Injuries and Compartment Syndrome Acute Traumatic Ischemias Thermal Burns ORN Soft Tissue Radionecrosis Other Wounds with Demonstrated Tissue Hypoxia

Page 60: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Refractory Nature

Refractory to conventional therapy Low tissue oxygen tensions TCOM correlation

Page 61: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 62: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 63: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Hyperbaric Treatment Protocol

Diabetic Non-Healing Wounds of the Lower Extremities

Diabetic Patient. Wound >30 days standard

conventional wound care w/o clinical response.

Yes No

Complete History.

Physical Examination. Labs.

Transcutaneous oxygen assessment. Vascular assessment and correction.

Wound photography. Wound measurements.

Wagner III or >. Chest X-ray.

ECG.

Institute Non-Healing Wound Table 2.4 ATA QD

Re-assessment after every 20 treatments.

Wound must show measurable signs of healing Continue treatments if wound is Showing measurable signs of

improvement.

Follow-up Wound Photography.

TCOM. Diabetes Education.

Nutritional assessment and education

Discontinue if the wound fails of show measurable signs

of healing.

Wound must be treated with

standard conventional

wound care for > 30 days.

Treatment Threshold

30 treatments

Page 64: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

OSTEOMYELITIS

Page 65: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Osteomyelitis

Ischemic & Infectious disease Bone & muscle infection with draining sinus Trauma or idiopathic Poor blood supply causes lowered oxygen

tension Impedes collagen formation, fibroblast

activity & leukocyte response

Page 66: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Osteomyelitis

Poor blood supply impedes introduction of antibiotics

Surgery to remove infected bone & tissue High dose antibiotics If failing despite surgery and antibiotics

consider HBO

Page 67: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Osteomyelitis

HBO reverse tissue anoxia Promotes collagen formation Stimulates osteoclast’s Augments some antibiotics including

aminoglycides

Page 68: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Gas Gangrene

Caused by introduction of Clostridium Perfringens via trauma or post-surgery

Other Clostridial organisms are not gas gangrene, but can be terrible infections

Acute, rapidly progressive, non-pyogenic, invasive muscle infection

Profound toxemia, extensive edema, massive tissue death & variable amount of gas production

Page 69: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Gas Gangrene Rx

Surgery Antibiotics Hyperbaric oxygen 3 times per day at 60’ fsw

for :80- :90 minutes X 2 days, then BID for 2 or 3 days

Page 70: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Gas Gangrene

•gas gangrene is a rapidly progressive myonecrosis caused by Clostridial species

•alpha toxin facilitates infection virulence

•surgery removes dead tissue

•antibiotics kill bacteria

•HBO halts alpha toxin production and preserves ischemic tissue ***bactericidal action is not sought***

Page 71: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Radiation Injuries

• Osteoradionecrosis • Soft tissue radionecrosis • Radiation enteritis • Radiation cystitis

Page 72: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Delayed Radiation Injury

(Soft & Bony Tissue Necrosis)

Radiation causes the endothelium of blood vessels to proliferate

Blood supply decreases or is obliterated Radiated area becomes ischemic and fibrotic Tissue often survives the hypoxia Subsequent injury leads to infection &

enlargement of the wound

Page 73: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Treatment Goals

Reverse, hypo cellular, hypo vascular and hypoxic tissue changes (3Hs) – HBOT

Resect necrotic tissue Reconstruct tissues Preserve/restore function, esthetics and

quality of life

Page 74: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 75: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Medical / Social Needs

Metabolic Control – Hg A1c

Cessation of Smoking Nutritional Support Other Medical Conditions Pain Relief

Page 76: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 77: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Drainage Debridement Granulation

Drawtex Santyl Prisma

Silver Dressings Wound Gel

Iodoflex/ Iodosorbe Silvadene

Wound Vac Bactroban

Calcium Alginate

Page 78: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Topical Wound Management

Wound Care “ Preparation of Wound Bed Appropriate Dressing Do they need off loading or compression Advanced Dressing ie Grafix or Skin Graft

Page 79: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Patient

Family

Other Health Care

Page 80: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Wound Healing and Hyperbaric Medicine Center

Page 81: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Wound Healing and Hyperbaric Medicine Center

Page 82: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

.

Wound Healing and Hyperbaric Medicine Center

Page 83: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 84: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 85: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 86: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 87: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 88: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 89: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Case Study

Wound Healing and Hyperbaric Medicine Center

Nov. 15, 00

K 296

Page 90: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Treatment Goals

Preserve/restore function, esthetics and quality of life

Page 91: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Case Study

Page 92: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 93: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 94: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 95: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 96: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 97: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 98: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 99: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 100: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 101: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 102: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 103: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 104: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 105: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 106: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 107: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
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Page 109: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 110: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 111: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 112: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 113: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 114: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 115: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs
Page 116: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Periodic Reassessment

Look for consistent progress Regularly reevaluate the wound Failure to progress needs prompt

reevaluation

Page 117: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Bringing the excellence of the Outpatient Wound programs to the Inpatient Arena

Advanced Wound Care

Continuum of Care – Inpatient consults – Follow up in KHN Outpatient Wound Centers – Follow up in LTC facilities

Decreased readmission rate for exacerbation of wound pathology

Wound Physician Consult Program

Page 118: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Patients with: – Pressure ulcers – Stage II, III, or IV – Lower extremity ulcers – Lymphedema – Diabetic foot ulcers – Non-healing surgical wounds – Any wound that will follow the patient upon

discharge

Who Needs a Referral?

Page 119: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Placing a Wound Physician Consult

IP Consult to

Wound Care

Contact info: (937) 477-8552 / (513) 543-1861

Page 120: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Summary:

Problem Wound

Treatment

Reassessment Evaluation

Education

Page 121: Louis Pilati MD FACEP HUM Medical Director Wound Healing ......Institute Non-Healing Wound Table 2.4 ATA QD Re-assessment after every 20 treatments. Wound must show measurable signs

Wound Healing Lec

Wound Healing Lec

Wound healing and Wound care. - University of Medical ...oer.unimed.edu.ng/LECTURE NOTES/1/2/OM-Oluwatosin---Wound-healing...Wound healing and Wound care. Odunayo M. Oluwatosin, FMCS

Wound healing and Wound care. - University of Medical ...oer.unimed.edu.ng/LECTURE NOTES/1/2/OM-Oluwatosin---Wound-healing...Wound healing and Wound care. Odunayo M. Oluwatosin, FMCS

Wound Healing and the Problem Wound

Wound Healing and the Problem Wound

Wound healing November 4, 2004. Wound healing Wound healing is the process of repair that follows injury to the skin and other soft tissues. Wound healing.

Wound healing November 4, 2004. Wound healing Wound healing is the process of repair that follows injury to the skin and other soft tissues. Wound healing.

Functional Keratin Applications in Wound Healing47265aeea708b5a58a1c... · Functional Keratin New Paradigm in wound healing - Physiologic approach to wound healing Healing acute wounds

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Wound healing - gmch.gov.in lectures/Pathology/L10 wound healing.pdf · Wound healing • Healing of skin wounds- example of combination of regeneration and repair. • Wound healing

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Wound Healing & Wound Care

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Wound Healing/ Bandaging. Learning Objectives Describe the process of wound healing List and describe the factors that affect wound healing Discuss.

Wound Healing/ Bandaging. Learning Objectives Describe the process of wound healing List and describe the factors that affect wound healing Discuss.

Wound Healing, Wound Types, Wound Dressings, & Drainage Devices

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Wound Healing =)

Wound Healing =)

Wound Healing – Scar Minimization · Wound Healing – Scar Minimization ... Optimization of wound healing • Surgical principles: ... • Ubiquitous use in management of hypertrophic

Wound Healing – Scar Minimization · Wound Healing – Scar Minimization ... Optimization of wound healing • Surgical principles: ... • Ubiquitous use in management of hypertrophic

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Wound Healing

Wound Healing Scars Types of Treatment › system › files › adam_withey-_scar_therapy... · •Wound Healing •Scars •Types of Treatment. The Skin. Wound Healing. Healing by

Wound Healing Scars Types of Treatment › system › files › adam_withey-_scar_therapy... · •Wound Healing •Scars •Types of Treatment. The Skin. Wound Healing. Healing by

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Moist Wound Healing - Geneseo Wound Healing with Advanced Wound Care ... Clean wound – one that is ... Dakin’s solution (sodium hypochlorite)

Moist Wound Healing - Geneseo Wound Healing with Advanced Wound Care ... Clean wound – one that is ... Dakin’s solution (sodium hypochlorite)

Fracture healing and wound healing

Fracture healing and wound healing

Wound Healing for the Plastic Surgery Nurse - Wound Healing 101

Wound Healing for the Plastic Surgery Nurse - Wound Healing 101

WOUND HEALING DISTURBANCES AND WOUND …akupunkturtierarzt.de/wp-content/uploads/15-Halifax-Wound-Healing... · 2015 AVAC/IVAS Joint Congress on Veterinary Acupuncture 83 WOUND HEALING

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