Principles of Wound Management Indiana University Department of Emergency Medicine Nurse...
-
Upload
bennett-thornton -
Category
Documents
-
view
216 -
download
2
Transcript of Principles of Wound Management Indiana University Department of Emergency Medicine Nurse...
![Page 1: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/1.jpg)
Principles of Wound Management
Indiana University Department of Emergency Medicine
Nurse Practitioner Lecture Series
![Page 2: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/2.jpg)
Skin Preparation
• Used to decrease bacterial counts surrounding wounds
• Povidine-Iodine solution (Betadine®) and Chlorhexidine (Hibiclens®) solutions are available– can be used to cleanse surrounding skin surfaces
but may inhibit the immune response when placed within wounds.
![Page 3: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/3.jpg)
Hair and Eyebrows
• Don’t shave, this increases infection 10x secondary to abrasions produced by razor
• Potential that the eyebrow may not grow back• Clipping of hair or applying lubricant jelly are
good alternatives
![Page 4: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/4.jpg)
Wound Irrigation
• Most important determinant in decreasing risk of infection
• Goal is decreasing bacterial load within wounds• High-pressure irrigation– Technique seems to be more important than type of
irrigation solution used– Approx. 7 psi needed to significantly decrease bacterial
load and rate of infection• Accomplished with a 18g angiocath with large
syringe.
![Page 5: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/5.jpg)
![Page 6: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/6.jpg)
Wound Irrigation
• Low pressure irrigation is not as effective as high pressure irrigation…– Pouring– Soaking – Gravity wash– Poke a hole in the top of a bottle– Bulb syringe ……All do not create enough pressure
![Page 7: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/7.jpg)
Wound Irrigation
• Normal saline shown to be as effective (and more cost effective) than other commercial solutions
• Do Not use betadine, hydrogen peroxide, or isopropyl alcohol– Tissue toxicity
• The KEY is copious use of wound irrigation• General rule is at least 50 cc of irrigation applied with
at least 7psi of pressure per cm of wound
![Page 8: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/8.jpg)
Wound Closure
Three options– Healing by primary intention– Healing by secondary intention– Delayed primary closure
Choice is based on risk for infection, location and inherent wound characteristics
![Page 9: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/9.jpg)
Healing by Primary Intention
• Also called primary closure• Most common method used• Wound bandaged, glued, stapled or sutured
![Page 10: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/10.jpg)
Healing by Secondary Intention
• Wound is left open and allowed to granulate from within
• Grossly contaminated and other high risk wounds can be handled this way
• Often results in less desirable functional and cosmetic outcome
![Page 11: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/11.jpg)
Delayed Primary Closure
• Useful for wounds which are high risk for infection, but where the cosmetic outcome of secondary intention would be undesirable
• Wounds are left open, packed, and covered with a dressing
• 3-5 days later the wound is debrided and closed
![Page 12: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/12.jpg)
Method of Closure
• Goal of primary closure is to approximate the wound edges with the best cosmetic outcome
• Scaring is the result of tension on wound edges and wound contraction with healing
• Gaping wounds tend to scar more because of increased tension on the wound
• Everting wound edges results in a better outcome because it allows for wound contraction
![Page 13: Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series.](https://reader030.fdocuments.in/reader030/viewer/2022032414/56649ef45503460f94c07ca6/html5/thumbnails/13.jpg)