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Dr Mohammad Nazir Hassan
Traumatic andInfected Wound
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Wound
1. An injury, especially one in which theskin or another external surface is torn,
pierced, cut, or otherwise broken.2. An injury to the feelings.
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A wound is an injury to theintegument or the underlyingstructures that may or may not
result in a loss of skin integrity.Physiological function of the tissueis impaired (Keryln Carville 2001).
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Type of wound
Surgical/traumatic wound
Venous ulcer
Arterial insuficency
Necrotising fascitis
Pressure soreDiabetic foot ulcer
Etc..
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TRAUMATIC WOUNDS
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Traumatic Wound
sudden, unplannedinjury
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Contusion bruising or haemorrhage. Causedby a blow from something blunt
Abrasion caused by skin being scraped alonga hard surface
Incision clean cut/surgical. Skin, soft tissuesand muscle may be severed
TYPES OF WOUND
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Laceration jagged edges e.g. from teeth,claws, barbed wire.
Puncture small entry. May have someinternal damage and can become infected
Tear/Avulsion skin and soft tissue partiallyor completely torn away
Cavity chronic, open wound
TYPES OF WOUND
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Contusions
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Abrasion Wound
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Laceration Wound
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Sutured Wound
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Open Incisional Wound
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Burn wound
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Degloving Injury
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Gun Shot Wound
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A detailed, thorough history is essential forassessing the extent of injury and fororganising appropriate wound management.
When did the injury occur? The longer thewound has been present, the more likely aninfection will occur after closure
HISTORY:
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Where did the injury occur? What are thepotential contaminants? E.g. saliva, pus,faeces, soil
How did the injury occur? Must assess anypotential damage to deeper structures
HISTORY:
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Is there loss of function in the injured part?
Are important underlying structures involvede.g. nerves, major vessels, ligaments, bones?
EXAMINATION:
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What is the level of contamination?
Are any foreign bodies present?
What is the viability of the injured parts? Are
any parts missing?
EXAMINATION:
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Swelling Pain Surrounding skin colour (redness suggests
infection)
ASSESSMENT:
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Control bleeding
Prevent infection
Reduce pain
WOUND MANAGEMENT
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Clean the wound thoroughly with gauze
soaked in saline or cooled, boiled water Apply a non-stick dressing
MINOR WOUNDS
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Follow DRABC
Control bleeding apply firm direct pressure,elevate bleeding part, apply pad over wound Clean the wound as best as possible
Apply a sterile or clean dressing
MAJOR WOUNDS
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o REST o ICEPACKS o COMPRESSION o ELEVATE
SPECIFIC WOUNDS:
Haematoma
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Cleanse wound thoroughly with sterile gauzesoaked in sterile water or cooled boiled water
Apply non-adherent dressing
Abrasion/incision/laceration
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Return skin to original position if possible Apply pressure to wound using a dressing and
a pad to control any bleeding Bandage
Tear/avulsion
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o DO NOT remove the foreign objecto Control bleeding by applying pressure to
surrounding area (not on foreign object)o Place a ring pad around the object and
bandage over the padding
Embedded object:
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Control bleeding by applying direct pressure
around the wound Keep wound as clean as possible DO NOT try
to pick out any embedded foreign material Apply a clean or sterile dressing Rest the injured person in a comfortable
position
Penetrating wounds
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Follow DRABC If you suspect a fracture, control bleeding with
gentle pressure around wound If there appears to be no fracture, control
bleeding with firm direct pressure If casualtys condition permits, sitting up may
help control bleeding Monitor casualtys condition
Bleeding from the scalp
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DO NOT wash venom off skin or cut/suck
venom out or try to catch the snake/spider DO NOT use a constrictive bandage e.g.
arterial tourniquet Check breathing and pulse follow DRABC Calm casualty Apply pressure immobilisation bandage
Snake and Spider bite
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Apply a firm roller bandage starting just abovefingers/toes and moving up limb as far as canbe reached
Bandage needs to be firm but not too tight check circulation
Immobilise casualty Apply a splint to immobilise bitten limb If possible, ensure casualty does not move
Snake and Spider bite
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DRESSINGSPRINCIPLES
TYPES OFDRESSING
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Infected Wound
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ContentIntroduction
Host-Pathogen Reaction
Making a diagnosis
Management Strategy
Wound CleansingWound Dressing
Summary
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INTRODUCTION
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HOST-PATHOGEN INTERACTION
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Host-Pathogen Interaction
Immunocompetency
Bacterial CountVirulence
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Outcome of Host-Pathogen
Interaction
Contamination Colonization Infection
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TERMINOLOGY
Wound contamination the presence of bacteria within a wound without any
host reaction/multiplicationWound colonisation
the presence and multiplication of bacteria within the
woundWound infection
the deposition and multiplication of bacteria in tissuewith an associated host injury and reaction
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Critical Colonization
An intermediate stage between benigncolonization and overt infection
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MAKING A DIAGNOSIS
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Infection?
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Investigations
Full Blood Counts
ESR/CRP
C&S
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MANAGEMENT STRATEGY
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TREATMENT SUMMARY OF THEMANAGEMENT OF WOUND INFECTIONS
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WOUND DEBRIDEMENT
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Wound Debridement
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WOUND CLEANSING
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Wound Cleansing
Helps optimize wound healing
Decreases the potential for infectionLoosens and washes away cellular debris
(bacteria, exudate, purulent material andresidual topical agents)
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WOUND DRESSING
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Cadexomer Iodine
0.9% iodine is immobilisedin the matrix and releasedconstantly over 3 days
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Damages the cell wall
Interferes with the DNAsynthesis
Denatures proteins &enzymes and inhibits protein
synthesis
Ionic silver
1. Castellano JJ, Shafii SM, Ko F, et al. Comparative evaluation of silver-containing antimicrobial dressings and drugs. Int Wound J . 2007;492):114-122.
Mode of Action
S
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Many type of traumaticwound
Initial managementcounts
Infected wound isinitially not infected!!
Summary