Traumatic and Infected Wound Mx

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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

Traumatic and Infected Wound Mx

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