Wound Assessment Using the LADD SECO Model
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Transcript of Wound Assessment Using the LADD SECO Model
Wound Assessment Using the LADD SECO Model
Bryan LevayHSCI 5108: Instructional Media
Summer 2013
Overview
• Importance of wound care• Lecture• Describe wounds• Activity• Evaluation
Importance of wound care
• 15-25% of all diabetics will have an ulcer in their lifetime
• Recurrence rate 40%• Amputation– 85% of lower-extremity amputation are preceded by an
ulcer– 5-year mortality rate following a BKA is ~50%– Amputation have varying psychosocial issues
accompanying– Most amputations are preventable
Diabetic foot ulceration
• Neuropathic– Neuropathy– Deformity – Minor trauma
http://www.google.com/url?sa=i&rct=j&q=&source=images&cd=&cad=rja&docid=5WWAQUHnqiWP5M&tbnid=IRw7Ps56D5DayM:&ved=0CAUQjRw&url=http%3A%2F%2Fhealthylogica.blogspot.com%2F2012%2F07%2Fhow-to-prevent-onset-of-diabetic-foot.html&ei=qN21UcKeBYbSyAGlm4GwAQ&bvm=bv.47534661,d.aWc&psig=AFQjCNFBCGpwm1K3C9kDBScAKMg4RE13XQ&ust=1370959653987682
Summary
• 2nd-year DO & DPM students– Basic knowledge from previous courses
• Objectives– Identify DFU from non-DFU– Verbally and transcribe the wound description with
LADD SECO criteria– Be able to explain 7 of 8 components of LADD SECO
• Technologies– Computer, MS Word, PPT, Blackboard access
Learning module
• 2-hour lecture– Basic information– Intro to LADD SECO
• 2-hour activity– 5-item exercise packet– Evaluation
Lecture
• Traditional learning • 2-hour• Lecture hall 2 of the
HEC at WesternU• Certified Wound
Specialist• Reinforce previous
knowledge• Introduce LADD SECO
http://www.google.com/imgres?q=lecture&um=1&safe=active&client=safari&rls=en&hl=en&biw=1136&bih=712&tbm=isch&tbnid=Uzj6-RhpnC4shM:&imgrefurl=http://www.123rf.com/photo_16614791_orange-cartoon-characters-sit-in-on-a-lecture.html&docid=xWwpmLpX_iephM&imgurl=http://us.123rf.com/400wm/400/400/limbi007/limbi0071211/limbi007121100130/16614791-orange-cartoon-characters-sit-in-on-a-lecture.jpg&w=1200&h=849&ei=6d21UcC0M4PfyQGkwoG4Dg&zoom=1&ved=1t:3588,r:64,s:0,i:280&iact=rc&dur=391&page=4&tbnh=176&tbnw=232&start=50&ndsp=18&tx=93&ty=104
LADD SECO
• Location• Aspect• Dimensions• Drainage
• Shape• Edge• Color• Other
Location
• Where is the wound located?
http://www.google.com/imgres?q=anatomical+position&um=1&hl=en&safe=active&client=safari&rls=en&biw=1179&bih=723&tbm=isch&tbnid=w_CNJwmb0KaW6M:&imgrefurl=http://www.cafepress.com/%2Banatomical_position_artwork_large_poster,664782979&docid=R8XU5XjP3Eg2pM&imgurl=http://images.cpcache.com/merchandise/514_400x400_NoPeel.jpg%253Fregion%253Dname:FrontCenter,id:69332470,w:16&w=400&h=400&ei=31ZcUcrULIn8iAequYDIDQ&zoom=1&ved=1t:3588,r:43,s:0,i:218&iact=rc&dur=495&page=2&tbnh=172&tbnw=210&start=21&ndsp=27&tx=111&ty=114
Aspect
• What aspect of the body is it located?• Example: Inside, outside, front, rear• Like location, it distinguishes position
http://www.google.com/url?sa=i&rct=j&q=views+from+different+angles&source=images&cd=&docid=XRsFkfXk4ShNRM&tbnid=WDoiN7oqcOuxzM:&ved=&url=http%3A%2F%2Fcghub.com%2Fforum%2Fshowthread.php%3Fp%3D151622&ei=PlVcUe-CI6OriAfb5oHoAg&bvm=bv.44697112,d.aGc&psig=AFQjCNGzvb9-1E8hoVgopZaKkehdeedNCw&ust=1365092030944569
Drainage
• Is there any drainage coming out?• Example: purulent, serous, blood
http://www.google.com/url?sa=i&rct=j&q=purulent+discharge&source=images&cd=&docid=ZYj8KGfawdI-qM&tbnid=ymr9oyULXt1NHM:&ved=0CAUQjRw&url=http%3A%2F%2Fdermatologyoasis.blogspot.com%2F2012_05_01_archive.html&ei=rG9cUZ7UAuquiQeM2YGwCg&bvm=bv.44697112,d.aGc&psig=AFQjCNEL9euCuqyeFIeop9Zibe52hVneVQ&ust=1365098743919879
http://www.google.com/url?sa=i&rct=j&q=weeping+wound+venous+ulcer&source=images&cd=&docid=4UAVnwaAg_dwqM&tbnid=VtJiVBp1fSVS1M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.lymphedemapeople.com%2Fthesite%2Fedema_chronic_venous_insufficiency.htm&ei=13BcUZTxE8ujiAfG1IGQAg&bvm=bv.44697112,d.aGc&psig=AFQjCNE_Ggdh55QilrI0nuwdnd2mVprECw&ust=1365099005423999
http://www.google.com/url?sa=i&rct=j&q=weeping+wound+venous+ulcer&source=images&cd=&docid=uj0onwI6ihIbiM&tbnid=kik_pTRdGHGAoM:&ved=&url=http%3A%2F%2Fwww.worldwidewounds.com%2F2006%2Fseptember%2FHarker%2FWound-Healing-Complications-Limb-Amputation.html&ei=fXBcUaPLBa2SiQezvIH4CQ&bvm=bv.44697112,d.aGc&psig=AFQjCNE_Ggdh55QilrI0nuwdnd2mVprECw&ust=1365099005423999
Dimensions
• What are the dimensions of the wound?• Length x Width x Depth• Metric only
http://www.google.com/url?sa=i&rct=j&q=measuring+a+wound&source=images&cd=&docid=MV-nhJ1cE3MZ9M&tbnid=sx8JKbQ5v2qwZM:&ved=&url=http%3A%2F%2Fwww.woundstick.com%2Fwoundstick_20cm_product_page.htm&ei=IFdcUcfqOuPMiAe8moHICg&bvm=bv.44697112,d.aGc&psig=AFQjCNEXsIT8lQujSLzpAd4gXCSfvnOoxQ&ust=1365092513327661
Shape
• How is the wound shaped?• Example: circular, linear, irregular
http://www.google.com/url?sa=i&rct=j&q=irregular+shaped+ulcer&source=images&cd=&docid=cBUvVZzqOrb4HM&tbnid=QY7dy9Nuw3SNXM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.podiatrytoday.com%2Fcase-studies-unusual-wounds%3Fpage%3D3&ei=a15cUZbvFuWTiAfNo4GoDQ&bvm=bv.44697112,d.aGc&psig=AFQjCNGH16I7SCYPPn0bCTtQE9GH--5xYA&ust=1365094360440745
http://www.google.com/url?sa=i&rct=j&q=foot+chainsaw+wound&source=images&cd=&docid=0mLF3V03ARJKmM&tbnid=RjF9mtgaGV777M:&ved=&url=http%3A%2F%2Fwww.bchw.org%2FTech%2520tips%2FSawCertification%2FChain%2520Saw%2520Injuries.htm&ei=HelZUb2YGqzVigLm94DICA&bvm=bv.44442042,d.cGE&psig=AFQjCNEROUCQqJQX-eweOXLExzrydsulkw&ust=1364933277917644
http://www.google.com/imgres?q=diabetic+ulcer&um=1&hl=en&safe=active&client=safari&rls=en&biw=1179&bih=723&tbm=isch&tbnid=IRw7Ps56D5DayM:&imgrefurl=http://healthylogica.blogspot.com/2012/07/how-to-prevent-onset-of-diabetic-foot.html&docid=5WWAQUHnqiWP5M&imgurl=http://1.bp.blogspot.com/-QUVSBwO1d0I/T_VsHpitZqI/AAAAAAAABiM/kWfCftbE2xc/s1600/How%252BTo%252BPrevent%252BThe%252BOnset%252BOf%252BDiabetic%252BFoot%252BUlcers.jpg&w=800&h=600&ei=D19cUfybOIj_iAeJjIHoDA&zoom=1&ved=1t:3588,r:5,s:0,i:96&iact=rc&dur=827&page=1&tbnh=180&tbnw=242&start=0&ndsp=15&tx=136&ty=102
Edge
• How does the wound edges appear?• Example: macerated, callused, necrotic
http://www.google.com/url?sa=i&rct=j&q=macerated+wound&source=images&cd=&docid=16femcYuqFNmQM&tbnid=Rnvp3I8cXNx9ZM:&ved=0CAUQjRw&url=http%3A%2F%2Fwocn.confex.com%2Fwocn%2F2007AM%2Ftechprogram%2FP2467.HTM&ei=G2FcUf2_GYWfiAfo6oCgAQ&bvm=bv.44697112,d.aGc&psig=AFQjCNFCT-_HFJHCXAiIuczM1cKIz9btcQ&ust=1365095054762175
http://www.google.com/url?sa=i&rct=j&q=hyperkeratotic+rim+ulcer&source=images&cd=&docid=LgvOhMrukma5BM&tbnid=cOUolUH8FVAN3M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.studyblue.com%2Fnotes%2Fnote%2Fn%2Fskin%2Fdeck%2F5281900&ei=7WFcUcHtCOX_iAfxyoHIBw&bvm=bv.44697112,d.aGc&psig=AFQjCNGjLNnoKcbBVq-Hc6TWqrpYnZWlHg&ust=1365095263991005
http://www.google.com/url?sa=i&rct=j&q=necrotic+ulcer&source=images&cd=&docid=u_4IxDraUJXYdM&tbnid=Vk6kEM4qxCX5UM:&ved=0CAUQjRw&url=http%3A%2F%2Fopeni.nlm.nih.gov%2Fdetailedresult.php%3Fimg%3D3105064_pone.0020492.g002%26req%3D4&ei=gWJcUfyICs-5iAeIwYGADA&bvm=bv.44697112,d.aGc&psig=AFQjCNFyoy0NiqcBL7eu-e-nmi_wPituWw&ust=1365095397186211
Color
• What is the color of the wound base?• Example: Red, white, yellow, black
http://www.google.com/url?sa=i&rct=j&q=venous+ulcer&source=images&cd=&docid=-jNJwK6c6lT2OM&tbnid=ioD9PfVud7j0aM:&ved=0CAUQjRw&url=http%3A%2F%2Fpics8.this-pic.com%2Fkey%2Fdifference%2520between%2520arterial%2520venous%2520ulcers&ei=t_VZUYvTD4epkAXHkYGADw&bvm=bv.44442042,d.dGI&psig=AFQjCNHVgEv36weHpBuYG-OFCPGkjEoVGA&ust=1364936195878872
http://www.google.com/url?sa=i&rct=j&q=ulcer+color&source=images&cd=&docid=H8aN--s8OMZAxM&tbnid=CXePJOwpqHLDCM:&ved=&url=http%3A%2F%2Fwww.skinsight.com%2Fadult%2FaphthousUlcerCankerSore.htm&ei=-WNcUenbFKiiiAff34GYBg&bvm=bv.44697112,d.aGc&psig=AFQjCNFjqwOKYBrw_l6Nn165Gw24E3bUVA&ust=1365095801684734
http://www.google.com/url?sa=i&rct=j&q=yellow+wound&source=images&cd=&docid=sP-KGNu6izdraM&tbnid=1gShQ_ETkvAVpM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.worldwidewounds.com%2F1997%2Fjuly%2FThomas-Guide%2FDress-Select.html&ei=_2VcUZfLMubqiAfQrIGIBQ&bvm=bv.44697112,d.aGc&psig=AFQjCNHJzccSGyEBZN9AVB4cZc_Q48tQ_Q&ust=1365096312735874
http://www.google.com/url?sa=i&rct=j&q=black+wound&source=images&cd=&docid=sP-KGNu6izdraM&tbnid=b4m1zyaq2Tsk1M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.worldwidewounds.com%2F1997%2Fjuly%2FThomas-Guide%2FDress-Select.html&ei=n2ZcUYD7Ke2tiQf5u4HIDA&bvm=bv.44697112,d.aGc&psig=AFQjCNFl771nUPqSEzYgbLW2fq49PZqu0g&ust=1365096465479103
Other
• Other things you notice?– Warmth?– Odor?– Satellite wounds?– Tunneling?– Periwound area?
Activity
• 2-hour session• 6-8 students per break out room– 1-2 DPM, 5-6 DO
• 5 cases with image• Individual needs to complete• Rounding faculty will provide assistance
Evaluation
Student feedback
References• American Diabetes Association. (2013). Economic Costs of Diabetes in U.S. in 2012. Diabetes Care, 36(4), 1033-1046. doi:
10.2337/dc12-2625• Armstrong, D. G., Nguyen, H. C., Lavery, L. A., van Schie, C. H. M., Boulton, A. J. M., & Harkless, L. B. (2001). Off-loading the diabetic
foot wound: A randomized clinical trial. Diabetes Care, 24(6), 1019-1022. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11375363
• Bryant, R. A., & Nix, D. P. (Eds.). (2003). Acute & chronic wounds: Current management concepts (3 ed.). St. Louis, Missouri: Mosby Elsevier.
• Bumpus, K., & Maier, M. A. (2013). The ABC’s of wound care. Current Cardiology Reports. Advance online publication. doi: 10.1007/s11886-013-0346-6
• Carls, G. S., Gibson, T. B., Driver, V. R., Wrobel, J. S., Garoufalis, M. G., DeFrancis, R. R., . . . . Christina, J. R. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. Journal of the American Podiatric Medical Association, 101(2), 93-115. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21406693
• Cavanagh, P. R., & Bus, S. A. (2010). Off-loading the diabetic foot for ulcer prevention and healing (Supplemental material). Plastic and Reconstructive Surgery, 127(1S), 248S-256S. doi: 10.1097/PRS.0b013e318202484
• Harkless, L., & Holmes, C. (2004). Linking risk factors: The role of history in predicting outcome. The Diabetic Foot, 7(3), 114-122. Retrieved from http://www.highbeam.com/doc/1G1-124137347.html
• Leung, P. C. (2007). Diabetic foot ulcers – a comprehensive review. Surgeon, 5(4), 219-231. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17849958
• Ramsey, S. D., Newton, K., Blough, D., McCulloch, D. K., Sandhu, N., Reiber, G. E., & Wagner, E. H. (1999). Incidence, outcomes, and cost of foot ulcers in patients with diabetics. Diabetes Care, 22(3), 382-387. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10097914
• Rhim, B., & Harkless, L. (2012). Prevention: Can we stop problems before they arise? Seminars in Vascular Surgery, 25(2), 122-128. doi: 10.1053/j.semvascsurg.2012.05.002
Questions?