Wound Care 101 - POMA
Transcript of Wound Care 101 - POMA
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Wound Care
101KATHERINE LINCOLN, DO, FAAFP
POFPS AUG 4, 2018
HERSHEY, PA
Disclosure
Consultant for Acelity, Inc
Has no relevance to this talk through finance, deck preparation, or topic discussion matter
Objective
Provide wound care education at a basic level
to fill in training gaps
Review common chronic wounds that present in clinic/UC
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Who am I? Why are we here?
Patient comes in to see you…
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
2 most important questions in
Wound Care
To the patient: How long as it been there?
(Timeline? What has been done? Who have you seen?)
To yourself: why do they have a wound? (Why didn’t it
go away as planned?)
(AKA Get a history of the Hole in the patient AND a
history of the whole patient)
What does “normal” look like?
Acute vs Chronic Wounds
Acute
Defined onset
Time less then 3 weeks!
Usually clear trauma
(surgery, etc)
Is following usually
progression
Patient is a fairly usual
suspect
Good granulation
No heroic wound
measures
Chronic
Less clear onset
Greater than 3 weeks
May have been started
with a trauma
Is following a weird
trajectory
Doesn’t look “Good”
Has required more visits,
Abx, going to Walmart
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Factors that affect wound closure Diabetes
Smoking
Cancer
Obesity
Long term steroid use
Malnutrition
Smoking
Age of the patient
Incontinence of urine
Incontinence of stool
Smoking
Gait disturbance
Limb loss
Neurologic changes
Quadriplegia/Para
Meds: Anti-rejection, NSAIDs
Chemotherapy
Length of time to care
Smoking
Local tissue hypoxia
Put your finger in it..
Help Me Help You
(Proper wound documentation) MEASURE
M = Measure (length x width x depth)
E = Exudate (quality and quality)
A = Appearance (wound bed and surrounding skin)
S = Suffering (pain type and level)
U = Undermining (gap under skin edge)
R = Reevaluation (monitoring of parameters)
E = Edge
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Acute Wounds
Common wound questions What solution should be used to clean a
wound?
Tap water vs sterile saline
Should wounds be occluded?
Moist wound healing
When are prophylactic antibiotics used?
Clean wound: no; human bites and deep punctures, yes.
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Stepwise Approach
Step 1: Is there adequate profusion?
Step 2:Is nonviable tissue present?
Step 3:Are signs/symptoms of infection
and/or inflammation present?
Step 4: Is edema present?
Step 5: Is the wound microenvironment
conducive to healing?
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Stepwise approach (con’t)
Step 6: Is tissue growth optimized?
Step7: Is offloading or pressure relief
appropriate?
Step 8: Is pain controlled?
Step 9: Are host factors optimized?
Chronic Wounds
1) Diabetic foot ulcer (DFU)
2) Arterial origin
3) Venous etiology
4) Pressure injury/ pressure ulcer
Diabetic Foot Ulcers
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Arterial Disease
Venous Leg Ulcer (VLU)
Pressure Ulcer/ Injury
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Pressure Ulcer/Injury
Make a diagnosis
Words of Wound Wisdom
Diabetes = off load and control blood sugar
Arterial = reestablish flow ASAP
Venous = compression
Pressure = multifactorial, takes a team
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Who should be referred to a
Wound Center?
Words of Wisdom from the Nurses
“You have to take the
bandage OFF”
Wound dressings
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Dressings
GOAL: Keep it clean and moist; exudate management
If wet, dry it: calcium alginate will absorb moisture
If its dry, wet it: hydrogel, medihoney, autolytic occlusion
Cover it: Foam dressing, kerlex, tubigrip
Resources Scottsdale Wound Management Guide
Diagnosis and Treatment of Peripheral Arterial Disease. DUANE R. HENNION, MD, et al. Am Fam Physician. 2013
Sep 1;88(5):306-310.
Diagnosis and Treatment of Venous Ulcers. LAUREN
COLLINS, MD. Am Fam Physician. 2010 Apr 15;81(8):989-
996.
Diabetic Foot Infections. FASSIL W. GEMECHU, MD, et al.
Am Fam Physician. 2013 Aug 1;88(3):177-184.
Pressure Ulcers: Prevention, Evaluation, and
Management. DANIEL BLUESTEIN, MD, et al. Am Fam
Physician. 2008 Nov 15;78(10):1186-1194.
“Wound Care 101”Katherine Lincoln, DO
POFPS 43RD Annual CME SymposiumAugust 3-5, 2018
Questions? Email me [email protected]