1、-Wounds on dutynClassificationnWound management -Tissue ViabilitynStages of wound healingnWound managementA disruption of the integrity and function of the tissues in the body (Baharestani 2004)Wounds can be classified into 7 different types depending on the object that produces the wound and the ma
2、nner which it has been inflicted.Each wound type carries specific risks associated with surrounding tissue damage and infectionCAN YOU REMEMBER WHAT THEY ARE?!nINCISEDnCaused by a clean cut from a sharp edged object. nBlood vessels are cut straight across so bleeding may be profusenStructures such a
3、s tendons, nerves or arteries may be damagednLACERATIONnCaused by crushing or ripping forcesnMay bleed less profusely than incised woundsnLikely to be more tissue damagenMore often contaminated with germs so infection risk is highnABRASIONnSuperficial wound in which the topmost layers of the skin ar
4、e scraped off leaving a raw tender areanCaused by sliding falls or friction burnsnCan contain embedded foreign particles that may result in infectionnCONTUSIONnCaused by a blunt blow or punch rupturing the capillaries beneath the skin causing blood to leak into the tissues resulting in bruising.nSev
5、ere contusion may indicate deeper damage such as internal injury or fracturenPUNCTUREnSuch as standing on a nail or being pricked by a needle.nSmall entry site but a deep track of internal damage.nAs germs and dirt can be carried far into the body, the infection risk is highnSTABnCaused by a long or
6、 bladed instrument usually a knife penetrating the body.nStab wounds to the trunk must always be treated seriously due to dangers of injury to vital organs or life threatening internal bleedingnGUNSHOTn2 woundsnCaused by a bullet or missile which may cause serious internal injurynEntry wound may be
7、small and neatnExit wound may be large and raggednThe process by which tissue damaged or destroyed by injury or disease are restored to normal functionnINFLAMMATORY nUp to 3 days after the initial woundnRedness, swelling, heatnPROLIFERATIONnDays 3-24nConstruction of the wound, development of new gra
8、nulation tissuenMATURATIONn24 days after wound- 1 yearnEpithelial cells migrate over new tissue, becomes less vascularnAfter 3 months the tensile strength is only 50% of normal tissuenCardiovascular disordersnPeripheral Vascular Disease, Chronic Heart DiseasenTherapiesnRadiotherapy, ChemotherapynMal
9、nutritionnPsychological & social factorsnIncreasing age nImmune disordersnRheumatoid arthritis nEndocrine disordersnAnaemia, DiabetesnInappropriate wound management1.Wash your hands and apply gloves2.Clean the wound with running water if the wound is dirty. 3.Pat dry with gauze4.Cover with adhesive
10、dressing.nCells migrate over viable tissue and wounds heal 3 times faster in a moist environment (Winter 1962)nWound temperature below 37 degrees delays mitotic activity for up to 4 hours (Torrance 1986) nWhite cells will not function in a low temperature increasing potential for clinical infectionn
11、GOALnTo remove any hindrance to the maintenance or restoration of healing, achieved with minimal physical discomfort and psychological distress to the patient. THEREFORE if there is no debris in the wound, the wound is not bleeding or the wound is not dirty- there is no need to clean it.THERE IS NO
12、EVIDENCE TO USE ONE OR THE OTHERnSaline 0.9% is an isotonic solution compatible with similar osmotic pressure to living cells so should not cause cell damage during wound irrigation. nEasy application in the middle of a field however, ideally the solution should warmed to body temperature.nWarmed ta
13、p water is just as effective and much cheaper!Warm tap water or warmed sterile saline solution 0.9% can be used with gauze. 1.Let the water run off the wound into an appropriate reciprocal. 2.Use clean swabs for each stroke. 3.Always ensure the wound is completely dry to prevent maceration. 4.Dispos
14、e in yellow clinical waste bag.nIt is not recommended to use Cotton wool to clean as it can redistribute bacteria within wounds and drive fibres into the tissuesnThese then may act as foci for infection.nLocalised rednessnLocalised painnLocalised heatnSwellingnDiscoloured dischargenIncreased exudate
15、nMalodournCasualty feeling unwellnThe routine use of antiseptics in wound cleansing is not recommended as it may be detrimental to wound healing, the bacteria may develop a resistance, and there may be a potential toxic effect on viable tissue.Superficial (1st degree)Can be managed. Anything else, s
16、end to hospitalPartial thickness Full thickness(2nd degree) (3rd degree)nApply cold water to localised superficial burnn Maintain moist environment and minimise risk of infection by covering with cling film, tegaderm, hydrocolloid nReview a new burn after 24/48 hours to reassessSuperficial burns usu
17、ally heal in 7-14 daysIf delayed consider infection and refer to secondary care.Once healed advise to protect newly healed tissue. Use of emollient may sooth and ease itching. Use high factor sun block for first year whilst new skin maturesnHave protective functionnIf not large and will not obstruct
18、 dressing or movement- leave intactnLarge blisters may need to be drained but do not deroof as may increase risk of infectionnMoisture Winter (1962) found that epithelial cells migrate over viable tissue and wounds heal three times faster in a moist environmentnThermal insulation any drop in tempera
19、ture below 37 degrees delays mitotic activity for up to four hours (Torrance 1986). Leucocytes will not function in a low temperature wound increasing the potential for clinical infectionnHighly absorptive exudate can be harmful to good skin. Chronic wound exudate can delay healing (Phillips et al 1
20、998)nFree of contaminants cotton wool, remains of dressings, necrotic tissue are foreign bodies and are foci for infectionnLow-adherent adherent dressings may tear dried exudate off the wound bed, causing trauma to newly forming tissues. Newly forming capillaries can grow through gauze loops and wil
21、l be torn when the gauze is removednNon-toxic/harmful many antiseptics have been found to damage healthy tissuenPatient factors acceptable to the patient and the need to bathe or shower for example. Taking into consideration known sensitivities, fragile tissue type or ethical considerations(Adapted from Hampton and Collins 2004)nLow AdherentnVapour permeable filmnAntimicrobialnOdour AbsorbentnAlginatenFoamnHydrocolloidnLarval Therapy
