Acute Skin Trauma (2016)

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Acute Skin Trauma (2016) by Mind Map: Acute Skin Trauma (2016)

1. Background

1.1. Amount of tissue damage

1.1.1. Superficial thickness wounds superficial epidermis

1.1.2. Partial thickness wounds extend through epidermis superficial dermis

1.1.3. Full thickness wounds extend through epidermis dermis subcutaneous tissue

1.2. Time frame

1.2.1. 4-6 weeks

2. Supplies for AT facilities and kits

3. Follow-up

3.1. as a moist environment is created

3.1.1. the collection of exudate will be visible under transparent film and hydrogel dressings

3.1.2. this brownish fluid should not be confused with infection

4. Identification of infection and adverse reactions

4.1. Infection

4.1.1. Overview colonization a normal state contain 10*5 organisms / g of tissue critical colonization the transition state between colonization and invasive wound infection infection multiplying bacteria overwhelms the host defenses > 10*5 organisms / g of tissue Clinical features as a result

4.1.2. bacteria group A beta hemolytic Staphylococcus aureus Pseudomonas aeruginosa Enterococcus Escherichia coli Enterobacter Klebsiella Streptococcus

4.1.3. antiseptic iodine chlorhexidine

4.1.4. prophylactic antibiotics may increase the rate of infection so discourage to use

4.2. Adverse reactions

4.2.1. treatment of anaphylaxis epinephrine corticosteroids antihistamines

4.2.2. folliculitis caused by occlusion of the skin occurs at the base of hair follicles

4.2.3. maceration white discoloration of the periwound tissues

4.2.4. Anti-inflammatory (steroids), nonsteroidal anti-inflammatory, and COX-2 inhibitors may suppress wound healing

4.3. Criteria for referral

4.3.1. deep wounds that require tissue approximation with sutures or staples

4.3.2. heavily contaminated wounds that require more extensive cleansing, debridement, or possibly prophylactic antibiotics

4.3.3. wound with tendon or nerve injury

4.3.4. delay in normal healing

4.3.5. development of an allergic reaction

4.3.6. clinical features of infection or adverse reactions including erythema

5. Dressings

5.1. Nonocclusive dressings

5.1.1. Examples woven nonwoven impregnated sterile gauze nonadherent pads adhesive strips patches wound closure strips

5.1.2. Primary dressings Definition designed to make contact with the wound bed Overview temporary primary dressings Woven and nonwoven gauze used for Woven gauze technique with

5.1.3. Secondary dressings Definition designed to be used in combination with primary dressings to provide Strike through Examples Woven nonwoven nonadherent pads adhesive strips patches

5.2. Occlusive dressings

5.2.1. Definition semipermeable impermeable

5.2.2. Primary dressings Examples film hydrogel hydrocolloid dermal adhesives foam alginate antimicrobial silver dressings

5.2.3. Secondary dressings some foams and hydrogels are nonadhesive require a secondary dressing examples films hydrocolloids

5.3. Healing

5.3.1. Overall Occlusive > Non occlusive Occlusive Non-occlusive

5.3.2. Standard wound closure OR dermal adhesives? Standard wound closure examples lessened dehiscence Dermal adhesives types lessened increase the risk of

5.4. Pain

5.4.1. more pain with nonocclusive dressings > occlusive dressing occlusive dressing examples

5.5. Infection

5.5.1. Infection rate occlusive dressings 2.6% nonocclusive dressings 7% nonocclusive dressings > occlusive dressing ??? still controversial though

6. Debridement

6.1. Definition

6.1.1. the removal of necrotic or devitalized tissue microorganisms contaminated tissue fibrin foreign bodies cellular debris from the wound bed

6.1.2. Purpose to improve function of leukocytes to decrease the energy required for healing

6.1.3. Don't confuse with irrigation cleansing the process of applying a nontoxic solution to remove this is necessary to to create Acute wounds initially considered to be contaminated After the initial cleansing cleansing may not be necessary if infected

6.2. Technique

6.2.1. Irrigation Pressure 4-15 psi 2-4 psi

6.2.2. Hydrotherapy not recommended for acute skin trauma increase the risk of cross-contamination not cost effective not time effective to

6.2.3. Wet-dry debridment Definition the use of moistened woven gauze with large pores not recommended why? How to woven gauze leave on the wound bed Definition

6.2.4. Wet-to-moist debridement Definition the placement of woven gauze with large pores that is premoistened with normal saline or potable tap water over the wound bed. the gauze is removed before drying is complete recommended why?

6.2.5. Scrubbing not recommended nonselective removal of healthy granulation tissue mechanical pressure of the sponge or brush

6.2.6. Conservative sharp debridement make sure to check state practice acts How to use forceps or tweezers use when it's appropriate

6.2.7. Chemical deridement Definition application of not recommended & controversal may cytotoxic

6.2.8. Autolytic debridement Definition the use of the body's mechanisms to promote proteolytic digestion of necrotic tissue in a moist environment created by the application of How it works moist environment Advantage no pain Used for abrasions avulsions incisions lacerations blisters puncture Not use for infection What to be used hydrogel

7. Cleansing

7.1. Definition

7.1.1. cleansing the process of applying a nontoxic solution to remove exudate bacteria foreign bodies dressing residue this is necessary to to create an optimal environment for wound healing

7.1.2. Acute wounds initially considered to be contaminated 有無を言わさず comtaminationされていると考える。 that's why

7.1.3. After the initial cleansing cleansing may not be necessary if infected wound cleansing is necessary

7.2. Technique

7.2.1. Irrigation Definition the steady flow of solution across the wound surface Purpose to remove loose debris to create an optimal healing environment Risk splash back additional trauma bacteria driven into deeper tissues How to Pressure what to use

7.2.2. Showering Purpose for larger traumatic wounds Risk pressure is rarely controlled

7.2.3. Hydrotherapy Whirlpool baths can be used for chronic wounds for 72 hrs post op surgical incisions Risk disrupting the moisture balance the wound bed macerating periwound tissues impairing healing by introducing

7.2.4. Scrubbing and swabbing Risk cotton wool fiber remnants from woven gauze what to use non woven gauze if preferred

7.3. Solutions

7.3.1. Normal saline and potable tap water good evidence! tap water advantage contraindication Normal saline indication

7.3.2. Antiseptics Risk may impede wound healing may reduce wound strength Examples hydrogen peroxide betadine Purdue Products LP Stamford CT How to use safely in diluted concentrations

7.4. Temperature

7.4.1. 98.68F and 107.68F (37C and 42C). why this range? mitotic activity decreases