1. Background
1.1. Amount of tissue damage
1.1.1. Superficial thickness wounds
1.1.1.1. superficial epidermis
1.1.2. Partial thickness wounds
1.1.2.1. extend through epidermis
1.1.2.2. superficial dermis
1.1.3. Full thickness wounds
1.1.3.1. extend through
1.1.3.1.1. epidermis
1.1.3.1.2. dermis
1.1.3.2. 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
4.1.1.1. colonization
4.1.1.1.1. a normal state
4.1.1.1.2. contain 10*5 organisms / g of tissue
4.1.1.2. critical colonization
4.1.1.2.1. the transition state between colonization and invasive wound infection
4.1.1.3. infection
4.1.1.3.1. multiplying bacteria overwhelms the host defenses
4.1.1.3.2. > 10*5 organisms / g of tissue
4.1.1.3.3. Clinical features
4.1.1.3.4. as a result
4.1.2. bacteria
4.1.2.1. group A beta hemolytic
4.1.2.1.1. Staphylococcus aureus
4.1.2.2. Pseudomonas aeruginosa
4.1.2.3. Enterococcus
4.1.2.4. Escherichia coli
4.1.2.5. Enterobacter
4.1.2.6. Klebsiella
4.1.2.7. Streptococcus
4.1.3. antiseptic
4.1.3.1. iodine
4.1.3.2. chlorhexidine
4.1.4. prophylactic antibiotics
4.1.4.1. may increase the rate of infection
4.1.4.1.1. so discourage to use
4.2. Adverse reactions
4.2.1. treatment of anaphylaxis
4.2.1.1. epinephrine
4.2.1.2. corticosteroids
4.2.1.3. antihistamines
4.2.2. folliculitis
4.2.2.1. caused by occlusion of the skin
4.2.2.2. occurs at the base of hair follicles
4.2.3. maceration
4.2.3.1. white discoloration of the periwound tissues
4.2.4. Anti-inflammatory (steroids), nonsteroidal anti-inflammatory, and COX-2 inhibitors
4.2.4.1. may suppress wound healing
4.3. Criteria for referral
4.3.1. deep wounds
4.3.1.1. that require
4.3.1.1.1. tissue approximation with sutures or staples
4.3.2. heavily contaminated wounds
4.3.2.1. that require
4.3.2.1.1. 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
5.1.1.1. woven
5.1.1.2. nonwoven
5.1.1.3. impregnated sterile gauze
5.1.1.4. nonadherent pads
5.1.1.5. adhesive strips
5.1.1.6. patches
5.1.1.7. wound closure strips
5.1.2. Primary dressings
5.1.2.1. Definition
5.1.2.1.1. designed to make contact with the wound bed
5.1.2.2. Overview
5.1.2.2.1. temporary primary dressings
5.1.2.3. Woven and nonwoven gauze
5.1.2.3.1. used for
5.1.2.4. Woven gauze
5.1.2.4.1. technique with
5.1.3. Secondary dressings
5.1.3.1. Definition
5.1.3.1.1. designed to be used in combination with primary dressings to provide
5.1.3.1.2. Strike through
5.1.3.2. Examples
5.1.3.2.1. Woven
5.1.3.2.2. nonwoven
5.1.3.2.3. nonadherent pads
5.1.3.2.4. adhesive strips
5.1.3.2.5. patches
5.2. Occlusive dressings
5.2.1. Definition
5.2.1.1. semipermeable
5.2.1.1.1. impermeable
5.2.2. Primary dressings
5.2.2.1. Examples
5.2.2.1.1. film
5.2.2.1.2. hydrogel
5.2.2.1.3. hydrocolloid
5.2.2.1.4. dermal adhesives
5.2.2.1.5. foam
5.2.2.1.6. alginate
5.2.2.1.7. antimicrobial silver dressings
5.2.3. Secondary dressings
5.2.3.1. some foams and hydrogels
5.2.3.1.1. are nonadhesive
5.2.3.1.2. require a secondary dressing
5.2.3.2. examples
5.2.3.2.1. films
5.2.3.2.2. hydrocolloids
5.3. Healing
5.3.1. Overall
5.3.1.1. Occlusive > Non occlusive
5.3.1.1.1. Occlusive
5.3.1.1.2. Non-occlusive
5.3.2. Standard wound closure OR dermal adhesives?
5.3.2.1. Standard wound closure
5.3.2.1.1. examples
5.3.2.1.2. lessened dehiscence
5.3.2.2. Dermal adhesives
5.3.2.2.1. types
5.3.2.2.2. lessened
5.3.2.2.3. increase the risk of
5.4. Pain
5.4.1. more pain with
5.4.1.1. nonocclusive dressings > occlusive dressing
5.4.1.1.1. occlusive dressing examples
5.5. Infection
5.5.1. Infection rate
5.5.1.1. occlusive dressings
5.5.1.1.1. 2.6%
5.5.1.2. nonocclusive dressings
5.5.1.2.1. 7%
5.5.1.3. nonocclusive dressings > occlusive dressing ???
5.5.1.3.1. still controversial though
6. Debridement
6.1. Definition
6.1.1. the removal of
6.1.1.1. necrotic or devitalized tissue
6.1.1.2. microorganisms
6.1.1.3. contaminated tissue
6.1.1.4. fibrin
6.1.1.5. foreign bodies
6.1.1.6. cellular debris
6.1.1.6.1. from the wound bed
6.1.2. Purpose
6.1.2.1. to improve function of leukocytes
6.1.2.2. to decrease the energy required for healing
6.1.3. Don't confuse with irrigation
6.1.3.1. cleansing
6.1.3.1.1. the process of applying a nontoxic solution to remove
6.1.3.1.2. this is necessary to to create
6.1.3.2. Acute wounds
6.1.3.2.1. initially considered to be contaminated
6.1.3.3. After the initial cleansing
6.1.3.3.1. cleansing may not be necessary
6.1.3.3.2. if infected
6.2. Technique
6.2.1. Irrigation
6.2.1.1. Pressure
6.2.1.1.1. 4-15 psi
6.2.1.1.2. 2-4 psi
6.2.2. Hydrotherapy
6.2.2.1. not recommended for acute skin trauma
6.2.2.1.1. increase the risk of cross-contamination
6.2.2.1.2. not cost effective
6.2.2.1.3. not time effective to
6.2.3. Wet-dry debridment
6.2.3.1. Definition
6.2.3.1.1. the use of moistened woven gauze with large pores
6.2.3.2. not recommended
6.2.3.2.1. why?
6.2.3.3. How to
6.2.3.3.1. woven gauze leave on the wound bed
6.2.3.4. Definition
6.2.4. Wet-to-moist debridement
6.2.4.1. Definition
6.2.4.1.1. the placement of woven gauze with large pores that is premoistened with normal saline or potable tap water over the wound bed.
6.2.4.1.2. the gauze is removed before drying is complete
6.2.4.2. recommended
6.2.4.2.1. why?
6.2.5. Scrubbing
6.2.5.1. not recommended
6.2.5.1.1. nonselective
6.2.5.1.2. removal of healthy granulation tissue
6.2.5.1.3. mechanical pressure of the sponge or brush
6.2.6. Conservative sharp debridement
6.2.6.1. make sure to check state practice acts
6.2.6.2. How to
6.2.6.2.1. use forceps or tweezers
6.2.6.3. use when it's appropriate
6.2.7. Chemical deridement
6.2.7.1. Definition
6.2.7.1.1. application of
6.2.7.2. not recommended & controversal
6.2.7.2.1. may cytotoxic
6.2.8. Autolytic debridement
6.2.8.1. Definition
6.2.8.1.1. the use of the body's mechanisms to promote proteolytic digestion of necrotic tissue in a moist environment created by the application of
6.2.8.2. How it works
6.2.8.2.1. moist environment
6.2.8.3. Advantage
6.2.8.3.1. no pain
6.2.8.4. Used for
6.2.8.4.1. abrasions
6.2.8.4.2. avulsions
6.2.8.4.3. incisions
6.2.8.4.4. lacerations
6.2.8.4.5. blisters
6.2.8.4.6. puncture
6.2.8.5. Not use for
6.2.8.5.1. infection
6.2.8.6. What to be used
6.2.8.6.1. hydrogel
7. Cleansing
7.1. Definition
7.1.1. cleansing
7.1.1.1. the process of applying a nontoxic solution to remove
7.1.1.1.1. exudate
7.1.1.1.2. bacteria
7.1.1.1.3. foreign bodies
7.1.1.1.4. dressing residue
7.1.1.2. this is necessary to to create
7.1.1.2.1. an optimal environment for wound healing
7.1.2. Acute wounds
7.1.2.1. initially considered to be contaminated
7.1.2.1.1. 有無を言わさず comtaminationされていると考える。
7.1.2.1.2. that's why
7.1.3. After the initial cleansing
7.1.3.1. cleansing may not be necessary
7.1.3.2. if infected
7.1.3.2.1. wound cleansing is necessary
7.2. Technique
7.2.1. Irrigation
7.2.1.1. Definition
7.2.1.1.1. the steady flow of solution across the wound surface
7.2.1.2. Purpose
7.2.1.2.1. to remove loose debris
7.2.1.2.2. to create an optimal healing environment
7.2.1.3. Risk
7.2.1.3.1. splash back
7.2.1.3.2. additional trauma
7.2.1.3.3. bacteria driven into deeper tissues
7.2.1.4. How to
7.2.1.4.1. Pressure
7.2.1.4.2. what to use
7.2.2. Showering
7.2.2.1. Purpose
7.2.2.1.1. for larger traumatic wounds
7.2.2.2. Risk
7.2.2.2.1. pressure is rarely controlled
7.2.3. Hydrotherapy
7.2.3.1. Whirlpool baths
7.2.3.1.1. can be used
7.2.3.1.2. for chronic wounds
7.2.3.1.3. for 72 hrs post op surgical incisions
7.2.3.2. Risk
7.2.3.2.1. disrupting the moisture balance the wound bed
7.2.3.2.2. macerating periwound tissues
7.2.3.2.3. impairing healing by introducing
7.2.4. Scrubbing and swabbing
7.2.4.1. Risk
7.2.4.1.1. cotton wool fiber remnants from woven gauze
7.2.4.2. what to use
7.2.4.2.1. non woven gauze if preferred
7.3. Solutions
7.3.1. Normal saline and potable tap water
7.3.1.1. good evidence!
7.3.1.2. tap water
7.3.1.2.1. advantage
7.3.1.2.2. contraindication
7.3.1.3. Normal saline
7.3.1.3.1. indication
7.3.2. Antiseptics
7.3.2.1. Risk
7.3.2.1.1. may impede wound healing
7.3.2.1.2. may reduce wound strength
7.3.2.2. Examples
7.3.2.2.1. hydrogen peroxide
7.3.2.2.2. betadine
7.3.2.2.3. Purdue Products LP
7.3.2.2.4. Stamford
7.3.2.2.5. CT
7.3.2.3. How to use safely
7.3.2.3.1. in diluted concentrations
7.4. Temperature
7.4.1. 98.68F and 107.68F (37C and 42C).
7.4.1.1. why this range?
7.4.1.1.1. mitotic activity decreases