Module 1 - Wound care & Healing

Wound Assessment and Primary Care

 

1.)    Patient History and Physical Exam – Time and mechanism of injury. Neurological and vascular examination distal to the sight of injury. Ensure tetanus shot is up to date.

2.)    Anesthesia – Lidocaine/epinephrine; avoid epinephrine in fingers and toes.

3.)    Tourniquet – Used for extremities and digits only in cases of excessive and life-threatening hemorrhage.

4.)    Wound preparation – Cleanse surrounding skin with a surgical solution but use only a physiologic solution, such as normal saline, on wound itself to prevent further tissue damage. Remove, by careful scrubbing, any dirt, gravel or other foreign materials that may lead to traumatic tattooing.

5.)    Wound exploration and hemostasis – Explore wound carefully for any foreign bodies and to determine extent of injury by assessing tissue injury, amount of tissue lost, and the degree of injury to deeper structures. Hemostasis by means of direct pressure, elevation, electrocautery, or suture ligation.

6.)    Débribement – After viability of wound margins are assessed, remove all devitalized tissue and excise ragged edges to prepare for realignment. The goal of débribement is to produce a clean, bleeding margin of viable tissue.

7.)    Wound Closure – See wound closure section.

8.)    Dressing – See wound healing section.

9.)    Antibiotic usage – Antibiotics can be used prophylactically, before a surgical wound is made, or empirically, in the case of a traumatic wounds. In either case, the location and age of the wound, as well as the mechanism of injury/surgical incision should be considered to determine the microbes most likely of concern for infection.

Author: SP Zinn