Traumatic and Infected Wound

Dr Mohammad Nazir Hassan

Wound
. An injury, especially one in which the skin or another external surface is torn, pierced, cut, or otherwise broken. 2. An injury to the feelings.

A wound is an injury to the integument or the underlying structures that may or may not result in a loss of skin integrity. Physiological function of the tissue is impaired (Keryln Carville 2001).

Type of wound
Surgical/traumatic wound
Venous ulcer Arterial insuficency Necrotising fascitis Pressure sore Diabetic foot ulcer Etc..

TRAUMATIC WOUNDS

Traumatic Wound
sudden, unplanned injury

TYPES OF WOUND
Contusion bruising or haemorrhage. Caused by a blow from something blunt Abrasion caused by skin being scraped along a hard surface Incision clean cut/surgical. Skin, soft tissues and muscle may be severed

TYPES OF WOUND
Laceration jagged edges e.g. from teeth, claws, barbed wire. Puncture small entry. May have some internal damage and can become infected Tear/Avulsion skin and soft tissue partially or completely torn away Cavity chronic, open wound

Contusions

Abrasion Wound

Laceration Wound

Puncture/Penetrating Wound

Sutured Wound

14

Open Incisional Wound

15

Burn wound

16

Degloving Injury

Gun Shot Wound

Assessing a wound

History

Examination

Assessment

HISTORY:
A detailed, thorough history is essential for assessing the extent of injury and for organising appropriate wound management. When did the injury occur? The longer the wound has been present, the more likely an infection will occur after closure

HISTORY:
Where did the injury occur? What are the potential contaminants? E.g. saliva, pus, faeces, soil How did the injury occur? Must assess any potential damage to deeper structures

EXAMINATION:
Is there loss of function in the injured part? Are important underlying structures involved e.g. nerves, major vessels, ligaments, bones?

EXAMINATION:
What is the level of contamination? Are any foreign bodies present? What is the viability of the injured parts? Are any parts missing?

ASSESSMENT:

Swelling Pain Surrounding skin colour (redness suggests infection)

WOUND MANAGEMENT

Control bleeding Prevent infection

Reduce pain

MINOR WOUNDS
Clean the wound thoroughly with gauze soaked in saline or cooled, boiled water Apply a non-stick dressing

MAJOR WOUNDS
Follow DRABC Control bleeding apply firm direct pressure, elevate bleeding part, apply pad over wound Clean the wound as best as possible Apply a sterile or clean dressing

SPECIFIC WOUNDS: Haematoma

o REST o ICEPACKS o COMPRESSION o ELEVATE

Abrasion/incision/laceration

Cleanse wound thoroughly with sterile gauze soaked in sterile water or cooled boiled water Apply non-adherent dressing

Tear/avulsion
Return skin to original position if possible Apply pressure to wound using a dressing and a pad to control any bleeding Bandage

Embedded object:
o DO NOT remove the foreign object o Control bleeding by applying pressure to surrounding area (not on foreign object) o Place a ring pad around the object and bandage over the padding

Penetrating wounds
Control bleeding by applying direct pressure around the wound Keep wound as clean as possible DO NOT try to pick out any embedded foreign material Apply a clean or sterile dressing Rest the injured person in a comfortable position

Bleeding from the scalp

Follow DRABC If you suspect a fracture, control bleeding with gentle pressure around wound If there appears to be no fracture, control bleeding with firm direct pressure If casualtys condition permits, sitting up may help control bleeding Monitor casualtys condition

Snake and Spider bite

DO NOT wash venom off skin or cut/suck venom out or try to catch the snake/spider DO NOT use a constrictive bandage e.g. arterial tourniquet Check breathing and pulse follow DRABC Calm casualty Apply pressure immobilisation bandage

Snake and Spider bite

Apply a firm roller bandage starting just above fingers/toes and moving up limb as far as can be reached Bandage needs to be firm but not too tight check circulation Immobilise casualty Apply a splint to immobilise bitten limb If possible, ensure casualty does not move

WOUND DRESSING
Control bleeding

Protect the wound from infection.

DRESSINGS PRINCIPLES TYPES OF DRESSING

Infected Wound

Content
Introduction
Host-Pathogen Reaction Making a diagnosis Management Strategy Wound Cleansing Wound Dressing Summary

INTRODUCTION

HOST-PATHOGEN INTERACTION

Host-Pathogen Interaction

Immunocompetency
Bacterial Count Virulence

Outcome of Host-Pathogen Interaction

Contamination

Colonization

Infection

TERMINOLOGY
Wound contamination the presence of bacteria within a wound without any host reaction/multiplication Wound colonisation the presence and multiplication of bacteria within the wound Wound infection the deposition and multiplication of bacteria in tissue with an associated host injury and reaction

Critical Colonization
An intermediate stage between benign colonization and overt infection

MAKING A DIAGNOSIS

Infection?

Investigations

Full Blood Counts ESR/CRP C&S

MANAGEMENT STRATEGY

Management

TREATMENT SUMMARY OF THE MANAGEMENT OF WOUND INFECTIONS

WOUND DEBRIDEMENT

Wound Debridement

WOUND CLEANSING

Wound Cleansing
Helps optimize wound healing Decreases the potential for infection Loosens and washes away cellular debris (bacteria, exudate, purulent material and residual topical agents)

Cleansing Solutions

Normal Saline Water for irrigation chlorhexidine Superoxide Acetic acid,hydrogen peroxide,acetic acid????

WOUND DRESSING

Cadexomer Iodine

0.9% iodine is immobilised in the matrix and released constantly over 3 days

Silver

ACTICOAT

ACTICOAT Absorbent

Mode of Action

Ionic silver Damages the cell wall Interferes with the DNA synthesis Denatures proteins & enzymes and inhibits protein synthesis
1. Castellano JJ, Shafii SM, Ko F, et al. Comparative evaluation of silver-containing antimicrobial dressings and drugs. Int Wound J. 2007;492):114-122.

Summary
Many type of traumatic wound Initial management counts Infected wound is initially not infected!!