急救知识伤口处理-课件.ppt

Wound Management,The Plan for tonight,-Wounds on dutyClassificationWound management-Tissue ViabilityStages of wound healingWound management,Wound Definition,A disruption of the integrity and function of the tissues in the body(Baharestani 2004),First Aid Classification of wounds,Wounds can be classified into 7 different types depending on the object that produces the wound and the manner which it has been inflicted.Each wound type carries specific risks associated with surrounding tissue damage and infectionCAN YOU REMEMBER WHAT THEY ARE?!,Types of wound,INCISEDCaused by a clean cut from a sharp edged object.Blood vessels are cut straight across so bleeding may be profuseStructures such as tendons,nerves or arteries may be damaged,Types of wound,LACERATIONCaused by crushing or ripping forcesMay bleed less profusely than incised woundsLikely to be more tissue damageMore often contaminated with germs so infection risk is high,Types of wound,ABRASIONSuperficial wound in which the topmost layers of the skin are scraped off leaving a raw tender areaCaused by sliding falls or friction burnsCan contain embedded foreign particles that may result in infection,Type of wounds,CONTUSIONCaused by a blunt blow or punch rupturing the capillaries beneath the skin causing blood to leak into the tissues resulting in bruising.Severe contusion may indicate deeper damage such as internal injury or fracture,Type of wound,PUNCTURESuch as standing on a nail or being pricked by a needle.Small entry site but a deep track of internal damage.As germs and dirt can be carried far into the body,the infection risk is high,Type of wound,STABCaused by a long or bladed instrument usually a knife penetrating the body.Stab wounds to the trunk must always be treated seriously due to dangers of injury to vital organs or life threatening internal bleeding,Type of Wound,GUNSHOT2 woundsCaused by a bullet or missile which may cause serious internal injuryEntry wound may be small and neatExit wound may be large and ragged,Wound management,Wound healing,The process by which tissue damaged or destroyed by injury or disease are restored to normal function,Stages of wound healing,INFLAMMATORY Up to 3 days after the initial woundRedness,swelling,heatPROLIFERATIONDays 3-24Construction of the wound,development of new granulation tissueMATURATION24 days after wound-1 yearEpithelial cells migrate over new tissue,becomes less vascularAfter 3 months the tensile strength is only 50%of normal tissue,Factors affecting wound healing,Cardiovascular disordersPeripheral Vascular Disease,Chronic Heart DiseaseTherapiesRadiotherapy,ChemotherapyMalnutritionPsychological&social factors,Increasing age Immune disordersRheumatoid arthritis Endocrine disordersAnaemia,DiabetesInappropriate wound management,Wound Management-What the book says,Wash your hands and apply glovesClean the wound with running water if the wound is dirty.Pat dry with gauzeCover with adhesive dressing.,Optimum healing environment,Cells migrate over viable tissue and wounds heal 3 times faster in a moist environment(Winter 1962),Wound temperature below 37 degrees delays mitotic activity for up to 4 hours(Torrance 1986)White cells will not function in a low temperature increasing potential for clinical infection,To clean or not to clean?!,GOALTo 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.,Sterile saline solution 0.9%.Vs Tap Water,THERE IS NO EVIDENCE TO USE ONE OR THE OTHERSaline 0.9%is an isotonic solution compatible with similar osmotic pressure to living cells so should not cause cell damage during wound irrigation.Easy application in the middle of a field however,ideally the solution should warmed to body temperature.Warmed tap water is just as effective and much cheaper!,How to clean a wound?,Warm tap water or warmed sterile saline solution 0.9%can be used with gauze.Let the water run off the wound into an appropriate reciprocal.Use clean swabs for each stroke.Always ensure the wound is completely dry to prevent maceration.Dispose in yellow clinical waste bag.,Cotton Wool-DO NOT USE!,It is not recommended to use Cotton wool to clean as it can redistribute bacteria within wounds and drive fibres into the tissuesThese then may act as foci for infection.,How to tell if a wound is infected,Localised rednessLocalised painLocalised heatSwellingDiscoloured dischargeIncreased exudateMalodourCasualty feeling unwell,Antiseptics,The 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.,BURNS-specialist area,Superficial(1st degree)Can be managed.Anything else,send to hospitalPartial thickness Full thickness(2nd degree)(3rd degree),Superficial Burn Management,Apply cold water to localised superficial burn Maintain moist environment and minimise risk of infection by covering with cling film,tegaderm,hydrocolloid Review a new burn after 24/48 hours to reassess,Superficial burns usually 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 matures,Blisters,Have protective functionIf not large and will not obstruct dressing or movement-leave intactLarge blisters may need to be drained but do not deroof as may increase risk of infection,So.How to pick an ideal wound dressing,Its more than applying a plaster!,Dressing Requirements-In Summary!,Moisture Winter(1962)found that epithelial cells migrate over viable tissue and wounds heal three times faster in a moist environmentThermal insulation any drop in temperature 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 infectionHighly absorptive exudate can be harmful to good skin.Chronic wound exudate can delay healing(Phillips et al 1998),Free of contaminants cotton wool,remains of dressings,necrotic tissue are foreign bodies and are foci for infectionLow-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 will be torn when the gauze is removedNon-toxic/harmful many antiseptics have been found to damage healthy tissuePatient 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),Dressings available to HCPs,Low AdherentVapour permeable filmAntimicrobialOdour AbsorbentAlginateFoamHydrocolloidLarval Therapy,Any Questions?,