SlideShare a Scribd company logo
1 of 22
Basic principles of
acute and
traumatic wounds
care
Dr Arnaud DEPIL DUVAL
Chef de service – Urgences Evreux - Vernon
Mylan makes no claim or warranty of, and is
not responsible for, any medical, scientific or
other information that may be disseminated
through this presentation
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Infectious risk
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Risk?
• Each wound is
colonized
• But not infected
Protection
• Don’t bring more germs
• Use protective equipments
• Clean but not sterile
• Don’t forget the mask (especially
doctors…)
Cleaning and
detersion
• Abundant washing for fragments, germs,
etc
• Soaking is not indicated
• Kamolz LP, Wild T. Wound bed preparation: The
impact of debridement and wound cleansing. Wound
med 2013; 1:44-50
• No evidence of superiority of saline
solution compared to controlled tap water
• Fernandez R, Griffiths R. Water for wounds cleansing.
Cochrane Database Syst Rev 2012; 2:cd003861
Antisepsis
• No benefits with antisepsis
• Khan MN, Naqvi AH (2006) Antiseptics, iodine, povidone iodine and
traumatic wound cleansing. J Tissue Viability 16:6–10
• Ghafouri HB, Zare M, Bazrafshan A, Abazarian N, Ramim T. Randomized
controlled trial of povidoneiodine to reduce simple traumatic wound
infections in the emergency department. Injury 2016; 47:1913-8
• Antisepsis only required for pre-incision
• Evidence-based richtlijn voor de behandeling van wonden met een
acute etiologie in de ketenzorg
Water is better
• Sterile water not superior to tap
water
• Fernandez R, Griffiths R. Water for wounds
cleansing. Cochrane Database Syst Rev 2012;
2:cd003861
• Moscati RM, Mayrose J, Reardon RF, Janicke
DM, Jehle DV. A multicenter comparison of
tap water versus sterile saline for wound
irrigation. Acad Emerg Med 2007; 14:404-9.
• With soap
• Instead after suture…
Waiting for
exploration
• Maintained in a humid environment
with a compress soaked in water
• Economic excision and as complete
as possible of contused tissues, dead
or doomed to necrosis as well as the
evacuation of foreign bodies
• Under local or regional anesthesia
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Suture
• No demonstrated association
between closure time and risk of
infection
• Quinn JV, Polevoi SK, Kohn MA. Traumatic
lacerations: what are the risks for infection
and has the 'golden period' of laceration care
disappeared? Emerg Med J 2014; 31:96-100
• Head up to 24h
• Berk WA, Osbourne DD, Taylor DD. Evaluation of
the 'golden period' for wound repair: 204 cases
from a Third World emergency department. Ann
Emerg Med 1988; 17:496-500
• Control after 48h
Antibiotherapy
• No skin specimen
• No indication for local antibiotic therapy
• Antibiotherapy to evaluate only if:
• Clinical signs of regional or systemic infection
• Late management (beyond 24 hours)
• Important or deep bacterial inoculum
• Difficulty of access to effective washing
• Particular location
• Risk about medical status of patient
• Unsatisfactory trimming
• Systematic if bite
Antibiotherapy
Absence of local or general infectious signs
Heavily soiled wound
Amoxicillin + clavulanic acid 1 g / 8 hours per os
If penicillin allergy
Pristinamycin 1 g / 8 hrs PO
Or Clindamycin 600 mg / 8 hr
Or Cotrimoxazole 800 mg / 160 mg / 12 hrs PO
5 days
Local ischemic terrain
Other situations No antibiotics
Presence of local inflammatory signs
Erythema / induration
peri-lesional <5 cm
even in the presence of pus
AND
no general sign
No antibiotic therapy
EXCEPT local ischemic terrain : antibiotherapy
Erythema / induration
peri-lesional> 5 cm
or
lymphangite
or
general signs
Absence of gravity
Antibiotherapy
7 days
Presence of severity criteria
local (crepitus, necrosis) or general
Immediate hospitalization
and urgent surgical opinion and infectiologist
Bites
Bites
• 30 to 50% infections
• <12h : Pasteurella multocida
Germs
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Source Germs Diseases / incubation times
Dog and cat Pasteurella multocida
Aerobic bacteria (streptocoques, Staphylococcus aureus,
Caonocytophaga canimorsus, Eikenella corrodens)
and anaerobia (Prevotella, Fusobacterium, Veillonella,
Peptostreptococcus), Bartonella henselae (only cat), Rhabdovirus
Pasteurellosis / <24 h
Pyogenic infections / 2 days
Disease of cat's claws / 3 to 15
days
Rage / 15 to 90 days (or even
years)
Rat and
other
rodents
Pasteurella multocida
Streptobacillus moniliformis
Spirillum minus
Leptospira
Pasteurellosis / <24 h
Streptobacillary
sodoku
leptospirosis
Human Aerobic bacteria (streptocoques, Staphylococcus aureus,
Caonocytophaga canimorsus, Eikenella corrodens)
and anaerobia (Prevotella, Fusobacterium, Veillonella,
Peptostreptococcus)
Pyogenic infections / 2 days
HIV infections, HCV, HBV
Animal bites
(mammalians)
• If less accessible to abundant
washing
• Left open
• Drained by a greasy dressing for
a secondary closure (j4-j5)
• If absence of infectious sign
• In other cases, suture possible,
with follow-up in the first days
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Antibiotherapy animal bites (mammalians)
Absence of local or general infectious signs
Absence of local or general
infectious signs
Amoxicillin + clavulanic acid 1 g / 8 hours per os
If penicillin allergy :
Doxycycline 100 mg / 12 hrs PO
If contraindicated cyclines AND penicillin allergy :
Pristinamycin 1 g / 8 hrs PO
Or Clindamycin 600 mg / 8 hr
Or Cotrimoxazole 800 mg / 160 mg / 12 hrs PO
5 days
Presence of local
inflammatory signs 5 days and more
Tetanos
Tetanos
Quick Test
Tetanos quick test only
if non-up-to-date
vaccination AND wound
with tetanos risk
Tetanos, rage and virus
Dr Arnaud Depil Duval - Urgences Evreux Vernon
Type of wound vaccinations up to date vaccinations non up to date
Minor, clean No injection
Specify the date of the next
reminder
Immediate administration of a vaccine dose (0.5 mL
intramuscular or deep subcutaneous) containing tetanus
valence.
Propose if necessary an update program and specify the
date of the next reminder
Major (extended, penetrating,
with foreign body or treated
late) or likely to have been
contaminated by telluric germs
No injection
Specify the date of the next
reminder
In one arm, human tetanus immunoglobulin, 250 IU.
In the thigh for children <3 years or <15 kg
In the other arm, administering a dose of anti-tetanus
vaccine (or prescription)
Propose if necessary an update program and specify the
date of the next reminder
Take home messages
• Don’t need sterile gloves only
clean
• Tap water is better
• No demonstrated association
between closure time and risk of
infection
• Indications for antibiotics
• Don’t forget tetanus vaccination

More Related Content

What's hot

What's hot (20)

Case study :Dengue fever
Case study :Dengue feverCase study :Dengue fever
Case study :Dengue fever
 
Streptococccal sore throat
Streptococccal sore throatStreptococccal sore throat
Streptococccal sore throat
 
Dr.adeel
Dr.adeelDr.adeel
Dr.adeel
 
Mammalian bites
Mammalian bitesMammalian bites
Mammalian bites
 
Rabies
Rabies Rabies
Rabies
 
Ophthalmia neonatorum bondi
Ophthalmia neonatorum bondiOphthalmia neonatorum bondi
Ophthalmia neonatorum bondi
 
approach to sore throat in children
approach to sore throat in childrenapproach to sore throat in children
approach to sore throat in children
 
The Febrile Neonate and Young Infant: An Evidence Based Review
The Febrile Neonate and Young Infant: An Evidence Based ReviewThe Febrile Neonate and Young Infant: An Evidence Based Review
The Febrile Neonate and Young Infant: An Evidence Based Review
 
Needle Stick Injury Presentation
Needle Stick Injury PresentationNeedle Stick Injury Presentation
Needle Stick Injury Presentation
 
Chikungunya
Chikungunya Chikungunya
Chikungunya
 
Safety measures in hcw
Safety measures in hcwSafety measures in hcw
Safety measures in hcw
 
Needle stick injury and hazards of needle stick
Needle stick injury and hazards of needle stickNeedle stick injury and hazards of needle stick
Needle stick injury and hazards of needle stick
 
Lab diagnosis of Dengue
Lab diagnosis of DengueLab diagnosis of Dengue
Lab diagnosis of Dengue
 
Scrub typhus
Scrub typhusScrub typhus
Scrub typhus
 
Respi
RespiRespi
Respi
 
Scrub typhus
Scrub typhusScrub typhus
Scrub typhus
 
Croup
CroupCroup
Croup
 
Scrub typhus
Scrub typhus Scrub typhus
Scrub typhus
 
PROPHYLAXIS AGAINST HBV
PROPHYLAXIS AGAINST HBVPROPHYLAXIS AGAINST HBV
PROPHYLAXIS AGAINST HBV
 
Heroic procedures you should know
Heroic procedures you should knowHeroic procedures you should know
Heroic procedures you should know
 

Similar to Acute & Traumatics wounds - Infectious risk

Case presentation eczema herpeticum
Case presentation eczema herpeticumCase presentation eczema herpeticum
Case presentation eczema herpeticumBen Widaja
 
CME Varicella-zoster Infection in Paediatric.pdf
CME Varicella-zoster Infection in Paediatric.pdfCME Varicella-zoster Infection in Paediatric.pdf
CME Varicella-zoster Infection in Paediatric.pdfzackaim754
 
Herpes Simplex Keratitis .pptx
Herpes Simplex Keratitis .pptxHerpes Simplex Keratitis .pptx
Herpes Simplex Keratitis .pptxAmeyTamhane
 
rabies, definition, introduction, diagnosis.pptx
rabies, definition, introduction, diagnosis.pptxrabies, definition, introduction, diagnosis.pptx
rabies, definition, introduction, diagnosis.pptxadesholakhaliid
 
Chickenpox,measles,small pox,rubella
Chickenpox,measles,small pox,rubellaChickenpox,measles,small pox,rubella
Chickenpox,measles,small pox,rubellaDr.Rani Komal Lata
 
Dengue and chikungunya in Children
Dengue and chikungunya in ChildrenDengue and chikungunya in Children
Dengue and chikungunya in ChildrenMilind Bapat
 
Uveitis: Workup and Management
Uveitis: Workup and ManagementUveitis: Workup and Management
Uveitis: Workup and ManagementSmith Snehal Sute
 
Michael rose on anaphylaxis
Michael rose on anaphylaxisMichael rose on anaphylaxis
Michael rose on anaphylaxisSMACC Conference
 
Empiric antibiotic management for major infections
Empiric antibiotic management for major infectionsEmpiric antibiotic management for major infections
Empiric antibiotic management for major infectionsderosaMSKCC
 
Empiric Antibiotic Management for Major Infections at MSKCC
Empiric Antibiotic Management for Major Infections at MSKCCEmpiric Antibiotic Management for Major Infections at MSKCC
Empiric Antibiotic Management for Major Infections at MSKCCderosaMSKCC
 
2. fever with rash
2. fever with rash2. fever with rash
2. fever with rashWhiteraven68
 
Monkeypox Facts 2022.pdf
Monkeypox Facts 2022.pdfMonkeypox Facts 2022.pdf
Monkeypox Facts 2022.pdfMelaniePaday1
 
Epidemiology, Disease and Preventive Strategies of Rabies
Epidemiology, Disease and Preventive Strategies of RabiesEpidemiology, Disease and Preventive Strategies of Rabies
Epidemiology, Disease and Preventive Strategies of RabiesDilshan Wijeratne
 
Viral food born infections
Viral food born infectionsViral food born infections
Viral food born infectionsDalia El-Shafei
 

Similar to Acute & Traumatics wounds - Infectious risk (20)

Case presentation eczema herpeticum
Case presentation eczema herpeticumCase presentation eczema herpeticum
Case presentation eczema herpeticum
 
CME Varicella-zoster Infection in Paediatric.pdf
CME Varicella-zoster Infection in Paediatric.pdfCME Varicella-zoster Infection in Paediatric.pdf
CME Varicella-zoster Infection in Paediatric.pdf
 
Herpes Simplex Keratitis .pptx
Herpes Simplex Keratitis .pptxHerpes Simplex Keratitis .pptx
Herpes Simplex Keratitis .pptx
 
Rabies.pptx
Rabies.pptxRabies.pptx
Rabies.pptx
 
Aquamid
AquamidAquamid
Aquamid
 
rabies, definition, introduction, diagnosis.pptx
rabies, definition, introduction, diagnosis.pptxrabies, definition, introduction, diagnosis.pptx
rabies, definition, introduction, diagnosis.pptx
 
Chickenpox,measles,small pox,rubella
Chickenpox,measles,small pox,rubellaChickenpox,measles,small pox,rubella
Chickenpox,measles,small pox,rubella
 
Ebola ppt
Ebola pptEbola ppt
Ebola ppt
 
Animal And Insect Bites
Animal And Insect BitesAnimal And Insect Bites
Animal And Insect Bites
 
Dengue and chikungunya in Children
Dengue and chikungunya in ChildrenDengue and chikungunya in Children
Dengue and chikungunya in Children
 
Uveitis: Workup and Management
Uveitis: Workup and ManagementUveitis: Workup and Management
Uveitis: Workup and Management
 
Michael rose on anaphylaxis
Michael rose on anaphylaxisMichael rose on anaphylaxis
Michael rose on anaphylaxis
 
Empiric antibiotic management for major infections
Empiric antibiotic management for major infectionsEmpiric antibiotic management for major infections
Empiric antibiotic management for major infections
 
Dengue
DengueDengue
Dengue
 
Empiric Antibiotic Management for Major Infections at MSKCC
Empiric Antibiotic Management for Major Infections at MSKCCEmpiric Antibiotic Management for Major Infections at MSKCC
Empiric Antibiotic Management for Major Infections at MSKCC
 
2. fever with rash
2. fever with rash2. fever with rash
2. fever with rash
 
Monkeypox Facts 2022.pdf
Monkeypox Facts 2022.pdfMonkeypox Facts 2022.pdf
Monkeypox Facts 2022.pdf
 
Hand infection - An often ignored problem
Hand infection - An often ignored problemHand infection - An often ignored problem
Hand infection - An often ignored problem
 
Epidemiology, Disease and Preventive Strategies of Rabies
Epidemiology, Disease and Preventive Strategies of RabiesEpidemiology, Disease and Preventive Strategies of Rabies
Epidemiology, Disease and Preventive Strategies of Rabies
 
Viral food born infections
Viral food born infectionsViral food born infections
Viral food born infections
 

More from Arnaud Depil-Duval

Intelligence artificielle et soin.pptx
Intelligence artificielle et soin.pptxIntelligence artificielle et soin.pptx
Intelligence artificielle et soin.pptxArnaud Depil-Duval
 
Innovations et impact sur notre pratique de soins
Innovations et impact sur notre pratique de soinsInnovations et impact sur notre pratique de soins
Innovations et impact sur notre pratique de soinsArnaud Depil-Duval
 
Digital medical-hub-aphp-patient-numerique
Digital medical-hub-aphp-patient-numeriqueDigital medical-hub-aphp-patient-numerique
Digital medical-hub-aphp-patient-numeriqueArnaud Depil-Duval
 
Optimiser son temps de travail et pourquoi pas la sieste
Optimiser son temps de travail et pourquoi pas la siesteOptimiser son temps de travail et pourquoi pas la sieste
Optimiser son temps de travail et pourquoi pas la siesteArnaud Depil-Duval
 
Tele enseignement en medecine generale
Tele enseignement en medecine generaleTele enseignement en medecine generale
Tele enseignement en medecine generaleArnaud Depil-Duval
 
Le cabinet médical numérique
Le cabinet médical numériqueLe cabinet médical numérique
Le cabinet médical numériqueArnaud Depil-Duval
 
Souffrance des soignants sfetd
Souffrance des soignants sfetdSouffrance des soignants sfetd
Souffrance des soignants sfetdArnaud Depil-Duval
 
Les nouvelles technologies contre la douleur
Les nouvelles technologies contre la douleurLes nouvelles technologies contre la douleur
Les nouvelles technologies contre la douleurArnaud Depil-Duval
 
Alcool et chute des personnes âgées aux urgences
Alcool et chute des personnes âgées aux urgencesAlcool et chute des personnes âgées aux urgences
Alcool et chute des personnes âgées aux urgencesArnaud Depil-Duval
 
Nouvelles technologie et urgences SUdF
Nouvelles technologie et urgences SUdFNouvelles technologie et urgences SUdF
Nouvelles technologie et urgences SUdFArnaud Depil-Duval
 
Easy antalgie 2019 opioides en pediatrie
Easy antalgie 2019 opioides en pediatrieEasy antalgie 2019 opioides en pediatrie
Easy antalgie 2019 opioides en pediatrieArnaud Depil-Duval
 

More from Arnaud Depil-Duval (20)

Intelligence artificielle et soin.pptx
Intelligence artificielle et soin.pptxIntelligence artificielle et soin.pptx
Intelligence artificielle et soin.pptx
 
Justified antalgiques.pptx
Justified antalgiques.pptxJustified antalgiques.pptx
Justified antalgiques.pptx
 
Justified IPP.pptx
Justified IPP.pptxJustified IPP.pptx
Justified IPP.pptx
 
Urgences du futur ghpsj
Urgences du futur ghpsjUrgences du futur ghpsj
Urgences du futur ghpsj
 
Innovations et impact sur notre pratique de soins
Innovations et impact sur notre pratique de soinsInnovations et impact sur notre pratique de soins
Innovations et impact sur notre pratique de soins
 
Digital medical-hub-aphp-patient-numerique
Digital medical-hub-aphp-patient-numeriqueDigital medical-hub-aphp-patient-numerique
Digital medical-hub-aphp-patient-numerique
 
Optimiser son temps de travail et pourquoi pas la sieste
Optimiser son temps de travail et pourquoi pas la siesteOptimiser son temps de travail et pourquoi pas la sieste
Optimiser son temps de travail et pourquoi pas la sieste
 
Les urgences du futur
Les urgences du futurLes urgences du futur
Les urgences du futur
 
Tele enseignement en medecine generale
Tele enseignement en medecine generaleTele enseignement en medecine generale
Tele enseignement en medecine generale
 
Le cabinet médical numérique
Le cabinet médical numériqueLe cabinet médical numérique
Le cabinet médical numérique
 
La tele sante en pratique
La tele sante en pratiqueLa tele sante en pratique
La tele sante en pratique
 
Souffrance des soignants sfetd
Souffrance des soignants sfetdSouffrance des soignants sfetd
Souffrance des soignants sfetd
 
Led project certdc
Led project certdcLed project certdc
Led project certdc
 
ESCale news
ESCale newsESCale news
ESCale news
 
Les nouvelles technologies contre la douleur
Les nouvelles technologies contre la douleurLes nouvelles technologies contre la douleur
Les nouvelles technologies contre la douleur
 
Revascularisation sca sfmu
Revascularisation sca sfmuRevascularisation sca sfmu
Revascularisation sca sfmu
 
Alcool et chute des personnes âgées aux urgences
Alcool et chute des personnes âgées aux urgencesAlcool et chute des personnes âgées aux urgences
Alcool et chute des personnes âgées aux urgences
 
Nouvelles technologie et urgences SUdF
Nouvelles technologie et urgences SUdFNouvelles technologie et urgences SUdF
Nouvelles technologie et urgences SUdF
 
Guide du sommeil GPM
Guide du sommeil GPMGuide du sommeil GPM
Guide du sommeil GPM
 
Easy antalgie 2019 opioides en pediatrie
Easy antalgie 2019 opioides en pediatrieEasy antalgie 2019 opioides en pediatrie
Easy antalgie 2019 opioides en pediatrie
 

Recently uploaded

VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...JRRolfNeuqelet
 
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019Akash Agnihotri
 
Gait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis usersGait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis usersJoe Antony
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsNaveen Gokul Dr
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaNehamehta128467
 
How to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialHow to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialSherrylee83
 
Sell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stockSell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stocktammysayles9
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...Ayman Seddik
 
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341Sherrylee83
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?bkling
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxpalsonia139
 
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATROROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATROKanhu Charan
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifierNidhi Joshi
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenRaju678948
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptxclaviclebrown44
 
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxIs Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxSamar Tharwat
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Health Kinesiology Natural Bioenergetics
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...marcuskenyatta275
 

Recently uploaded (20)

VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
 
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
NDCT Rules, 2019: An Overview | New Drugs and Clinical Trial Rules 2019
 
Gait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis usersGait deviations in Transtibial prosthesis users
Gait deviations in Transtibial prosthesis users
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
 
DR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in IndiaDR. Neha Mehta Best Psychologist.in India
DR. Neha Mehta Best Psychologist.in India
 
How to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw materialHow to buy 5cladba precursor raw 5cl-adb-a raw material
How to buy 5cladba precursor raw 5cl-adb-a raw material
 
Sell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stockSell 5cladba adbb JWH-018 5FADB in stock
Sell 5cladba adbb JWH-018 5FADB in stock
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
 
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?
 
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait CityIn Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
In Kuwait Abortion pills (+918133066128)@Safe abortion pills in Kuwait City
 
Sonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptxSonia Journal club presentation (2).pptx
Sonia Journal club presentation (2).pptx
 
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATROROSE  CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
ROSE CASE SPINAL SBRT BY DR KANHU CHARAN PATRO
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifier
 
Video capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in childrenVideo capsule endoscopy (VCE ) in children
Video capsule endoscopy (VCE ) in children
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
 
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxIs Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
 
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
Unlocking Holistic Wellness: Addressing Depression, Mental Well-Being, and St...
 
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
TEST BANK for The Nursing Assistant Acute, Subacute, and Long-Term Care, 6th ...
 

Acute & Traumatics wounds - Infectious risk

  • 1. Basic principles of acute and traumatic wounds care Dr Arnaud DEPIL DUVAL Chef de service – Urgences Evreux - Vernon
  • 2. Mylan makes no claim or warranty of, and is not responsible for, any medical, scientific or other information that may be disseminated through this presentation
  • 3. Dr Arnaud Depil Duval - Urgences Evreux Vernon
  • 4. Infectious risk Dr Arnaud Depil Duval - Urgences Evreux Vernon
  • 5. Risk? • Each wound is colonized • But not infected
  • 6. Protection • Don’t bring more germs • Use protective equipments • Clean but not sterile • Don’t forget the mask (especially doctors…)
  • 7. Cleaning and detersion • Abundant washing for fragments, germs, etc • Soaking is not indicated • Kamolz LP, Wild T. Wound bed preparation: The impact of debridement and wound cleansing. Wound med 2013; 1:44-50 • No evidence of superiority of saline solution compared to controlled tap water • Fernandez R, Griffiths R. Water for wounds cleansing. Cochrane Database Syst Rev 2012; 2:cd003861
  • 8. Antisepsis • No benefits with antisepsis • Khan MN, Naqvi AH (2006) Antiseptics, iodine, povidone iodine and traumatic wound cleansing. J Tissue Viability 16:6–10 • Ghafouri HB, Zare M, Bazrafshan A, Abazarian N, Ramim T. Randomized controlled trial of povidoneiodine to reduce simple traumatic wound infections in the emergency department. Injury 2016; 47:1913-8 • Antisepsis only required for pre-incision • Evidence-based richtlijn voor de behandeling van wonden met een acute etiologie in de ketenzorg
  • 9. Water is better • Sterile water not superior to tap water • Fernandez R, Griffiths R. Water for wounds cleansing. Cochrane Database Syst Rev 2012; 2:cd003861 • Moscati RM, Mayrose J, Reardon RF, Janicke DM, Jehle DV. A multicenter comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med 2007; 14:404-9. • With soap • Instead after suture…
  • 10. Waiting for exploration • Maintained in a humid environment with a compress soaked in water • Economic excision and as complete as possible of contused tissues, dead or doomed to necrosis as well as the evacuation of foreign bodies • Under local or regional anesthesia Dr Arnaud Depil Duval - Urgences Evreux Vernon
  • 11. Suture • No demonstrated association between closure time and risk of infection • Quinn JV, Polevoi SK, Kohn MA. Traumatic lacerations: what are the risks for infection and has the 'golden period' of laceration care disappeared? Emerg Med J 2014; 31:96-100 • Head up to 24h • Berk WA, Osbourne DD, Taylor DD. Evaluation of the 'golden period' for wound repair: 204 cases from a Third World emergency department. Ann Emerg Med 1988; 17:496-500 • Control after 48h
  • 12. Antibiotherapy • No skin specimen • No indication for local antibiotic therapy • Antibiotherapy to evaluate only if: • Clinical signs of regional or systemic infection • Late management (beyond 24 hours) • Important or deep bacterial inoculum • Difficulty of access to effective washing • Particular location • Risk about medical status of patient • Unsatisfactory trimming • Systematic if bite
  • 13. Antibiotherapy Absence of local or general infectious signs Heavily soiled wound Amoxicillin + clavulanic acid 1 g / 8 hours per os If penicillin allergy Pristinamycin 1 g / 8 hrs PO Or Clindamycin 600 mg / 8 hr Or Cotrimoxazole 800 mg / 160 mg / 12 hrs PO 5 days Local ischemic terrain Other situations No antibiotics Presence of local inflammatory signs Erythema / induration peri-lesional <5 cm even in the presence of pus AND no general sign No antibiotic therapy EXCEPT local ischemic terrain : antibiotherapy Erythema / induration peri-lesional> 5 cm or lymphangite or general signs Absence of gravity Antibiotherapy 7 days Presence of severity criteria local (crepitus, necrosis) or general Immediate hospitalization and urgent surgical opinion and infectiologist
  • 14. Bites
  • 15. Bites • 30 to 50% infections • <12h : Pasteurella multocida
  • 16. Germs Dr Arnaud Depil Duval - Urgences Evreux Vernon Source Germs Diseases / incubation times Dog and cat Pasteurella multocida Aerobic bacteria (streptocoques, Staphylococcus aureus, Caonocytophaga canimorsus, Eikenella corrodens) and anaerobia (Prevotella, Fusobacterium, Veillonella, Peptostreptococcus), Bartonella henselae (only cat), Rhabdovirus Pasteurellosis / <24 h Pyogenic infections / 2 days Disease of cat's claws / 3 to 15 days Rage / 15 to 90 days (or even years) Rat and other rodents Pasteurella multocida Streptobacillus moniliformis Spirillum minus Leptospira Pasteurellosis / <24 h Streptobacillary sodoku leptospirosis Human Aerobic bacteria (streptocoques, Staphylococcus aureus, Caonocytophaga canimorsus, Eikenella corrodens) and anaerobia (Prevotella, Fusobacterium, Veillonella, Peptostreptococcus) Pyogenic infections / 2 days HIV infections, HCV, HBV
  • 17. Animal bites (mammalians) • If less accessible to abundant washing • Left open • Drained by a greasy dressing for a secondary closure (j4-j5) • If absence of infectious sign • In other cases, suture possible, with follow-up in the first days Dr Arnaud Depil Duval - Urgences Evreux Vernon
  • 18. Antibiotherapy animal bites (mammalians) Absence of local or general infectious signs Absence of local or general infectious signs Amoxicillin + clavulanic acid 1 g / 8 hours per os If penicillin allergy : Doxycycline 100 mg / 12 hrs PO If contraindicated cyclines AND penicillin allergy : Pristinamycin 1 g / 8 hrs PO Or Clindamycin 600 mg / 8 hr Or Cotrimoxazole 800 mg / 160 mg / 12 hrs PO 5 days Presence of local inflammatory signs 5 days and more
  • 20. Tetanos Quick Test Tetanos quick test only if non-up-to-date vaccination AND wound with tetanos risk
  • 21. Tetanos, rage and virus Dr Arnaud Depil Duval - Urgences Evreux Vernon Type of wound vaccinations up to date vaccinations non up to date Minor, clean No injection Specify the date of the next reminder Immediate administration of a vaccine dose (0.5 mL intramuscular or deep subcutaneous) containing tetanus valence. Propose if necessary an update program and specify the date of the next reminder Major (extended, penetrating, with foreign body or treated late) or likely to have been contaminated by telluric germs No injection Specify the date of the next reminder In one arm, human tetanus immunoglobulin, 250 IU. In the thigh for children <3 years or <15 kg In the other arm, administering a dose of anti-tetanus vaccine (or prescription) Propose if necessary an update program and specify the date of the next reminder
  • 22. Take home messages • Don’t need sterile gloves only clean • Tap water is better • No demonstrated association between closure time and risk of infection • Indications for antibiotics • Don’t forget tetanus vaccination