cerebral concussion assessment

2. COURSE CODE 506
DR. SIDdiqa qamar
(fall 2022)
REFERENCE TEXT:
WoundCare Essentials, practice principles
By
Sharon Baranoski & Elizabeth A Ayello

3. Wound treatment
options
INTEGUMENTERY PHYSICAL THERAPY

4. Moist wound healing
wound healing must take place in a moist environment. Epithelial
cells require moisture to migrate from the wound edges to re-
epithelialize or close the wound. This process is likened to “leap-
frogging” of the cells. In a dry wound, these cells have to burrow
down underneath the wound bed to find a moist area upon
which to “march” or move forward.

5.  wound dressings were primarily used to protect the wound from secondary
infection by forming a barrier against bacteria and absorbing wound fluid
The most commonly used dressing for all types of wounds was
1. dry gauze
2. No dressing (that is, an uncovered wound) was the second most common
3. and saline-moistened gauze was third.
 Wound treatment decisions must be patient centered.

6. Clinician competencies for dressing
selection
Conduct a thorough wound assessment to identify wound
characteristics and treatment options.
1. Know the principles of wound care.
2. Be able to differentiate among the different types of
dressings.
3. Know the characteristics of an ideal dressing.
4. Consider the patient's health care coverage, financial abilities,
and access to appropriate products.
Take advantage of conferences, seminars, and self-study
opportunities to keep abreast of the latest treatment techniques
and products.

7. The case against gauze dressings
 A gauze dressing can impair wound healing because it lowers the wound temperature
and impedes fluid evaporation.
 Wet-to-dry gauze dressings are a nonselective mechanical debridement method.
Removal of healthy tissue causes injury to the wound and pain.
 Clinical studies have shown higher infection rates in wounds for which gauze dressings
were used compared to wounds dressed with transparent films or hydrocolloids.
 Changing a dressing more than once per day isn't always effective for patient outcomes.
 Research has shown that bacteria are released into the air when gauze dressings (wet
or dry) are removed from the wound.
 Semiocclusive dressings are more financially feasible from a total cost perspective

8. Treatment decisions
Why are gauze dressings still
used?
1. Gauze dressings have a long tradition in wound
care
2. Gauze is perceived as being inexpensive
3. Most advanced dressings are of discrete
dimensions and can't always be adjusted for
wounds of different sizes, requiring health care
facilities to stock multiple sizes. Gauze, on the
other hand, is easily tailored to fit the wound.

9. Treatment decisions
 Many practitioners are unaware of the broad array
of alternative dressing products available and the
way they work. The variations in appearance and
performance of new types of dressings may initially
confuse the health care provider

10. Principles of care: The MEASURES
 Minimize trauma to wound bed
 Eliminate dead space (tunnels, tracts, undermining)
 Assess and manage the amount of exudate
 Support the body's tissue defense system
 Use non-toxic wound cleansers
 Remove infection, debris, and necrotic tissue
 Environment maintenance, including thermal insulation
and a moist wound bed
 Surrounding tissue, protect from injury and bacterial
invasion

11. GOALS
Treatment goals may aim to achieve a
1. clean wound,
2. heal the wound,
3. maintain a clean wound bed.
 goal of care then becomes using the right product
on the right wound at the right time

12. Characteristics of an ideal dressing
The ideal dressing should:
 maintain a moist environment
 facilitate autolytic debridement
 comfortable for the range of use needed (such as to
fill tunneling, undermining, or sinus tracts to
eliminate dead space)
 come in numerous shapes and sizes

13. Characteristics of an ideal
dressing
 be absorbent
 provide thermal insulation
 act as a bacterial barrier
 reduce or eliminate pain at the wound
site and not cause pain on dressing
removal

14. The following considerations can
be used to evaluate the dressing
 number of days the dressing can remain in place
 reason for change or removal
 appearance of dressing (soiled or intact)
 ease of dressing application
 ease of dressing removal
 ease of dressing maintenance
 ease of teaching about dressing to caregiver

15. NICE© for dressing decision making
 Is there any Necrotic tissue that needs to be debrided?
(Make sure the wound has the ability to heal; if not, however, moist interactive
dressings and active surgical debridement to bleeding tissue are contraindicated.)
 Is the wound Infected or inflamed?
 Do the specific wound Characteristics, such as location, need to be considered? (If
the wound is around the anus, a waterproof adhesive dressing may be preferred.)
 Is there any Exudate; if so, why, how much, and what is the color and consistency?

16. Using wound healing biology to select
treatment
use of growth factors.
 Growth factors are now available either derived from a
patient's own platelets or in a drug form dispensed in a tube
to apply to diabetic wounds.
 Yet another way technology is providing new options for
wound management is in the use of tissue-engineered skin
equivalents for healing chronic wound.

17. Major dressing categories
Transparent film dressings
 Thin polyurethane membranes
 They are coated with an adhesive that allows them to adhere to the wound
margins without sticking to the actual wound
 Transparent films have no absorptive capacity but do transmit moisture vapor and
are semipermeable to gases.
 These dressings imitate the outer skin layer to provide a moist environment.
 This covering allows epithelial cells to migrate over the surface of the wound.
Fluid may accumulate under these dressings. This fluid is sometimes mistaken for
pus, a sign of infection

19. Transparent film dressings
 The fluid create an autolytic environment, thereby inducing a
cleaner wound surface. When excess fluid accumulates or
leaks out from the sides of the dressing, it needs to be
changed. Maceration of periwound skin can occur if not
changed in a timely manner.
 Transparent films also provide protection from friction and aid
in autolytic debridement and pain control.

20. Transparent film dressings
Transparent films can be used on a variety of wound types, such as
 stages I and II pressure ulcers,
 superficial wounds,
 minor burns,
 lacerations;
 over sutures,
 catheter sites,
 donor sites, and
 superficial dermal ulcers;
 and for protection of the skin against friction.

21. Practice essentials
 Apply transparent film dressings to healthy skin; use with caution on aging and fragile
skin. These dressings aren't recommended for infants and small children.
 These dressings may be used on dry to minimally moist wounds.
 Don't use transparent film dressings on exudating wounds.
 Transparent film dressings make excellent secondary dressings.
 Not all film dressings can be used on infected wounds.
 Change the dressing when fluid reaches the edge of the dressing, when the seal is
broken, or as needed

22. Practice essentials
 When removing the dressing, lift the corner and pull the film
toward the outside of the wound to break the adhesive
barrier.
 Avoid roughness when pulling the film off; gently stretch the
dressing and support the skin as you're removing the dressing.
 Skin protective wipes and sprays can be used on the
periwound area before applying the dressing. Skin wipes also
provide an additional seal to prevent the dressing edges from
rolling

23. Hydrocolloid dressings
 New wafer-shaped dressings
 Hydrocolloids are impermeable to gases and water vapor.
 Hydrophilic particles within the dressing react with the wound fluid to form a soft
gel over the wound bed
 some hydrocolloid dressings provide an acidic environment and some act as a
bacterial or viral barrier.
 Their translucent appearance allows for viewing of the amount of exudate
absorbed and fluid accumulation under the dressing

25.  noticeable odor
 Correct application requires the dressing to be bigger then the actual wound
size
 Dressing change could be from 3 to 7 days
 Hydrocolloids are indicated for minimally to moderately heavy exudating
wounds, abrasions, skin tears, lacerations, pressure ulcers, dermal wounds,
granular, or necrotic wounds and under compression wraps.
 provide a moist environment conducive to autolytic debridement.

26. Practice essentials
 Change the dressing every 3 to 7 days
 Not all hydrocolloid dressings can be used on infected wounds.
 These dressings aren't recommended for undermining, tunnels, or sinus tracts.
 Hydrocolloid dressings may be cut to fit the wound area, such as on an elbow or
heel.

27.  These dressings may be used as primary or secondary
dressings or over other wound filler products.
 Remove the dressing by starting at a corner and gently
rolling it off the wound; don't pull to remove.
 Flush out any residue with saline.
 Skin protective wipes or sprays may be used on the
periwound area to enhance adherence

28. Hydrogel dressings
 Hydrogel dressings means to hydrate dry wound beds.
 They entraps water and reduces the temperature of the
wound bed by up to 5° C. This moist environment
facilitates autolysis and removal of devitalized tissue.

30. Hydrogel dressings
The main application for hydrogels is hydrating dry wound beds and softening and
loosening slough and necrotic wound debris.
They can be used for many types of wounds, including
 pressure ulcers,
 partial- and full-thickness wounds,
 and vascular ulcers.
The soothing and cooling properties also make them excellent choices for use in skin tears,,
dermal wounds, donor sites, and radiation burns.

31. Hydrogel dressings
 One of the benefits of a hydrogel is the ability to be
used with topical medications or antibacterial agents.
 Hydrogels are packaged as sheets, tube gels, sprays, and
impregnated gauze pads or strips for packing tunneling
and undermined areas within the wound bed.

32. Practice essentials
 Don't use hydrogels with heavily draining wounds or on intact skin.
 Daily dressing changes may be necessary
 Some sheet hydrogels may last for several days.
 Protect the surrounding skin with a skin barrier ointment, wipe, or spray.

33. Foam dressings
 Foam dressings are permeable to both gases and water vapor,
and their hydrophilic properties allow for absorption of exudate
into the layers of the foam

34. They are indicated for wounds
 with moderate to heavy exudate,
 prophylactic protection over bony prominences or friction areas,
 partial- and full-thickness wounds,
 granular or necrotic wound beds,
 skin tears, donor sites,
 under compression wraps,surgical or dermal wounds
 They can also be used on infected wounds, if changed daily.

35.  Foams shouldn't be used on dry eschar. Foams may be used in combination with
topical treatments and or enzymatic debriders.
 Foams are available in many sizes and shapes, and as cavity (pillow type) dressings.
Many foams don't have an adhesive border, so they'll need to be secured with
tape. Caution with fragile skin may be warranted

36. Practice essentials
 Foam dressings can be left in place for up to 7 days, depending on the amount of
exudate absorption.
 Removal of these dressings is trauma-free.
 Foam dressings can be cut to fit the size of the wound.
 Skin wipes or sprays can be used to protect the periwound area from maceration.
 Nonadhesive border dressings will require taping or wraps to secure.
 Make sure you put the correct side of the foam dressing in contact with the wound
bed.

38. Calcium alginate dressings
 Calcium alginate dressings, highly exudative
wounds.
 Alginate dressings are absorbent, nonadherent,
biodegradable, nonwoven fibers derived from
brown seaweed.

39.  When alginate dressings come in contact with sodium-rich solutions such as
wound drainage, the calcium ions undergo an exchange for the sodium ions,
forming a soluble sodium alginate gel. This gel maintains a moist wound bed
and supports a therapeutic healing environment.
 Alginates can absorb 20 times their weight
 They are extremely beneficial in managing large draining cavity wounds,
pressure ulcers, vascular ulcers, surgical incisions, wound dehiscence, tunnels,
sinus tracts, skin graft donor sites, exposed tendons, and infected wounds.
useful on bleeding wounds.
 .

40.  They are usually changed daily or as indicated
by the amount of drainage.
 Alginates are contraindicated for dry
wounds, eschar covered wounds, surgical
implantation, or on third-degree burns

41. Practice essentials
 Calcium alginate dressings provide easy application and trauma-free removal.
 These dressings are a good choice for undermined or tunneled, draining wounds.
 These dressings require a secondary dressing.
 These dressings may leave fiber residue, which may be flushed with saline to
remove.
 Calcium alginate dressings facilitate autolytic debridement.
 These dressings are cost-effective if used appropriately.