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Wound management

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Wound management

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Wound management

  1. 1. Wound Management in the ED James Pocock
  2. 2. Topics for this Session  Assessment of Wounds in ED  Types of Wound Closure  Sutures  Suture Techniques  Staples  Steristrips  Adhesive Glue  Wound Dressing
  3. 3. Lacerations and Wounds in the ED  Common  Most common in young men  Sites  Head & Neck- 50%  Upper limbs- 35%  1.1-12% risk of infection in all wounds presenting to ED
  4. 4. Lacerations and Wounds in the ED  Concerns for Patient  Functional outcome  Cosmesis  Least painful repair  Avoiding infection
  5. 5. Initial Assessment of Wounds in ED  Stabilisation  History  Host factors  Allergies  Tetanus  Time since injury  ‘Golden Period’  Examination  Distal neurovascular status  Functional status of surrounding structures  Foreign Bodies
  6. 6. ED Management  Anaesthesia  Local  Topical  Regional  Irrigation  ~100ml per 1cm  Debridement
  7. 7. Wound Closure Methods
  8. 8. Staples  Fast  Low wound reactivity  Low rates of infection  Use on scalp, trunk  Avoid in areas where cosmesis is important
  9. 9. Tissue Adhesive Glue  Simple lacerations with minimal tension  <3cm in length  Fast  Less painful than sutures  Needs to be dry skin  Hold wound for 30s  Comparable to 5-0 suture
  10. 10. Steri-Strips  Least reactive of all wound closure methods  Need clean wound  Oppose slightly separated wound edges  Minimal tensile strength  Placed perpendicularly across the wound  2-4mm between each strip  Must be kept dry and
  11. 11. Sutures  Variety of materials, sizes available  Absorbable leads to increased reactivity  Natural fibres more reactive than synthetic  Avoid silk in ED  Monofilament vs multifilament  Absorbable suture uses:  Deep dermal- degrade in ~60 days  Mucosal  Unlikely to seek follow up  Suture size should be smallest to resist the wound’s tension
  12. 12. Suture Sizes by Region
  13. 13. Suture Removal Times
  14. 14. Delayed Primary Closure  Uses  Heavily contaminated wounds  Delayed presentation  Concerns about infection  Decreases infection rate by ~50%  Technique  Clean & Debride  Fine mesh dressing  Large gauze dressing  Review in 3-4 days
  15. 15. Suture Types
  16. 16. Suture Types at SCGH  Surgipro  Synthetic  Unbraided  Sizes from 3-0 to 6-0  Most commonly used suture at SCGH
  17. 17. Suture Types at SCGH  Vicryl Rapide  Synthetic  Braided  Sizes 4-0 & 5-0 in ED  Uses:  Mucosal injuries  Deep dermal sutures  If patient is unlikely to engage in follow up
  18. 18. Suture Types at SCGH  Cat Gut  6-0  Absorbable, natural  Used for nail bed lacerations  Braided Silk  Securing CVC, ICDs, etc  Not used for wound closure
  19. 19. Suture Techniques
  20. 20. Suture Techniques  Simple interrupted
  21. 21. Suture Techniques  Deep Dermal Suture
  22. 22. Suture Techniques  Vertical Mattress  Useful in areas of high tension (e.g. shin)  Can lead to ischaemia around wound edges
  23. 23. Dressings in ED
  24. 24. Dressings at SCGH  Large number of dressings available in ED  When working out what dressing, think about intention
  25. 25. Burns- simple!
  26. 26. Burns Management  Acticoat  Silver coated  Prevent infection  Uses:  Burns  Needs activation with sterile water
  27. 27. Wound Management  Intrasite  Hydrogel-impregnated  Uses:  Slow healing/ necrotic wounds  Lifts aware slough, necrotic tissue and eschar  Allows granulation tissue to form  Burns
  28. 28. Active Bleeding  Major bleeds  Consider direct or indirect pressure  ?Tourniquet  Ligature of the vessel if collateral available  Ongoing ooze  Alginate or Kaltostat  Seaweed based  Promote haemostasis and form a gel  Consider Jelonet as further barrier  Compression gauze
  29. 29. Wound Management  Mepilex/ Mepilex Border  Silicone based  Uses:  Secondary closure  E.g ulcers, pressure injuries  Skin tears  Thick abrasions  Mepitel  Tacky  Useful in skin tears
  30. 30. References  Jamie Bawden, SCGH ED ANP  www.lacerationrepair.com  https://lifeinthefastlane.com/own-the-wound/  https://hqmeded.com/wound-care-ed/  Wound Care: Modern Evidence in the Treatment of Man’s Age-Old Injuries; Emergency Medicine Practice; March 2005; 7(3)  https://www.rch.org.au/clinicalguide/guideline_index/Lacerations/  https://coreem.net/core/suture-materials/

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