SlideShare a Scribd company logo
Wound Management in
the ED
James Pocock
Topics for this Session
 Assessment of Wounds in ED
 Types of Wound Closure
 Sutures
 Suture Techniques
 Staples
 Steristrips
 Adhesive Glue
 Wound Dressing
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
Lacerations and Wounds in the ED
 Concerns for Patient
 Functional outcome
 Cosmesis
 Least painful repair
 Avoiding infection
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
ED Management
 Anaesthesia
 Local
 Topical
 Regional
 Irrigation
 ~100ml per 1cm
 Debridement
Wound Closure Methods
Staples
 Fast
 Low wound reactivity
 Low rates of infection
 Use on scalp, trunk
 Avoid in areas where cosmesis is important
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
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
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
Suture Sizes by Region
Suture Removal Times
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
Suture Types
Suture Types at SCGH
 Surgipro
 Synthetic
 Unbraided
 Sizes from 3-0 to 6-0
 Most commonly used suture at SCGH
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
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
Suture Techniques
Suture Techniques
 Simple interrupted
Suture Techniques
 Deep Dermal Suture
Suture Techniques
 Vertical Mattress
 Useful in areas of high tension (e.g. shin)
 Can lead to ischaemia around wound edges
Dressings in ED
Dressings at SCGH
 Large number of dressings available in ED
 When working out what dressing, think about intention
Burns- simple!
Burns Management
 Acticoat
 Silver coated
 Prevent infection
 Uses:
 Burns
 Needs activation with sterile water
Wound Management
 Intrasite
 Hydrogel-impregnated
 Uses:
 Slow healing/ necrotic wounds
 Lifts aware slough, necrotic tissue and eschar
 Allows granulation tissue to form
 Burns
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
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
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/

More Related Content

What's hot

WOUND CARE
WOUND CAREWOUND CARE
Skin wounds. Classification
Skin wounds. ClassificationSkin wounds. Classification
Skin wounds. Classification
Eneutron
 
Wound healing and care presentation
Wound healing and care presentationWound healing and care presentation
Wound healing and care presentationpayneje
 
Classification of wounds
Classification of  woundsClassification of  wounds
Classification of wounds
Zamari
 
Basic surgical skills
Basic surgical skills Basic surgical skills
Basic surgical skills
MUHAMMAD HOSSAIN
 
Wound: classification, healing and principle of management
Wound: classification, healing and principle of managementWound: classification, healing and principle of management
Wound: classification, healing and principle of management
Kenna Urgessa
 
Wound Debridement
Wound DebridementWound Debridement
Wound Debridement
Muhammadasif909
 
Emergency Wound Management
Emergency Wound Management Emergency Wound Management
Emergency Wound Management
Subhankar Paul
 
Wound care management
Wound care managementWound care management
Wound care management
Gerinorth
 
Wounds
WoundsWounds
Surgical infection
Surgical infectionSurgical infection
Surgical infection
akshayadanapal
 
Wound ppt
Wound pptWound ppt
Wound management & dressings
Wound management & dressingsWound management & dressings
Wound management & dressings
OmEr HaXhme
 
Wound
WoundWound
Wound
Atul Yadav
 
Wound dressing
Wound dressingWound dressing
Wound dressing
kibria36
 
Wound care
Wound careWound care
Wound care
Shiva Nagu
 
Principles of use and abuse of suture 1
Principles of use and abuse of suture 1Principles of use and abuse of suture 1
Principles of use and abuse of suture 1
Drkabiru2012
 
Dressing or care of wound
Dressing or care of woundDressing or care of wound
Dressing or care of wound
Mahesh Chand
 

What's hot (20)

WOUND CARE
WOUND CAREWOUND CARE
WOUND CARE
 
Lect 6 wound mangement
Lect 6  wound mangementLect 6  wound mangement
Lect 6 wound mangement
 
Skin wounds. Classification
Skin wounds. ClassificationSkin wounds. Classification
Skin wounds. Classification
 
Wound healing and care presentation
Wound healing and care presentationWound healing and care presentation
Wound healing and care presentation
 
Classification of wounds
Classification of  woundsClassification of  wounds
Classification of wounds
 
Basic surgical skills
Basic surgical skills Basic surgical skills
Basic surgical skills
 
Wound: classification, healing and principle of management
Wound: classification, healing and principle of managementWound: classification, healing and principle of management
Wound: classification, healing and principle of management
 
Wound Debridement
Wound DebridementWound Debridement
Wound Debridement
 
Emergency Wound Management
Emergency Wound Management Emergency Wound Management
Emergency Wound Management
 
Wound care management
Wound care managementWound care management
Wound care management
 
Wound management by saumya agarwal
Wound management by saumya agarwalWound management by saumya agarwal
Wound management by saumya agarwal
 
Wounds
WoundsWounds
Wounds
 
Surgical infection
Surgical infectionSurgical infection
Surgical infection
 
Wound ppt
Wound pptWound ppt
Wound ppt
 
Wound management & dressings
Wound management & dressingsWound management & dressings
Wound management & dressings
 
Wound
WoundWound
Wound
 
Wound dressing
Wound dressingWound dressing
Wound dressing
 
Wound care
Wound careWound care
Wound care
 
Principles of use and abuse of suture 1
Principles of use and abuse of suture 1Principles of use and abuse of suture 1
Principles of use and abuse of suture 1
 
Dressing or care of wound
Dressing or care of woundDressing or care of wound
Dressing or care of wound
 

Similar to Wound management

Wound care in ER. Dr Erik Adler
Wound care in ER.  Dr Erik AdlerWound care in ER.  Dr Erik Adler
Wound care in ER. Dr Erik Adlerchricres
 
Sutures.ppt
Sutures.pptSutures.ppt
Sutures.ppt
Fridahchungu
 
Procedure for suturing wounds or hecting actions - a brief medical study
Procedure for suturing wounds or hecting actions -  a brief medical study Procedure for suturing wounds or hecting actions -  a brief medical study
Procedure for suturing wounds or hecting actions - a brief medical study
martinshaji
 
Basic Principles In The Management Of Soft Tissue Injuries of the Face
Basic Principles In The Management Of Soft Tissue Injuries of the FaceBasic Principles In The Management Of Soft Tissue Injuries of the Face
Basic Principles In The Management Of Soft Tissue Injuries of the Face
DJ CrissCross
 
Basic Principles In The Management Of Soft Tissue
Basic Principles In The Management Of Soft TissueBasic Principles In The Management Of Soft Tissue
Basic Principles In The Management Of Soft Tissue
guest91a22d
 
Suture, needle and knots
Suture, needle and knotsSuture, needle and knots
Suture, needle and knots
nuruladrianaazhari
 
Agnesian HealthCare Know & Go Showcase: Cutera Genesis Plus Laser
Agnesian HealthCare Know & Go Showcase: Cutera Genesis Plus LaserAgnesian HealthCare Know & Go Showcase: Cutera Genesis Plus Laser
Agnesian HealthCare Know & Go Showcase: Cutera Genesis Plus Laser
Agnesian HealthCare
 
Suture material & suturing technique
Suture material & suturing techniqueSuture material & suturing technique
Suture material & suturing technique
Abdelrhman Alaa Nosair
 
Basic skills in medicine
Basic skills in medicineBasic skills in medicine
Wound_Healing_and_Suture_Knowledge-Kim_Bayer.ppt
Wound_Healing_and_Suture_Knowledge-Kim_Bayer.pptWound_Healing_and_Suture_Knowledge-Kim_Bayer.ppt
Wound_Healing_and_Suture_Knowledge-Kim_Bayer.ppt
ssuser4d6bbb1
 
Wound Healing and Suture Knowledge-Kim_Bayer.ppt
Wound Healing and Suture Knowledge-Kim_Bayer.pptWound Healing and Suture Knowledge-Kim_Bayer.ppt
Wound Healing and Suture Knowledge-Kim_Bayer.ppt
PuiteaChhangte
 
Skin Grafting.pptx
Skin Grafting.pptxSkin Grafting.pptx
Skin Grafting.pptx
ShakilAhmed292984
 
Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...
Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...
Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...
Indian dental academy
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
College of Medicine, Sulaymaniyah
 
Dressing Surgical Wounds, Abrasion and Lacerations
Dressing Surgical Wounds, Abrasion and LacerationsDressing Surgical Wounds, Abrasion and Lacerations
Dressing Surgical Wounds, Abrasion and Lacerations
Gianne Gregorio
 
Burn wound management
Burn wound managementBurn wound management
Burn wound management
Aravind Endamu
 
Wound_Management.pptx
Wound_Management.pptxWound_Management.pptx
Wound_Management.pptx
FBTutorials
 
Wound healing
Wound healingWound healing
Wound healing
Vijyalaxmi Makwana
 
Current Management of Acute Cutaneous Wounds
Current Management of Acute Cutaneous WoundsCurrent Management of Acute Cutaneous Wounds
Current Management of Acute Cutaneous Wounds
Sun Yai-Cheng
 
Cauterization
CauterizationCauterization
Cauterization
mahrukhRajput
 

Similar to Wound management (20)

Wound care in ER. Dr Erik Adler
Wound care in ER.  Dr Erik AdlerWound care in ER.  Dr Erik Adler
Wound care in ER. Dr Erik Adler
 
Sutures.ppt
Sutures.pptSutures.ppt
Sutures.ppt
 
Procedure for suturing wounds or hecting actions - a brief medical study
Procedure for suturing wounds or hecting actions -  a brief medical study Procedure for suturing wounds or hecting actions -  a brief medical study
Procedure for suturing wounds or hecting actions - a brief medical study
 
Basic Principles In The Management Of Soft Tissue Injuries of the Face
Basic Principles In The Management Of Soft Tissue Injuries of the FaceBasic Principles In The Management Of Soft Tissue Injuries of the Face
Basic Principles In The Management Of Soft Tissue Injuries of the Face
 
Basic Principles In The Management Of Soft Tissue
Basic Principles In The Management Of Soft TissueBasic Principles In The Management Of Soft Tissue
Basic Principles In The Management Of Soft Tissue
 
Suture, needle and knots
Suture, needle and knotsSuture, needle and knots
Suture, needle and knots
 
Agnesian HealthCare Know & Go Showcase: Cutera Genesis Plus Laser
Agnesian HealthCare Know & Go Showcase: Cutera Genesis Plus LaserAgnesian HealthCare Know & Go Showcase: Cutera Genesis Plus Laser
Agnesian HealthCare Know & Go Showcase: Cutera Genesis Plus Laser
 
Suture material & suturing technique
Suture material & suturing techniqueSuture material & suturing technique
Suture material & suturing technique
 
Basic skills in medicine
Basic skills in medicineBasic skills in medicine
Basic skills in medicine
 
Wound_Healing_and_Suture_Knowledge-Kim_Bayer.ppt
Wound_Healing_and_Suture_Knowledge-Kim_Bayer.pptWound_Healing_and_Suture_Knowledge-Kim_Bayer.ppt
Wound_Healing_and_Suture_Knowledge-Kim_Bayer.ppt
 
Wound Healing and Suture Knowledge-Kim_Bayer.ppt
Wound Healing and Suture Knowledge-Kim_Bayer.pptWound Healing and Suture Knowledge-Kim_Bayer.ppt
Wound Healing and Suture Knowledge-Kim_Bayer.ppt
 
Skin Grafting.pptx
Skin Grafting.pptxSkin Grafting.pptx
Skin Grafting.pptx
 
Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...
Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...
Principles of oral surgery.. (nx power lite) /certified fixed orthodontic cou...
 
Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)Surgery 6th year, Tutorial (Dr. AbdulWahid)
Surgery 6th year, Tutorial (Dr. AbdulWahid)
 
Dressing Surgical Wounds, Abrasion and Lacerations
Dressing Surgical Wounds, Abrasion and LacerationsDressing Surgical Wounds, Abrasion and Lacerations
Dressing Surgical Wounds, Abrasion and Lacerations
 
Burn wound management
Burn wound managementBurn wound management
Burn wound management
 
Wound_Management.pptx
Wound_Management.pptxWound_Management.pptx
Wound_Management.pptx
 
Wound healing
Wound healingWound healing
Wound healing
 
Current Management of Acute Cutaneous Wounds
Current Management of Acute Cutaneous WoundsCurrent Management of Acute Cutaneous Wounds
Current Management of Acute Cutaneous Wounds
 
Cauterization
CauterizationCauterization
Cauterization
 

More from SCGH ED CME

Trauma teams
Trauma teamsTrauma teams
Trauma teams
SCGH ED CME
 
Haemostatic resuscitation
Haemostatic resuscitationHaemostatic resuscitation
Haemostatic resuscitation
SCGH ED CME
 
Arthrocentesis
ArthrocentesisArthrocentesis
Arthrocentesis
SCGH ED CME
 
Ultrasound in cardiac arrest
Ultrasound in cardiac arrest Ultrasound in cardiac arrest
Ultrasound in cardiac arrest
SCGH ED CME
 
Goals of patient care introduction
Goals of patient care introductionGoals of patient care introduction
Goals of patient care introduction
SCGH ED CME
 
Physiology Directed CPR
Physiology Directed CPRPhysiology Directed CPR
Physiology Directed CPR
SCGH ED CME
 
Ultrasound confirmation of ETT placement
Ultrasound confirmation of ETT placementUltrasound confirmation of ETT placement
Ultrasound confirmation of ETT placement
SCGH ED CME
 
Palliative care in the emergency department
Palliative care in the emergency departmentPalliative care in the emergency department
Palliative care in the emergency department
SCGH ED CME
 
Wilderness crisis and decision making weekend April 2018
Wilderness crisis and decision making weekend April 2018Wilderness crisis and decision making weekend April 2018
Wilderness crisis and decision making weekend April 2018
SCGH ED CME
 
Patient confidentiality in emergency department
Patient confidentiality in emergency departmentPatient confidentiality in emergency department
Patient confidentiality in emergency department
SCGH ED CME
 
Abscess management
Abscess managementAbscess management
Abscess management
SCGH ED CME
 
Hyperthermia and hypothermia
Hyperthermia and hypothermiaHyperthermia and hypothermia
Hyperthermia and hypothermia
SCGH ED CME
 
Electrical injury
Electrical injuryElectrical injury
Electrical injury
SCGH ED CME
 
D-dimer audit
D-dimer auditD-dimer audit
D-dimer audit
SCGH ED CME
 
It's all about the documentation
It's all about the documentationIt's all about the documentation
It's all about the documentation
SCGH ED CME
 
Paediatric rashes
Paediatric rashesPaediatric rashes
Paediatric rashes
SCGH ED CME
 
Choosing Wisely - Rational Antibiotic Usage
Choosing Wisely - Rational Antibiotic UsageChoosing Wisely - Rational Antibiotic Usage
Choosing Wisely - Rational Antibiotic Usage
SCGH ED CME
 
What's Hot in Emergency Medicine June 2018
What's Hot in Emergency Medicine June 2018What's Hot in Emergency Medicine June 2018
What's Hot in Emergency Medicine June 2018
SCGH ED CME
 
Emergency ophthalmology
Emergency ophthalmologyEmergency ophthalmology
Emergency ophthalmology
SCGH ED CME
 
Code Brown - Disaster Medicine in the ED
Code Brown - Disaster Medicine in the EDCode Brown - Disaster Medicine in the ED
Code Brown - Disaster Medicine in the ED
SCGH ED CME
 

More from SCGH ED CME (20)

Trauma teams
Trauma teamsTrauma teams
Trauma teams
 
Haemostatic resuscitation
Haemostatic resuscitationHaemostatic resuscitation
Haemostatic resuscitation
 
Arthrocentesis
ArthrocentesisArthrocentesis
Arthrocentesis
 
Ultrasound in cardiac arrest
Ultrasound in cardiac arrest Ultrasound in cardiac arrest
Ultrasound in cardiac arrest
 
Goals of patient care introduction
Goals of patient care introductionGoals of patient care introduction
Goals of patient care introduction
 
Physiology Directed CPR
Physiology Directed CPRPhysiology Directed CPR
Physiology Directed CPR
 
Ultrasound confirmation of ETT placement
Ultrasound confirmation of ETT placementUltrasound confirmation of ETT placement
Ultrasound confirmation of ETT placement
 
Palliative care in the emergency department
Palliative care in the emergency departmentPalliative care in the emergency department
Palliative care in the emergency department
 
Wilderness crisis and decision making weekend April 2018
Wilderness crisis and decision making weekend April 2018Wilderness crisis and decision making weekend April 2018
Wilderness crisis and decision making weekend April 2018
 
Patient confidentiality in emergency department
Patient confidentiality in emergency departmentPatient confidentiality in emergency department
Patient confidentiality in emergency department
 
Abscess management
Abscess managementAbscess management
Abscess management
 
Hyperthermia and hypothermia
Hyperthermia and hypothermiaHyperthermia and hypothermia
Hyperthermia and hypothermia
 
Electrical injury
Electrical injuryElectrical injury
Electrical injury
 
D-dimer audit
D-dimer auditD-dimer audit
D-dimer audit
 
It's all about the documentation
It's all about the documentationIt's all about the documentation
It's all about the documentation
 
Paediatric rashes
Paediatric rashesPaediatric rashes
Paediatric rashes
 
Choosing Wisely - Rational Antibiotic Usage
Choosing Wisely - Rational Antibiotic UsageChoosing Wisely - Rational Antibiotic Usage
Choosing Wisely - Rational Antibiotic Usage
 
What's Hot in Emergency Medicine June 2018
What's Hot in Emergency Medicine June 2018What's Hot in Emergency Medicine June 2018
What's Hot in Emergency Medicine June 2018
 
Emergency ophthalmology
Emergency ophthalmologyEmergency ophthalmology
Emergency ophthalmology
 
Code Brown - Disaster Medicine in the ED
Code Brown - Disaster Medicine in the EDCode Brown - Disaster Medicine in the ED
Code Brown - Disaster Medicine in the ED
 

Recently uploaded

Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
New Drug Discovery and Development .....
New Drug Discovery and Development .....New Drug Discovery and Development .....
New Drug Discovery and Development .....
NEHA GUPTA
 
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptxHow STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
FFragrant
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
Dr. Vinay Pareek
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
sisternakatoto
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
vimalpl1234
 
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradeshBasavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Dr. Madduru Muni Haritha
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
suvadeepdas911
 
A Classical Text Review on Basavarajeeyam
A Classical Text Review on BasavarajeeyamA Classical Text Review on Basavarajeeyam
A Classical Text Review on Basavarajeeyam
Dr. Jyothirmai Paindla
 
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley LifesciencesPharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Yodley Lifesciences
 
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptxPharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
aljamhori teaching hospital
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Gram Stain introduction, principle, Procedure
Gram Stain introduction, principle, ProcedureGram Stain introduction, principle, Procedure
Gram Stain introduction, principle, Procedure
Suraj Goswami
 
Top-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptxTop-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptx
SwisschemDerma
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAdv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
AkankshaAshtankar
 

Recently uploaded (20)

Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
New Drug Discovery and Development .....
New Drug Discovery and Development .....New Drug Discovery and Development .....
New Drug Discovery and Development .....
 
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptxHow STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
 
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradeshBasavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
 
A Classical Text Review on Basavarajeeyam
A Classical Text Review on BasavarajeeyamA Classical Text Review on Basavarajeeyam
A Classical Text Review on Basavarajeeyam
 
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley LifesciencesPharma Pcd Franchise in Jharkhand - Yodley Lifesciences
Pharma Pcd Franchise in Jharkhand - Yodley Lifesciences
 
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptxPharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
 
Cervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptxCervical & Brachial Plexus By Dr. RIG.pptx
Cervical & Brachial Plexus By Dr. RIG.pptx
 
Gram Stain introduction, principle, Procedure
Gram Stain introduction, principle, ProcedureGram Stain introduction, principle, Procedure
Gram Stain introduction, principle, Procedure
 
Top-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptxTop-Vitamin-Supplement-Brands-in-India.pptx
Top-Vitamin-Supplement-Brands-in-India.pptx
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAdv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
 

Wound management

  • 1. Wound Management in the ED James Pocock
  • 2. Topics for this Session  Assessment of Wounds in ED  Types of Wound Closure  Sutures  Suture Techniques  Staples  Steristrips  Adhesive Glue  Wound Dressing
  • 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. Lacerations and Wounds in the ED  Concerns for Patient  Functional outcome  Cosmesis  Least painful repair  Avoiding infection
  • 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.
  • 7. ED Management  Anaesthesia  Local  Topical  Regional  Irrigation  ~100ml per 1cm  Debridement
  • 9. Staples  Fast  Low wound reactivity  Low rates of infection  Use on scalp, trunk  Avoid in areas where cosmesis is important
  • 10. 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
  • 11. 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
  • 12. 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
  • 13.
  • 14. Suture Sizes by Region
  • 16. 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
  • 18.
  • 19. Suture Types at SCGH  Surgipro  Synthetic  Unbraided  Sizes from 3-0 to 6-0  Most commonly used suture at SCGH
  • 20. 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
  • 21. 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
  • 24. Suture Techniques  Deep Dermal Suture
  • 25. Suture Techniques  Vertical Mattress  Useful in areas of high tension (e.g. shin)  Can lead to ischaemia around wound edges
  • 27. Dressings at SCGH  Large number of dressings available in ED  When working out what dressing, think about intention
  • 29. Burns Management  Acticoat  Silver coated  Prevent infection  Uses:  Burns  Needs activation with sterile water
  • 30. Wound Management  Intrasite  Hydrogel-impregnated  Uses:  Slow healing/ necrotic wounds  Lifts aware slough, necrotic tissue and eschar  Allows granulation tissue to form  Burns
  • 31. 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
  • 32. 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
  • 33. 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/

Editor's Notes

  1. ‘’Golden period”- 6-10 hours for extremeties 10-12 hours for scalp and face Host factors: Increasing age DM Renal failure Malnutrition Obesity Immunocompromise Prolonged time since wound
  2. Do not let glue enter wound (acts as foreign body)