Please enable JavaScript.
Coggle requires JavaScript to display documents.
Wound care (Tetanus prophylaxis (Anti-tetanus prophylaxis (Vaccination…
Wound care
Tetanus prophylaxis
-
Pathophysiology
Clostridium tetani (Gram +ve, spore forming)
Exotoxin tetanoplasmin interferes with neurotransmission
Contaminated wounds at risk
Immunisation programme
Initial course of 3 IM/SC from 2m
Boosters at 4y and 14y
Lifelong immunity
Administered as tetanus/diphtheria/polio triple vaccine
Anti-tetanus prophylaxis
Tetanus prone wounds
Heavy contamination
Devitalised tissue
Infected wounds
Wounds >6h old
Puncture wounds
Animal bites
Vaccination status
Initial course, boosters up to date but incomplete
Vaccinate if next booster due
Human anti-tetanus Ig if high risk wound
Complete initial course, boosters not up to date
Reinforcing dose, refer to GP to complete boosters
Human anti-tetanus Ig if high risk wound
-
-
-
-
Cleaning
-
Methods
Gentle wash (most wounds)
Pressurised irrigation with 19G needle (ingrained dirt)
Toothbrush scrub (wear goggles; ingrained dirt)
Debridement (gross contamination; but NOT hands/face)
-
Aftercare
Dressings
Dry, non adherent best for most wounds
Not needed for facial/scalp wounds
Review
-
Process
Check at ~3d
Wound (eythema, pain, swelling)
Regional LNs
Obs (fever)
Advice
General
Keep clean and dry for first few days
Rest and elevate limb wounds for 24h
Restrict movement to avoid stress on wound
Return if signs of infection (red, swelling, pain, fever)
Advise on when to return for removal of sutures (GP, ED)
Provide information leaflet
-
Closure
Methods
Glue
-
MOA
Secure haemostasis
Oppose skin edges and apply to dry edges
Don't allow glue into the wound
Hold edges for 1min to dry
-
-
-
Sutures
-
Types
2.0/3.0 non-absorbable - scalp
3.0 non-absorbable - trunk
4.0 non-absorbable - limbs
5.0 non-absorbable - hands
6.0 non-absorbable - face
6.0 absorbable - lips, tongue, mouth
MOA
Oppose ends with slight eversion of edges
inert monofilament sutures, size according to site
Interrupted single sutures used in ED
Mattress sutures for deep wounds
Types
Secondary
No intervention, heals by granulation
Indication: shallow wounds
-
Primary
Surgical closure ASAP after injury
Indication: fresh wounds no FB or underlying injury
CI: stab wound to trunk/neck, tendon/joint/neurovascular injury,
crush injury/tissue or skin loss; contaminated/infected; >12h old
Infected wounds
and abx
Prophylactic abx
Indication
Compound fingertip fractures
High risk patients (e.g. immunocompromised)
Penetrating injuries that cannot be fully cleaned
-
Rationale
Not needed for all, for most a thorough
clean is adequate to prevent infection
Wound infection
Specific sites
-
Surgical
Common
Reduced operative success, increased mortality
Refer to relevant surgeons
Hand
Bite wounds on dorsum over MCPJ (punch)
Often present late with infection
Surgical exploration and washout plus abx
General
-
Diagnosis
-
Examination
Wound: erythema, tender, oedema, pus, crepitus (gas formers)
Systemic: fever, LNs
Investigations
Bedside: obs (temp)
Bloods: FBC, CRP, cultures (if septic)
Swabs: wound for MCS
Imaging: X-ray if possible retained FB
Pathophysiology
Soft tissue (cellulitis, erysepelas)
Bone (osteomyelitis)
Management
Conservative
Remove sutures
Clean, remove pus and devitalised tissue under LA
Leave open, cover with dressing, review 3d
Admit if septic, LNs, spreading lymphangitis, crepitus
-