Wound care, suture, tetanus, rabies vaccination, dressing course notes
After evaluation of the airway, respiration and circulation and stabilization of the patient, wound evaluation is performed.
Small objects can cause superficial injuries, while bite or crush injuries can cause greater tissue damage.
We look at the appearance of the wound and get clues about its closure. Irregular-looking wounds can be difficult to close and may take time to heal.
If we delay wound care, the risk of infection increases. If there is more than 12 hours delay, wound closure techniques change.
Age, physical condition, health status and even occupation of the patient affect wound healing; diabetes, neuropathy, obesity, malnutrition or corticosteroid use may delay wound healing.
The use of aspirin and corticosteroids also affects wound healing.
The patient's work; it affects wound healing if it is a problem in terms of wound care and the stability of the wound site.
Smoking also has negative effects on wound healing.
A history of allergy and all of the above information should be obtained from the patient; this history helps nurses for situations such as wound fixation techniques, wound closure techniques, and giving patient discharge information.
Concomitant injuries such as fracture-dislocation and vascular-nerve injury should be evaluated.
Tendon and ligament injuries and foreign body nerve damage should be evaluated.
Agricultural wounds, such as human bites, such as wounds in the very dirty environment during the injury should be carefully evaluated. The risk of infection is very high.
SPECIAL INJURIES
Abrasion, abscess, avulsion, laceration, penetrating wound and bite are divided into basic groups.
Let's examine them in detail.
abraded
It occurs when you rub your skin on a hard place.
Not only rubbing, but also minor burns. The main event is that the epidermis is damaged and part of the skin is separated and the substrate is vulnerable.
This can cause loss of fluid.
If foreign objects remain on the skin at this time, this may cause scarring. This can be prevented by wound cleaning.
In wound treatment, local anesthesia, antibiotic ointment and non-sticky dressing can be used until scar tissue is formed. Some wounds may be left open.
These wounds should be protected from the sun for 6 months in order to avoid color differences in the newly formed tissue.
Absa
Abscess develops by collecting pus formed under the skin. Treatment of abscess should be cleaned and a loose dressing should be performed. Antibiotics can be used in case of recurrence and fever.
the avulsion
It is a loss of skin where it is not possible to combine the wound edges.
Some avulsions may require tissue grafting. The wound should be drained, cleaned and closed.
Local anesthetics should be used.
contusion
Swelling is a trauma, contusion or crush injury where pain and discoloration are not impaired by tissue integrity.
Cold administration can be used in the treatment of analgesia.
Major injuries should be observed for cellulite or compartment syndrome.
the laceration
Wounds caused by cutting forces.
Bleeding must be stopped and neurovascular function distal to the injured area should be evaluated.
Foreign bodies should be removed and anesthetics should be used if necessary.
The wound suture or suture bands and wound edges are closed by bringing them closer together.
The antibiotic is covered with ointment and non-sticky dressing.
Piercing Wounds
More serious injuries from the surface where the underlying tissue is damaged.
They are usually not sutured since the body is not too large.
The risk of infection is high and the underlying tissue must be evaluated.
Necrotic tissue removal, drain insertion and sterile dressing are the treatment steps.
If the foreign body is not too small, it must be secured until it is safely removed.
The presence of foreign bodies inside can be investigated by radiography.
Bites
They are complicated wounds including contusion, avulsion, laceration and penetrating injuries.
It may be of human or animal origin.
Infection can have complications such as abscess, cellulitis, septicemia, osteomyelitis, tenosynovitis, rabies, tetanus.
The highest risk of infection is in human bites.
Immobilization and antibiotic treatment are important.
In human bites; Neurovascular evaluation, debridement of the devitalized tissue and dressing are very important. Antibiotics should be given within 3 hours, most of which are left open.
In animal bites; infection, tetanus and rabies risk. Patients over 50 years of age, hand injuries, deep injuries, and 24-hour delayed treatment have a higher risk of infection.
Wound cleaning, washing with plenty of soapy water, debridement, closing small wounds are among the treatments.
Antibiotic treatment, suturing of the wound is discussed according to the condition of the wound.
High-risk wounds should not be sutured, as they carry a risk of infection. Tetanus and rabies vaccine should be given to all patients.
Wound Preparation
High-pressure irrigation with debridement is the most recommended anti-infection preparation.
Wash heavily contaminated wounds for at least five minutes.
Piercing wounds are more pressureful and effective irrigation wounds.
The removed object must be completely removed.
Eyebrows should not be shaved, but eyebrows should be used as a mark for wound closure.
Other areas can be cut instead of shaving.
In wound cleaning 10% solution of povidone 1% concentration can be used. However, no solution is used.
Hydrogen peroxide and alcohol are not used in open wounds.
LOCAL ANESTHESIA
Local anesthesia is used to relieve pain during wound cleaning and closure.
Lidocaine is the most widely used, because of its long-acting effect.
Epinephrine is frequently added to prolong the duration of local anesthesia to provide hemostasis and to slow down the absorption of anesthetic.
Lidocaine with epinephrine is not used in areas with artery feeding.
If sodium bicarbonate is added to the anesthetics (8.4%), the pain associated with infiltration is further reduced.
Tropical anesthetics are ideal for children.
It can be applied by waiting 2-3 ml of anesthetic solution impregnated with cotton for 20 minutes in the wound and can eliminate the need for needles.
Since they contain an epinephrine component, they are not used in areas with artery feeding.
Another method is to numb the area with fewer anesthetics. This tourniquet is placed proximal to the tissue, then the analgesic material is injected distally into the wound. Wound repair is performed, the tourniquet is not opened during this period after the repair is opened so that the anesthetic substance is slowly absorbed.
Wound Closure
Primary; The edges of the wound are zoomed in, secondary; wounds that are left open due to non-converging or non-converging wound edges, tertiary; the wound is left open for edema or for reasons that need to remain open, then the wound edges are joined (after 5-10 days).
Wounds that cannot be closed with these methods require skin grafting.
Adhesive tape, stapler, wound adhesive can be used in primary closure.
Sticky tape
This method can be used for small wounds, to accelerate recovery after suture removal in elderly patients, and after some sutures can also be closed with these bands.
The adhesive tape remains in the wound until it falls off by itself.
sutures
It is a method used to connect the wound edges and prevent infection and scar formation.
There are types that are natural (absorbed) or synthetic (need to be taken).
After suturing a fine antibiotic ointment is applied and the wound is closed.
When do we get it back?
Eyelids 3-5 days,
eyebrows 4-5 days,
ear 4-6 days,
face and lip 3-5 days,
Hand foot body 7-10 days,
Arm and leg 10-14 days,
Joints should be taken after 14 days.
Stapler
It is a fast closing method used in scalp, trunk and extremities.
It protects better from infection, but is not as firm as the sutures and has more scars.
Stapler is preferred where scarring is less visible.
Stap wires remain in place for 7-10 days. Special remover is required for removal.
Dermabond
It is a tropical skin glue and the newest method.
It is not used in tight skin areas.
It is applied in separate layers in the form of zigzag and dries in 2.5 minutes.
No liquid or ointment is applied to the wound.
It gets up in 5-10 days.
Wound Dressing
The goal is to create a clean wound environment with balanced moisture.
Modern dressings aim to keep the wound wet, clean it and keep it away from bacteria.
A thin layer of antibiotic ointment can be used.
Wounds with a fluid flow of more than 50 ml per day or wounds containing liquids that will damage the skin are dressed by means of so-called wound pouch system to ensure that liquid is removed from the wound.
Tetenosis Prophylaxis
Tetenosis is a systemic infection caused by Clostiridum tetanus, a gram-positive, spore-forming, anaerobic bacillus.
Once activated, Basil is resistant to everything, including sterilization.
The incubation period may be from 2 days to 2 weeks or more.
This bacillus can be found anywhere in the soil, algae, animal and human faeces.
Spores can contaminate a wound and remain silent for years.
If tetany enters the circulatory system, it binds to CNS cells and can depress the respiratory center in the medulla.
Symptoms include; local joint stiffness, mild trismus or inability to open the jaw.
In severe cases; severe trismus, low back pain, penis pain, tachycardia, HT, dysrhythmias, hyperpyrexia, opistotonos, and seizures may develop.
It should be noted that most unvaccinated patients are over 50 years of age.
Tetanus should be considered in all patients.
The vaccine should be administered within 72 hours.
Rabies Prophylaxis
May occur by animal bite.
It is the result of a neurotoxic virus found in the saliva of some mammals.
The incubation period is 4-8 weeks.
If the virus is removed, it reaches the CNS from the peripheral nerves and fatal encephalomyelitis occurs.
Carnivore wild animals are always considered rabid.
Animals should be observed for 10 days, if possible, if rabies symptoms are vaccinated.
Vaccination is considered if the animal is missing.
Vaccination can be waited for 10 days according to the condition of the region and the frequency of rabies in animals. If the possibilities do not allow this, vaccination should be started.
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