Minor Wounds

Patient:

• General patient information

• Information from the patient about the wound/injury

• SCHOLAR-MAC

Wound:

• Wound characteristics - visual inspection... type, depth, location,

degree of contamination

What should you collect from the patient regarding minor wounds?

-Assess your "collected" information

• Wound characteristics - type, depth, location, degree of contamination, cause

• Signs of infection - excessive drainage, yellow/green fluid; excessive redness,

swelling, pain

• Patient information

-Determine if Self-Care (OTC treatment) is appropriate

What should you assess from the patient regarding minor wounds?

exclusions for self-tx for sunburns

-large areas of blistering

-fever

-extreme pain

-HA or confusion

-lightheadedness or vision changes

-sever swelling

-signs of infection such as areas of redness or red streaks spreading or moving away from open blisters

exclusions for self-treatment of minor burns and wounds

-cuts longer than 1/2 in

-a cute that continues to bleed after applying pressure for 10 mins

-chemical, electrical or inhalation burns

-wound secondary to an animal or human bite

-deep partial thickness, full thickness

-any injury that is a suspected non-accidental injury

-signs of infection

-circumferential burns

-pts with pre-existing medical disorders that could complicate management, prolong recovery or affect mortality, such as diabetes

-wound containing foreign matter after irrigation

-chronic wound

-site of injury: face, hands, feet, major joints, genitals or perineum

-burns larger than 3 inches in diameter

-a skin injury seems to worsen or does not show signs of healing in 7 days

minor wounds

-abrasions

-punctures

-lacerations

-incisions

-avulsions

< 1

Most minor wounds heal in _______ month

dermis

Self care generally appropriate when the wound does not extend beyond the __________

stage 1 skin injury

epidermis; minor burns

stage 2 skin injury

epidermis and part of dermis; severe sunburn, abrasions, superficial lacerations and punctures, superficial partial-thickness burns, and deep partial-thickness burns

stage 3 skin injury

epidermis, dermis, some subcutaneous tissue; full-thickness burns and deep lacerations and punctures

stage 4 skin injury

through subcutaneous tissue and underlying muscle, bone, tendon

3-4 days

How long is the inflammatory phase (hemostasis and inflammation)?

3 weeks

How long is the proliferative phase?

60 days (peak)

How long is the maturation/remodeling phase?

inflammatory phase

clot formation

inflammation phase

-accumulation of neutrophils and macrophages

-inflammatory and growth factor release

proliferation phase

-angiogenesis

-proliferation of fibroblasts

-epithelization

remodeling phase

collagen deposition and remodeling

things that may impact/delay healing

-Inadequate tissue perfusion/oxygenation; poor vascularization

-Infection

-Inadequate nutrition

-Comorbidities

• Diabetes, obesity, HF, PVD, hypotension, severe anemia

-Medication effects

-Unfavorable wound characteristics

• Scab, foreign bodies, inadequate moisture, infection

1) relieve symptoms

2) promote healing by protecting the wound from infection and further trauma

3) minimize scarring

What are the tx goals for minor wounds?

1. Cleansing of the damaged area

2. Selective use of non-prescription products/medications

3. Covering the wound with an appropriate dressing

What are the tx steps for minor wounds?

non-pharm tx for minor wounds

-remove exposure to offending agent

-stop bleeding

-decrease infection risk

-protect from further trauma

wound irrigation

-clean wound surface, remove dirt and debris

-flush with normal saline or water

-may need to remove debris with clean gauze

considerations for dressings/coverings

• Absorb moisture, maintain moisture, or provide moisture

• Adhesive?

• Secondary dressing required, or surgical tape?

• Frequency of dressing changes - follow product instructions, also if dirty, smells bad, not adhering

dressings/coverings

• Gauze

• Non-adherent gauze type

• Adhesive bandages

• Hydrocolloids

• Transparent adhesive films

tetanus

When breaks in the skin are present, assessment of the patient's __________ status should be done

systemic analgesics

• NSAIDS

• For patients who cannot tolerate NSAIDs - acetaminophen can

provide pain relief, although it does not have any anti-inflammatory effect

Skin Protectants

• May be beneficial for abrasions

• Reduce pain

• Protect from irritation (friction, rubbing)

• Prevent drying, provide lubrication

• Do not use on wounds with exudates

• May apply as often as needed

topical first aid antibiotics

-Prevent infection (not for wounds ALREADY infected)

-For contaminated wounds with moderate infection risk; debris, foreign matter

-Apply to wound after cleansing and before dressing; 1-3 times per day

-Prolonged use - resistant bacteria, secondary fungal infection

• >7 days and no improvement seek medical attention

-Antibacterial soaps - not better than regular soap and water; long term exposure could increase resistance

Bacitracin

polypeptide bactericidal antibiotic that inhibits cell wall synthesis in several gram-positive organisms; allergic contact dermatitis in2%; minimal absorption

Neomycin

aminoglycoside antibiotic; bactericidal activity by irreversibly binding to the 30S ribosomal subunit to inhibit protein synthesis in gram-negative organisms and some species of Staphylococcus; hypersensitivity in 3.5-6%; systemic toxicity only with large open areas; used in combination(bacitracin, polymyxin B) to prevent resistance

Polymixin B Sulfate

polypeptide antibiotic that is effective against several gram-negative organisms because it alters the bacterial cell wall permeability

topical first aid antibiotic drugs

-Bacitracin

-Neomycin

-Polymixin B Sulfate

topical anesthetics

-Benzocaine and lidocaine

-Short term pain relief, 15-45 minutes

-Lower concentration if skin not intact - increased drug absorption

-Apply no more than 3-4 times per day

• Hypersensitivity reaction, systemic absorption/toxicity

First Aid Antiseptics

• Disinfection; destroy or inhibit growth of microorganisms

• Can be cytotoxic, cause harm to tissue, and reduce healing rate

• If used - only apply to intact skin up to edge of damaged skin

• Example active ingredients: Hydrogen peroxide, ethyl alcohol,

isopropyl alcohol, chlorhexidine, povidone/iodine

• Evidence to support their ability to prevent infection and promote healing is unclear

• Clean tap water is safe and effective for wound irrigation (and has strong evidence)

first aid antiseptic drugs

-Hydrogen peroxide

-Alcohol

-Iodine and povidone/iodine

Hydrogen peroxide

• Should only be used when released gas can escape

• Limited benefit - limited bactericidal effect, risk of tissue toxicity

Alcohol

-Intact skin only; tissue irritation, cytotoxic effects

-Ethyl alcohol

-Isopropyl alcohol

• Somewhat stronger bactericidal activity

• Astringent action - greater potential for drying the skin

Iodine and povidone/iodine

tissue irritation, stain, systemic absorption, allergies

Patient Education for Minor Wounds

The objective of self-treatment is to promote healing by protecting the wound from infection or further trauma. For most patients, carefully following product instructions and the self-care measures listed here will help ensure optimal therapeutic outcomes.

-Cleans and irrigate the wound with tap water (or normal saline solution if needed; if debris still present, refer). Use antiseptic solutions selectively and cautiously.

-Advise patient how to promote moist wound healing, prevent infection, and protect injury with a skin protectant and dressing (selection based on wound characteristics).

-Change dressing if it becomes soiled or is not intact, or there is excessive fluid/exudate from wound. Most dressings should be changed every 3-5 days. More frequent changes may remove resurfacing layers of epithelium and slow the healing process.

-Continue using a wound dressing until the wound bed has firmly closed and signs of inflammation in surrounding tissue have subsided. This process usually takes 2-3 weeks. Failure to keep the wound covered may delay healing.

-Use a mild analgesic to control pain.

-Observe the wound for signs of infection.

-For prevention of scarring: skin protectant during healing, prevention of UVR exposure, application of silicone after healing.

Consult a primary care provider if infection is suspected or if the wound does not show signs of healing after 7 days of self-treatment

When should you seek medical attention for minor wounds?

healing

symptom improvement, decreasing inflammation, wound healing

infection

cellulitis; pus; increased redness, pain, swelling; foul odor

healing and infection

What do you monitor for when looking for s/s of "treatment" efficacy?

ex: contact dermatitis from topical tx or dressing

What do you monitor for when looking for s/s of "treatment" AEs?

moist

______ wound healing is considered the standard of care for minor wounds

self-care measures

Minor acute superficial and superficial partial-thickness burns, sunburn, and wounds often can betreated with: