Slide 39!

History of present illness :

30 minutes before arrived at the emergency room, the patient brought by his friends
because he attempted suicide by slashing his own left wrist with a stained dirty knife. Size
of the knife is 3x5 cm, only sharp in one side. There are no wounds on another location.
The patient immediately found with his friends. The wound has been closed by the patient
with bandage. The patient wasnt under alcohol or any psychotropic substances.

The patient had sad event a day before this accident happen. The patient lost his mood,
passion, having concentration decrement, feeling fatigue, and feeling like dont want to do
anything. The patient didnt having hallucination or heard another weird sound or
whispering voices.


Definition
The discontinuity of tissue, resulting in the separation of the
original normal tissue


Classification
Generally
1. Simplex: only involving the skin
2 Complications: involving the skin and underlying
tissue
Etiology
1. Mechanical Trauma
2. Electrical Trauma
3. Thermal Trauma
4. trauma Chemistry
Wound type
1 Closed wound (no link between the injury and the outside
world)
Contusion (vulnus contusum)
Vulnus traumaticum
2 Open Wounds (there is connection between the wound and
the outside world)
A. vulnus excoriatio (blisters)
B. vulnus scissum / incivisivum (sliced wound)
C. Vulnus laceratum (wound)
D. vulnus punctum (stab wounds)
E. vulnus caesum (cuts)
F. vulnus scoperotum (gunshot wound)
G. Morsum vulnus (bite wounds)
Anglo Saxon
Abrasion
Laceration
Penetrating wound
Avulsion
Open crushing injury
Clinical manifestation
1. Common signs
Shock
Crush syndrome
2. Local signs
Pain
Bleeding
Local care
Management of acute wounds begins with obtaining a careful history of the events
surrounding the injury. The history is followed by a meticulous examination of the
wound. Examination should assess
The depth and configuration of the wound
The extent of nonviable tissue, and the presence of foreign bodies and other contaminants.
Examination of the wound may require irrigation and debridement of the edges of
the wound, and is facilitated by use of local anesthesia.
Antibiotic administration and tetanus prophylaxis may be needed,and planning the
type and timing of wound repair should take place.
Lidocaine (0.51 percent) or bupivacaine (0.250.5 percent) combined with a
1:100,000 to 1:200,000 dilution of epinephrine provides satisfactory anesthesia
and hemostasis.
Epinephrine should not be used in wounds of the fingers, toes, ears, nose, or penis,
because of the risk of tissue necrosis secondary to terminal arteriole vasospasm in
these structures.
Antibiotics
Antibiotic treatment of acute wounds must be based on organisms suspected
to be found within the infected wound and the patients overall immune
status.
When a single specific organism is suspected, treatment may be commenced
using a single antibiotic.
When multiple organisms are suspected, as with enteric contamination or
when a patients immune function is impaired by diabetes, chronic disease, or
medication, treatment should commence with a broad-spectrum antibiotic or
several agents in combination.
Dressings
The main purpose of wound dressings is to provide the ideal environment for
wound healing. Covering a wound with a dressing mimics the barrier role of
epithelium and prevents further damage.


Absorbent dressings
The main purpose of wound
dressings is to provide the ideal
environment for wound healing.
Covering a wound with a dressing
mimics the barrier role of
epithelium and prevents further
damage.


Nonadherent Dressings
Nonadherent dressings are
impregnated with paraffin,
petroleum jelly,
orwatersoluble jelly for use as
nonadherent coverage.
A secondary dressing must be
placed on top to seal the
edges and prevent desiccation
and infection.
Hydrocolloid and Hydrogel
Dressings
Hydrocolloids and hydrogels
form complex structures
withwater which aids in
atraumatic removal of the
dressing. Absorption of exudates
by the hydrocolloid dressing
leaves a yellowish-brown
gelatinous mass after dressing
removal that can be washed off.
Hydrogel has high water content.
Hydrogels allow a high rate of
evaporation without
compromising wound hydration.
Medicated Dressings
Medicated dressings have long been
used as a drug-delivery system.
Agents delivered in the dressings
include benzoyl peroxide, zinc oxide,
neomycin, and bacitracin-zinc. These
agents have been shown to increase
epithelialization by 28 percent.
Mechanical Devices
The VAC (vacuum-assisted closure)
system assists in wound closure by
applying localized negative pressure to
the surface and margins of the
wound. The continuous negative
pressure is very effective in removing
exudates from the wound.
This form of therapy has been found
to be effective for chronic open
wounds (diabetic ulcers and stages 3
and 4 pressure ulcers), acuteand
traumatic wounds, flaps and grafts,
and subacute wounds