Wound Care
Cleaning the wound
General
Clean wounds as soon as possible to prevent bacterial counts from reaching infective levels.
Preparation
All wound care should be done with the patient supine because fainting commonly occurs.
Utilize universal precautions including protective eyewear and a mask.
Attend to patient comfort with appropriate local/systemic anesthetic.
Methods of wound cleaning
Mechanical scrubbing
First, scrub a wide area of skin around the wound with antiseptic.
Scrubbing the wound itself could be abrasive and lead to more tissue damage.
Therefore, one may choose to irrigate first and scrub if contaminants remain.
Irrigation
Delivering irrigation fluid at a higher pressure is most effective for cleaning.
Some emergency medicine studies show tap water had less of an infection rate than sterile saline.
Antibiotic solutions have been used for irrigation.
Agents of wound cleaning
Skin antiseptics—use only to clean intact skin; avoid significant amounts in open wounds
Povidone-iodine solution (Betadine 10%)
Chlorhexidine gluconate (Hibiclens)
General—bactericidal (better against gram-positive than gram-negative bacteria)
Uses—hand cleanser; avoid use for wounds that are open
Hydrogen peroxide (H2O2)
General—weak antibacterial
Uses—superficial lacerations/abrasions; toxic to tissue and hemolytic
Antibiotic solutions
Wound closure
For superficial lacerations/abrasions, may apply bacitracin and dressing or leave open.
For abrasions, consider applying zinc oxide BID to promote healing.
For lacerations, may need surgical consult.
Simple deep lacerations may only need cleaning, sutures, or steri-strips.
For these, use antibiotic ointment and dressing BID × 7 to 10 days.
More complex lacerations require exploration of the wound’s full extent.
Rule out hidden foreign bodies, structural injuries, and so on.
Employ debridement and/or excision if significant contamination exists.
Do NOT suture infected wounds → a closed-space infection may develop.
Therefore, make sure wounds are fully explored, cleaned, and so on before closure.
Tetanus toxoid
Adult formulations (for those 7 years or older)
Primary immunization and booster
Note: A fourth dose of tetanus toxoid completes the initial series
Prophylaxis and treatment in wound care
For clean, minor wounds
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Give Td if patient never got a fourth dose of tetanus toxoid.
For contaminated wounds, puncture wounds, burns, and so on
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Give Td and immune globulin if patient never got a fourth dose of toxoid.
Bite wounds
General—can result from any animal source, including humans.
Clinical—laceration injury, signs of infection appear within 3 days from direct inoculation of microorganisms.
Etiology—wounds contain polymicrobial flora.
Common microbes isolated
Human
Gram-positive bacteria (Staphylococcus aureus, viridans streptococci, peptostreptococci)
Gram-negative rods (Prevotella, Bacteroides, Fusobacterium, Eikenella)
Dog and cat
Gram-positive bacteria (S. aureus, Staphylococcus intermedius)
Gram-negative rods
Pasteurella multocida and other pasteurella species
Haemophilus felix
Capnocytophaga
PorphyromonasRelated posts:
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