Escolar Documentos
Profissional Documentos
Cultura Documentos
1. Moist
4. Optimum temperature
6. Correct pH
Different dressings are appropriate for different stages of the wound healing
Good wound management necessitates flexible approach to election and use of dressings
Requirements from a dressing
1. Wound
2. Patient
o Stimulates healing
3. Healthcare provider
o Inexpensive
o Easy to change
Pain Managment
Analgesic Ladder
1. Paracetamol
1. Analgesia
3. Liver injury (normally metabolised by P450 and NABQI) if metabolism becomes "super
saturated"
o Effects
2. NSAIDs
1. Renal: ARF - inhibition of PGI2 and PGE2 formation that occurs during situations of
reduced renal perfusion (PGs normally produce vasodilation)
2. Coagulation: Inhibit TXA2 - reduced ability of platelets to aggregate to form platelet plug,
permanent effect (only overcome by production of new platelets)
o Effects
3. Opiates
1. Respiratory depression
3. Sedation
5. Constipation
6. Euphoria
8. Increased tone of sphincters (esp sphincter of Oddi - stim contraction of GB; can
exacerbate biliary pain)
o Effects
4. Local anaesthetics
o Caudal block
o Epidurals
o Para/Spinal block
5. Antidepressants
Complementary
1. Hypnosis
2. Cogntive therapy
3. Acupuncture
Purpose of incision
Access
Optimise healing
Good cosmesis
Additional considerations:
Previous wounds which may impede blood supply to wound (parallel linear wounds render
separated tissue inschaemic)
Specific Incisions
Transverse: (1) muscle cutting (2) muscle splitting
Midline: "incision of indecision" rapid access, minimal blood loss, easy closure
Kochers
McBurney/gridiron
Lanz
Rooftop
Paramedian: take longer to form, close, higher risk of blood loss, low complication rate
Suprainguinal (Rutherford-Morrison)
Inguinal
Pfannenstiel
Edges should be in good apposition (with slight gaping to allow for swelling)
Closure options
2. Heal by secondary intention +/- VAC, large surface area wounds, large cavitating wounds
4. Steri-strips
5. Tissue glue
6. Skin staples
7. Sutures
o Vertical mattress
o Horizontal mattress