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Advanced Musculoskeletal Physiotherapy Self-directed Learning Modules:

Emergency Department 2014

Module 4: Traumatic Wounds

Prepared by Alfred Health on behalf of the Victorian Department of Health 2014

Module 4: Wound Management

Contents

Module 4: Wound Management 3

4.1 Traumatic Wounds 4

Theme 1 History taking in open wounds 4

Theme 2 Focused clinical wound assessment 5

Theme 3 Common Pathology of open wounds 6

Theme 4 Common Investigations of Open Wounds 9

Theme5 Common Pharmacology in Open Wounds 10

Theme 6 Wound Management 12

|4.1 Traumatic Wounds |

|Theme 1 History taking in open wounds |

|LEARNING OBJECTIVES: |

|To understand the key principles of history taking in open wounds |

|To understand the importance of mechanism of injury in open wounds |

|KNOWLEDGE: |

|HISTORY |

|What key areas of past medical history is important in open wounds |

|What key areas of social history are important in open wounds |

|What key areas of patients current medications important in open wounds |

|What information should be obtained regarding vaccination status |

|What key areas of allergy history is important in open wounds |

|MECHANISM OF INJURY |

|When obtaining information regarding the mechanism of injury, discuss the key areas |

|Discuss the implications of blast wounds |

|Discuss the implications of penetrating trauma |

|Discuss the implications of puncture trauma |

|Discuss the implications of blunt trauma |

|RECOMMENDED RESOURCES |

|Purcel, D (2010) Minor Injuries A Clinical Guide. Churchill Livingstone, UK. |

|Chapter 6, Minor Wounds and Burns, p173-199. |

| |

|Talley, NJ & O’Connor, S (2009) Clinical Examination: A systematic Guide to Physical Diagnosis. 6th Edition. Churchill Livingstone, |

|Sydney. |

| |

|Chapter 1, The General Principles of history taking, p1-12; Chapter 2, Advanced history taking, p13-21. |

| |

|Troutt, A (2005) Wounds and Lacerations Emergency care and closure. 3rd Edition. Elsevier Mosby. |

|Chapter 4, Surface Injury and Wound Healing: Mechanism of Injury, p19-22 |

| |

|Wardrope, J & Edhouse, J (2002) The Management of Wounds and Burns. 2nd Edition. Oxford University Press. |

|Chapter 3, Legal aspects and wound care, p31-36. |

| |

|Barnard, A & Allison, K (2009) The classification and principles of management of wounds in trauma. Trauma. 11, 3, p163-176. |

|Refer to your local organisations wound management guidelines/policies and resources |

|Theme 2 Focused clinical wound assessment |

|LEARNING OBJECTIVES: |

|To understand the principles of wound assessment |

|KNOWLEDGE |

|How does age of the wound effect the management and outcome? |

|Where on the body wound you be concerned regarding cosmetically features? |

|How would you measure the size of a wound? |

|How would you determine the depth of a wound? |

|How would you describe the characteristics of the wound? |

|What would concern you on the peri-wound areas? |

|How would you identify the type of wound? |

|Simple v Complex |

|Clean v Contaminated |

|Acute v Chronic |

|How would you assess the level of pain? |

|How would you assess the nerve innervations distally to the wound? |

|How would you assess the movements distally to the wound? |

|How would you assess for bony tenderness? |

|RECOMMENDED RESOURCES |

|Purcel, D (2010) Minor Injuries A Clinical Guide. Churchill Livingstone, UK. |

|Chapter 6, Minor Wounds and Burns, p173-199. |

| |

|Wardrope, J & Edhouse, J (2002) The Management of Wounds and Burns. 2nd Edition. Oxford University Press |

|Chapter 1, Wound Assessment, p5-12 |

| |

|Lazerus, G, Cooper D, Knighton, D, Margolis, D, Pecoraro, R, Rodeheaver, G & Robson, M (1994) Definitions and guidelines for assessment |

|of wounds and evaluation of healing. Archives of Dermatology. 130, (4), p489-493. |

| |

| |

|Local organisation’s wound care assessment and management policy – Nursing resources |

|Theme 3 Common Pathology of open wounds |

|LEARNING OBJECTIVES |

|Identify high risk groups for delayed wound healing |

|Demonstrate an understanding of high risk wounds |

|Demonstrate ability to apply focused knowledge of high risk wounds regarding history, assessment, investigations, management and pharmacological |

|agents |

|Demonstrates the ability to assess and manage nail injuries |

|KNOWLEDGE |

|WOUND HEALING |

|List the high risk patient groups that are predisposed to wound healing impairment |

|List medications that may affect wound healing and explain your reasons |

| |

|HIGH RISK GROUPS |

|Discuss the special considerations that must be given for patients who sustained an animal bite with regards to history, assessment, investigations,|

|management and pharmacological agents. |

|Discuss the special considerations that must be given for patients who sustained a human bite with regards to history, assessment, investigations, |

|management and pharmacological agents. |

|Discuss the special considerations that must be given for patients who sustained a crush injury with regards to history, assessment, investigations,|

|management and pharmacological agents. |

|Discuss the special considerations that must be given for patients with suspected foreign body with regards to history, assessment, investigations, |

|management and pharmacological agents |

|Discuss the special considerations that must be given for patients who delay in presenting with wounds with regards to history, assessment, |

|investigations, management and pharmacological agents. |

|Discuss the special considerations that must be given for patients with suspected infected wound with regards to history, assessment, |

|investigations, management and pharmacological agents |

|Discuss the special considerations that must be given for Pediatric Patient with an open wound with regards to history, assessment, investigations, |

|management and pharmacological agents. |

| |

|NAIL INJURIES |

|Describe the anatomy of the nail |

|What are the causes of a subungal haematoma |

|Describe how and when you would trephine a subungal haematoma |

|What further management is required for the patient post trephining |

|What is paronychia |

|What common organism is involved in paronychia |

|What are the common causes of paronychia |

|How would you treat a patient with a paronychia |

|What follow up education would you provide the patient with a paronychia |

|RECOMMENDED RESOURCES |

|Purcel, D (2010) Minor Injuries A Clinical Guide. Churchill Livingstone, UK. |

|Chapter 6, Minor Wounds and Burns, p173-199. |

| |

|Troutt, A (2005) Wounds and Lacerations Emergency care and closure. 3rd Edition. Elsevier Mosby. |

|Chapter 5, Wound Care and the Pediatric Patient, p35-47; Chapter 16, Common Wound Problem Foreign Bodies p.239-244 and Plantar puncture wounds, |

|p244-247. |

| |

|Wardrope, J & Edhouse, J (2002) The Management of Wounds and Burns. 2nd Edition. Oxford University Press. |

|Chapter 6, Wound Infection, p93-112; Chapter 7, Special types of wounds, p119-132; Chapter 8, Hand Wounds, p138-162; Chapter 9, Facial Wounds, |

|p171-181. |

| |

|Abraham, M & Oh, J (2010) Recent advances in Wound Care. Trauma Reports. Evidence based medicine for the ED. 11, 14. |

| |

| |

|Baranoski, S (2003) Skin tears: Staying on guard against the enemy of frail skin. Nursing 2003. 33, p.14. |

| |

|Staying_on_guard_against_the_enemy_of.5.aspx |

| |

|Burton, F (2004) Benchmarking and wound care in A&E. Nursing Standard. 18, 45 p67-72. |

| |

| |

|Conlon, S (2007) Human bites in Classroom: Incidence, treatment and complications. The Journal of School Nursing. 23, 4, p197-201. |

| |

| |

|Department of Health Victoria (2013) Children at risk learning portal |

| |

| |

|Therapeatuic guidelines limited (2011) eTG complete |

| |

| |

|Up to date |

|Baddour, L (2013) Soft tissue infections due to human bites |

| |

| |

|Baddour, L (2013) Soft tissue infections due to dog and cat bites |

| |

| |

|Baddour, L (2010) Soft tissue infections following water exposure |

| |

|Endom, E (2012) Initial management of animal and human bites |

| |

| |

|Berlowitz, D (2013) Pressure ulcers: Epidemiology, pathogenesis, clinical manifestations and staging |

| |

| |

|Bothner, J & Fastle, R (2012) Subungal hematoma |

| |

| |

|Calderwood, S (1997) Clinical Microbiology review: Wound, skin and soft tissue infections |

| |

| |

|de Asla, R & McCulloch, D (2013) Management of diabetic foot lesions |

| |

| |

|McCulloch, D (2012) Evaluation of diabetic foot |

| |

| |

|Sexton, D & Weintrob, A (2012) Clinical manifestations, diagnosis and management of diabetic infections of the lower extremities |

| |

| |

|Up to date doctors and editors (2013) Patient information: Paronychia (the basics) |

| |

|Theme 4 Common Investigations of Open Wounds |

|LEARNING OBJECTIVES |

|Identify clinical indications for radiology imaging for open wounds |

|Identify clinical indications for ultrasonic imaging for open wounds |

|Identify laboratory tests required for a patient presenting with a human bite |

|KNOWLEDGE |

|RADIOLOGY |

|When would you consider performing an x-ray and why? |

|What foreign bodies are radio-opaque? |

|What foreign bodies are non-radiopaque? |

|What precautions must be taken prior to radiology interventions for women and why? |

|ULTRASOUND |

|When would you consider performing an ultrasound in an open wound and why? |

|PATHOLOGY |

|What are the infectious risks to patients presenting with a human bite? |

|What blood tests are required? |

|What would the follow-up procedure be for patients who received a human bite? |

|RECOMMENDED RESOURCES |

|Raby, N, de Lacey, G & Berman, L (2005) Accident and Emergency Radiology A survival guide. 2nd Edition. Elsevier Saunders,UK. |

| |

|Troutt, A. (2005) Wounds and Lacerations Emergency care and closure. 3rd Edition. Elsevier Mosby. |

|Chapter 15, Bite Wounds, p223-238; Chapter 16, Common Wound Problem: Foreign Bodies, p239-244. |

| |

|The Royal Australian and New Zealand College of Radiologists (2013) Inside radiology |

|.au |

| |

|Refer to Radiology and Pathology Module |

|Theme5 Common Pharmacology in Open Wounds |

|LEARNING OBJECTIVES |

|Have a basic understanding of antibiotic choice for common skin infections |

|Have a basic understanding of antibiotic choice for human and animal bites |

|Understand the underlying principles for vaccinations and immunoglobulin’s |

|KNOWLEDGE |

|ANTIBIOTICS |

|What is the most common antibiotic for a local skin wound infection and why? |

|What is the choice of antibiotic for a human bite and why? |

|What is the choice of antibiotic for an animal bite and why? |

|VACCINATIONS |

|What are the national guidelines for immunization for tetanus-prone wounds? |

|What are the indications for Tetanus immunoglobulin? |

|Where and how would you access tetanus immunoglobulin? |

|Regarding tetanus vaccine discuss the following |

|Indications |

|Precautions |

|Adverse Effects |

|Dosage |

|What are the indications for Hepatitis B immunoglobulin? |

|Regarding Hepatitis B discuss the following |

|Indications |

|Precautions |

|Adverse Effects |

|Dosage |

|What are the indications for Rabies vaccination and Immunoglobulin? |

|Regarding Rabies vaccine discuss the following |

|Indications |

|Precautions |

|Adverse Effects |

|Dosage |

|How would you determine the immunity status of the patient? |

|Have an overall understanding of the recommended vaccinations required for children and adults in Australia |

|List the common presentations to ED that are notifiable diseases |

|RECOMMENDED RESOURCES |

|Byrant, B & Knights, K (2007) Pharmacology for health professionals. 2nd Edition. Mosby. |

| |

|Neal, M (2009) Pharmacology at a glance. 2nd Edition. Wiley-Blackwell. |

| |

|European Wound Management Association (2004) Principles of best practice: Minimising pain at wound dressing-related procedures. A consensus document,|

|London: MEP Ltd. |

| |

|Australian Government Department of Health and Ageing (2013)The Australian Immunisation Handbook. 10th edition. |

| |

| |

|Australian Medicines Handbook (2010) |

| |

| |

|Australian Red Cross Blood Service (2013) Immunoglobulins |

|.au/Immunoglobulins.aspx |

| |

|CSL Limited (2013) Product information Normal Immunoglobulin - VF |

| |

| |

|Up to date |

|Hibberd, P (2013) Tetanus-diphtheria toxoid vaccination in adults |

| |

| |

|Sexton, D (2012) Tetanus |

| |

| |

| |

|Refer to Pharmacology Module |

|Theme 6 Wound Management |

|LEARNING OBJECTIVES |

|Understand hemorrhage control |

|Understand basic wound management |

|Understand wound care dressing products |

|KNOWLEDGE |

|What measures would you take to control wound hemorrhaging? |

|When would you refer to Plastics Unit regarding wound debridement? |

|When would you consider using steri-strips method for wounds? |

|What are the advantages and disadvantages for using the steri-strip method? |

|How would you apply steri-strips to the open wound? |

|When would you consider using sutures for wound closure? |

|What are the advantages and disadvantages for using sutures? |

|When is sutures not indicated? |

|When is it appropriate to refer to a specialist unit regarding wound closure? |

|Describe the functions of the following dressings |

|Hydrocolloid |

|Hydrogel |

|Calcium Alignate |

|Hydrofibres |

|Foam |

|Hypertonic dressings |

|Parafin gauze |

|Topical Antimicrobials |

|RECOMMENDED RESOURCES |

|Mc Cann, J (2003) Wound Care made incredibly easy. Lippincott Williams & Wilkins. |

|Chapter 3, Basic Wound care Procedures-wound irrigation and debridement, p59-65. |

| |

|Troutt, A (2005) Wounds and Lacerations Emergency care and closure. 3rd Edition. Elsevier Mosby. |

|Chapter 4, Decisions before closure: Timing, Debridement and Consultation, p107-118; Chapter 14, Tissue Adhesives and Alternative Wound |

|Closure, p209-222; Chapter 20, Common Dressing and Bandaging Techniques, p227-310. |

| |

|The Australian Wound Management Association (2010) Standards For Wound Management. West Leederville WA, Cambridge Publishing. |

| |

| |

|Caton-Richards, M (2011) Closure of minor wounds with tissue adhesive. Emergency Nurse. 18, (9), p18-21. |

| |

| |

| |

|Up to date |

|Brancato, J (2012) Minor wound preparation and irrigation |

| |

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|Armstrong, D & Meyr, A (2012) Basic principles of wound management |

| |

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|Kronfol, R (2013) Closure of minor skin wounds with staples |

| |

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|deLemos, D (2012) Closure of skin wounds with sutures |

| |

| |

|Kronfol, R (2013) Superficial wound repair with tissue adhesives |

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