Wound evaluation and initial care

Slide 1 www.vmth.missouri.edu

Wound Evaluation and Initial Care

Joanne Kramer DVM, DACVSDave Wilson DVM, MS, DACVS

http://www.vmth.missouri.edu/


Basic Steps

Overall Initial Observation- Hands off

Overall Initial Evaluation- Hands on minimal

Key History Questions Initial Wound Evaluation Initial Wound CareAny remaining parts of physical exam



Overall Initial Observation

How distressed does the horse appear?

Is the horse markedly lame at a walk?

Are there any marked asymmetries noted (eg head tilt, joint swelling) aside from the wounded region?



Overall Initial Observation

Is the horse breathing normally?Can the horse see?Does it appear that the horse has been eating, drinking, urinating and defecating normally?



Overall Initial Evaluation

Keep the hands on part of the initial evaluation as minimal as necessary

Temperature, Pulse, Respiration,Capillary refill time, Membrane color, Hydration

Any physical palpation or movement considered necessary



Initial Wound Evaluation

Is this tissue damage likely the result of a wound or something else (eg tumor)?

What type of wound does it appear to be (eg laceration, contusion)?

What anatomical structures might be involved ?



Initial Wound Evaluation

Is immediate veterinary consultation required ?– Any abnormalities on initial

observation– Any wounds deeper than skin– Any wounds on the limb or face– Unsure of anatomy



Initial Wound Care

Preparing the wound for better assessment and or initial therapy– Protect the wound with sterile

water based gel or gauze– Heavily contaminated wounds may

need the surrounding area cleaned with light cleaning with gauze and saline or tap water to reduce large amounts of dirt etc.



Initial Wound Care

Preparing the wound for better assessment and or initial therapy– Protect the wound with sterile

water based gel or gauze– Clip the hair around the wound– Aseptically clean the wound and

surrounding tissues– Change gauze or sterile lube at

each stage of wound preparation



Initial Wound Care

Aseptic cleaning of the wound and surrounding tissues– Povidone-iodine or chlorhexidine

surgical scrub rinsed by saline– Scrub surrounding area first– Minimize amount of scrub solution

directly in wound. Rinse thoroughly

– Avoid using alcohol or hydrogen peroxide in open wounds.



Initial Wound Care

Chlorhexidine– Longer duration of action– Avoid near eyes or open synovial

structures– Saline rinses best

Povidone iodine– Can be used with alcohol rinses

but avoid getting alcohol in the wound



Initial Wound Care

Wound lavage– If very heavy contamination may

initially use tap water (causes tissue edema)

– Normal saline or lactated ringer solution typically used

– 8-15 psi ideal pressure. ~35 or 60 ml syringe through 18 gauge needle

– Take care not to drive contaminants deeper into wound



Veterinary Decisions after Initial Wound Evaluation and CareAre additional diagnostics required?

(eg radiographs, synovial structure evaluation)

What method of healing is best? (eg primary intention vs secondary intention)

Development of a care plan Local therapy (eg bandaging, regional medications)

Systemic therapy (eg activity restrictions, medications)



Key History Questions

Did you see how the wound happened?

Do you know when the wound happened?

Have any treatments been applied or medications been given?

Has the horse ever had a tetanus toxoid vaccine?


Education

Wound evaluation and initial care