References
Initial stabilisation and treatment of traumatic wounds
Abstract
Traumatic wounds occur as a result of a myriad of different circumstances including; environmental factors, road traffic accidents, chemical and thermal exposure, or incidents relating to interactions with other people and animals. Successful treatment of traumatic wounds requires initial stabilisation and assessment of the patient, including management of haemorrhage, application of temporary dressings, intravenous fluid therapy, oxygen, antibiotics and analgesia. Further investigation of the wound under sedation or a general anaesthetic may also be necessary to assess the level of wound contamination, the degree of trauma to the tissues, and the presence of or potential for infection. Through accurate assessment a wound can be classified and prepared for treatment in order to prevent or minimise complications from deep infection, wound dehiscence, seroma formation and wound contracture. The intention of wound management is to support and assist the body's own natural healing processes with a wound healing environment that provides viable, vascularised tissue, infection control and adequate oxygen to supply damaged tissues. As with all traumatic wounds an understanding of factors affecting wound repair and principals of healing is mandatory in making appropriate wound management assessment and treatment decisions.
Traumatic wounds and injuries to the skin and its underlying subcutaneous tissues, muscles and bone structures are very common conditions observed and treated in veterinary medicine. A wound is a disruption of the normal continuity of body structure. Wounding may cause injury to structures underlying and collateral to the skin (Waldron and Zimmerman, 2003).
Initial stabilisation and treatment of wounds aims as much as possible to restore the normal anatomical continuity to a damaged area of tissue. By providing prompt patient triage, wound assessments and facilitation of first aid care it is possible to enhance healing and prevent further complications. With multiple factors required by the body to engage optimal healing processes, careful attention to wound management will help to ensure the best patient outcome.
For any patient presenting with trauma, the initial physical examination or primary survey and assessment needs to be undertaken with a rapid and systematic approach, which will at times require multiple assessments simultaneously (Figure 1). The primary survey, or broad sweep assessment, is where the most immediate life threatening concerns and overall patient stability are addressed before focusing on wounds. While it is easy to be completely overwhelmed when a patient presents with multiple injuries and systemic failures, it is important to observe one of the most fundamental elements of treatment, A-B-C (Airways, Breathing, Circulation). If any part of the A-B-C survey is not intact, such as with a major haemorrhaging wound, the primary survey should be stopped and complications addressed.
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