General Guidelines for Wound Management
Summary
Wounds can be managed following 5 basic steps. These include cleaning/debridement of the wound, Tetanus prophylaxis, Antibiotics prophylaxis, Rabbies prophylaxis and management of any other associated injuries.
Basic Steps
- Clean the wound and Debride the wound
- Tetanus Prophylaxis
- Antibiotic Prophylaxis
- Rabbies prophylaxis
- Associated Injuries
Wash wound and Debride
- Wash/Irrigate the wound: Use soap and boiled water for 10mins, then irrigate the wound with saline
- Debride the wound: Remove dirt particles and other foreign objects mechanically. Use surgical techniques to remove damaged and dead tissue. Remember the 4 C’s: Contractility, Capacity to bleed, Consistency, and color. Use them to guide yourself on how much to remove. For instance, dead tissue does not bleed when it is cut. Depending on the depth and severity of the wound, the patient may need admission for wound debridement.
- Irrigate the wound again. If this is painful for the patient you may use 1% lignocaine without adrenaline
- Leave the wound open: Pack this wound with damp saline disinfected or clean gauze. Cover the wound with a dry dressing. The patient should receive daily dressings.
You should also apply one of these two antiseptics:
- Polyvidone-iodine 10% apply twice daily
- Cetrimide 15% + Chlorhexidine 1.5%
Tetanus Prophylaxis
- Identify if the wound is Tetanus Prone
- If it is a Tetanus Prone wound, then you either need to give Tetanus Toxoid (0.5ml IM stat) alone or Tetanus Toxoid AND Tetanus Immunoglobulins (250 units IM stat). These are given at the same time and using separate syringes and sites. You may need to increase the Tetanus Immunoglobulins to 500 units IM stat if the wound is older than 12 hours, has the presence of heavy contamination, or if the patient weighs more than 90kg.
Antibiotic Prophylaxis
Indications:
- Contaminated wounds
- Penetrating wounds
- Abdominal trauma
- Open/Compound fractures
- Lacerations greater than 5cm
- Wounds with devitalized tissues
- High-risk anatomical sites such as the hand or the feet
- Wounds requiring surgical interventions
Route: If an infection is present, or likely to occur then the administration of antibiotics should be via the IV route and not IM.
Antibiotics: This may vary according to the hospital protocol or the guideline followed. WHO recommended Penicillin G + Metronidazole for a period of 5 – 7 days.
Rabbies Prophylaxis
If the wound is caused by an animal bite, consider providing the patient with Rabbies prophylaxis depending on the category of the wound.
Associated Injuries
Consider treating other injuries found. For instance, if the patient has an associated fracture you would need to treat this patient as having an Open Fracture. Apart from doing some of the items above, you would also need to provide the patient with splint/backslab to immobilize the fracture site.
Principles to Remember
- Never close infected wounds: These wounds need a continuous cycle of surgical debridement and saline irrigation until the wound is completely clean.
- Do not close contaminated wounds or clean wounds that are more than 6 hours old. You need to debride these wounds surgically, then leave them open. After 48 hours you can close them. This is called closure by tertiary intention (delayed primary closure).
- Antibiotics do not reach the source of wound infection and they cannot “enter” the areas with pus: These wounds need to be debrided as well.
- Topical antibiotics are not required
Made with ❤️ by QuickBeat
We are a small education agency that aims to provide medical education.
EXPLORE
SERVICES
CONTACT
- Pretoria North, Gauteng
- contact@quickbeat.co.za