1. Principles of Wound Management Indiana University Department of Emergency Medicine Nurse Practitioner Lecture Series

2. Tetanus Prophylaxis in Wound Management History of Tetanus Toxoid Doses Received TdTIGTdTIG Unknown or <three YesNoYes >three doses No, unless last Td > 10 yrs ago No No, unless last Td > 5 years ago No Clean, Minor WoundsAll other Wounds

3. Antibiotic Prophylaxis “Antibiotic goo” on wounds for 48 hours – e.g., Bacitracin® No evidence to support the routine use for PO prophylaxis in wound management Possible exceptions: – Animal bites – Intra-oral lacerations

4. Cat Bites High incidence of infection – Most cats harbor Pasteurella multocida – Staph, strep, others also Long, sharp teeth can penetrate tendons and joints and inoculate deep tissue with bacteria Management with delayed primary closure and prophylactic antibiotics should be strongly considered

5. Dog Bites Powerful bite with relatively dull teeth often causing crush or tearing injury Infection less common than cat bite – P. multocida, staph, strep, polymicrobial Most can be closed primarily Selective use of prophylactic antibiotics

6. Dog and Cat Bites Antimicrobial Prophylaxis P. multocida – Sensitive to PCN, tetracycline, quinolones, amoxicillin/clavulanate, 2 nd and 3 rd generation cephalosporins – Not sensitive to 1 st generation cephalosporins (cephalexin)

7. Dog and Cat Bites Antimicrobial Prophylaxis Acceptable regimens – Amoxicillin/clavulanate (Augmentin) Expensive – Cephalexin + PCN – Others

8. Wound Care Dressing – Nonadherant – Permeable – Keep tissue moist to facilitate epithelization Immobilize Wounds over joints – Protects – Prevents increased tension on repaired wounds

9. Wound Care Instructions Elevate for 48hrs May bath surrounding skin after 24hrs No dressing necessary after 48hrs for simple lacerations Daily swabbing of wound margins with diluted H 2 O 2 until main scab separates Wound check in 48hrs (if high risk)

10. Wound Care Instructions Suture Removal – 3-5 days for face – 7-10 for extremities – 10-14 days for areas subject to large tension forces Sun protection for 6 months – SPF>15 prevents hyperpigmentation of scars

11. Complications Infection Poor apposition/closure – Dehiscence Scarring

12. Take Home Points Proper wound assessment and preparation are essential Make every effort to exclude an occult retained FB, tendon or nerve injury Always document a complete neurovascular exam Copious wound irrigation is key to decreasing rate of infection