Hemostasis Inflammatory Phase Proliferative/rebuilding Phase Maturation Phase

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1 The presenters are staff members of the CHI Health St. Elizabeth Burn and Wound Center. Many of the products discussed are used in our current practice but we have no conflict of interest to disclose. 1

2 EPIDERMIS DERMIS FAT MUSCLE BONE Hemostasis Inflammatory Phase Proliferative/rebuilding Phase Maturation Phase 2

3 Hemostasis Coagulation pathways activated & fibrin clot formed Controls blood loss Barrier against bacteria Platelets breakdown and release growth factors Chemoattraction of neutrophils and macrophages Inflammatory Phase Leakage of plasma, neutrophils, and macrophages into wound bed Observation: Edema, warmth and exudate (do not misinterpret as infection at this stage) Cellular debridement of necrotic tissue & phagocytosis of bacteria Cleans wound and creates bacterial balance 3

4 Proliferative Phase Vascular integrity is restored (neoangiogenesis, granulation tissue) Incisional defect mended Wound surface is covered with new epithelium (epithelialization) Maturation Phase Also known as remodeling Lasts beyond 1 year after initial injury Continuous matrix breakdown and matrix resynthesis Results in increased tensile strength to the wound Even at completion of this phase, scar tissue never has more than 80% the tensile strength of non-wounded tissue 4

5 ACUTE Traumatic or surgical Occur suddenly Move predictably through the repair process Result in durable closure WOUNDS CHRONIC Wounds that fail to proceed predictably through the repair process Caused by vascular compromise/pressure, chronic inflammation, repetitive injury, failure of closure Characteristics Prolonged inflammatory phase No initial bleeding event to trigger cascade 5

6 Burns Superficial (First-degree)-affect only epidermis or outer layer of skin Partial (Second-degree)- involve epidermis and part of dermis Full (Third-degree burn)- involve and go through the dermis and affect deeper tissue Infection Pressure Poor nutrition Moisture (too much or too little) Circulation Blood Sugar/DM Obesity Smoking Socio-economic factors/compliance Previous radiation to wound site Immunocompromised 6

7 Pressure Arterial Venous Neuropathic Diabetic Trauma Related to Co-morbidity My patient can t get their compression on. What is their living situation? What are the barriers? Is there family/friend that can help? Do they have home health and if so is it daily? 7

8 So What if Patient cannot tolerate compression What are they currently using for compression? Assess what other options might be. Some compression is better than no compression. Are they elevating their legs as advised? What is their activity level? So What If.. Patient needs to offload an area to avoid pressure and is having difficulty What are they currently doing to offload? What is their level of activity? What is their living situation? 8

9 So What If. Patient needs to increase protein intake to assist in healing. Patient cannot afford nutrition supplement drinks. Patient does not like to eat a lot of meat. Patient can only eat small amounts. So What If Patient has a reaction to dressing for burn and/or wound. What are they using? What are their allergies? What does the reactions look like? How much drainage are they having? 9

10 So What If.. Patient and/or family cannot do the dressing change? What are the barriers? Is pain a consideration? Is it a lack of dressing supplies? Is it a lack of skill? Do they qualify for home health care? Is there a local clinic that can provide dressing changes? So What If Wound or Burn appearance is concerning? Contact provider for orders. Assess wound or burn- is it red, is there an increase in drainage, what does the drainage look like, does the patient have a temperature of or greater, is there an increase in pain, is there an increase in edema 10

11 So What If.. Patient has some type of graft in place. Can patient take a shower if they have a skin graft or skin substitute in place What type of skin graft is in place? When was it placed? Should they be doing a dressing change? Can they take the outer dressing off? So What If If the burn area has a blister should it be ruptured? How much of the area was burned? How was the burn injury sustained? When was the burn sustained? What dressing do you have on the burns? 11

12 So What If. Patient has not been seen by provider yet.what to do and NOT do. Can the wound or burn be washed with soap and water? Can the wound or burn be washed with hydrogen peroxide? Can the wound or burn be left open to air? So What If Patient has a wound vac in place and it is alarming. When was the wound vac last changed? Where is the wound vac located? Is the wound vac charged? Has the wound vac been turned off? 12

13 So What If.. Patient presents with a burn What is the age of the patient? Where is the burn located? How big is the burn? Is the burn superficial, partial or full thickness? When was the burn sustained? How was the burn sustained? CHI Health St. Elizabeth Burn Center For questions and guidance on criteria for patient transfer into the burn unit. For questions regarding immediate care until patient can be seen in the burn outpatient clinic. 13

14 CHI Health St. Elizabeth Wound Care Center Physicians and nurses dedicated to treating wounds that are resistant to healing Questions???? 14