Wound Management in Urgent Care
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1 Wound Management in Urgent Care
2
3 Brittany Busse Wound Management in Urgent Care
4 Brittany Busse, MD Med 7 Urgent Care Folsom, CA, USA ISBN DOI / ISBN (ebook) Library of Congress Control Number: Springer Cham Heidelberg New York Dordrecht London Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (
5 Preface Lacerations, burns, and other wounds are a common reason for patients to present to the Urgent Care. The Center for Disease Control National Center for Health Statistics reports over 3.1 million visits to health care professionals for accidental cutting or piercing injuries in 2012, over 480,000 visits for burns, and over 5.3 million visits for diseases of the skin and subcutaneous tissues (i.e. cellulitis and/or abscess). Many of these patients present to an Urgent Care or Acute Care Center with a variety of acute and chronic wounds. Expedient assessment and treatment is often expected by the patient and leaves little time for the providers to educate themselves on the nuances of surgical wound care. It is often hard to establish best practice standards in the case of acute and chronic wounds. Lacerations occur in a variety of locations on the body and each wound requires a specialized evaluation and treatment approach. A one-size fits all approach to laceration repair can result in suboptimal wound healing and poor patient outcomes. In addition, the treatment of chronic wounds due to illness or neglect on the part of the patient or caregiver can involve a significant level of training and expertise. Due to the difficulty encountered in staying up to date with evidencebased medicine, many providers will fall back on dogma and prior training without realizing that these practices have been shown to lack benefit or may even be harmful to patients. Complications resulting from inadequate management of wounds early in the course of treatment can include scarring, infection, dehiscence, and/or loss of function of an affected limb. For this reason, many providers may shy away from more complex wounds and instead refer patients to the local Emergency Department, or they may call for the services of a specialist. The goal of this book is to establish a concise reference to rapidly assist each provider in wound management and increase the provider s overall confidence and competence, which will lead to better patient outcomes. Folsom, CA, USA Brittany Busse v
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7 Contents 1 Introduction to Wound Healing Time Course of Wound Healing and Treatment Goals Stage 1 (Days 1 3): Hemostasis and Inflammation Stage 2: Proliferation Stage 3: Scar Maturation and Remodeling Improving Outcomes in Wound Healing Local Wound Environment Infection Age Local Tissue Hypoxemia Diabetes Nutrition Treatment of Acute Wounds: The Basics Evaluation Prepare the Wound Hemostasis Cleansing Anesthesia Debridement Irrigation Wound Closure Layered Closure Superficial Closure Selecting Materials for Wound Closure Monofilament Nonabsorbable Suture Monofilament Absorbable Suture Braided (Multifilament) Absorbable Suture Needle Selection Selecting an Appropriately Sized Suture vii
8 viii Contents 4.6 Stainless Steel Staples Wound Closure with Adhesive Strips Octyl Cyanoacrylate Tissue Adhesive Proper Setup Surgical Tray Setup Positioning of the Needle Suturing Techniques for Wound Closure Simple Interrupted Closure Horizontal Mattress Suture Technique Vertical Mattress Suture Technique Specifics of Wound Closure Scalp Face Eyebrow Ear Nose Lip Other Facial Regions Neck and Trunk Repairing Superficial Neck and Trunk Lacerations Upper Extremity Repair of Lacerations to the Arm Hands and Fingers Lower Extremity Upper Leg Lower Leg (From the Knee Down) Feet and Toes Special Circumstances in Wounds Skin Tears in the Elderly Risk Factors Associated with Skin Tears Evidence-Based Approach to Caring for Skin Tears Wound Assessment Skin Cleansing and Wound Preparation Treatment Bite Wounds Dog and Cat Bite Treatment Human Bite Treatment Caring for Acute Wounds in Patients with Peripheral Edema Abscess Drainage Simple Abscess Multiloculated Abscess (Carbuncles) Paronychia... 64
9 Contents ix 9.4 Infected Sebaceous Cyst Infection in the Presence of a Foreign Body Necrotizing Infection Abscesses of Distinct Pathology and Anatomic Location Pilonidal Cyst Disease and Abscess Bartholin Gland Cyst and Abscess Hidradenitis Suppurativa Burns Classifying a Burn Assessment of Burn Surface Area (BSA) Burn Center Admission Criteria Caring for Burns in the Urgent Care Chronic Wounds Basics of Initial Evaluation and Treatment of Chronic Wounds Special Types of Wounds Diabetic Foot Ulcers Arterial Occlusive Disease Venous Insufficiency Decubitus (Pressure) Ulcers References Index... 87
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