Wound Care 101 - POMA

“Wound Care 101”Katherine Lincoln, DO

POFPS 43RD Annual CME SymposiumAugust 3-5, 2018

Wound Care

101KATHERINE LINCOLN, DO, FAAFP

POFPS AUG 4, 2018

HERSHEY, PA

Disclosure

Consultant for Acelity, Inc

Has no relevance to this talk through finance, deck preparation, or topic discussion matter

Objective

Provide wound care education at a basic level

to fill in training gaps

Review common chronic wounds that present in clinic/UC



Who am I? Why are we here?

Patient comes in to see you…



2 most important questions in

Wound Care

To the patient: How long as it been there?

(Timeline? What has been done? Who have you seen?)

To yourself: why do they have a wound? (Why didn’t it

go away as planned?)

(AKA Get a history of the Hole in the patient AND a

history of the whole patient)

What does “normal” look like?

Acute vs Chronic Wounds

Acute

Defined onset

Time less then 3 weeks!

Usually clear trauma

(surgery, etc)

Is following usually

progression

Patient is a fairly usual

suspect

Good granulation

No heroic wound

measures

Chronic

Less clear onset

Greater than 3 weeks

May have been started

with a trauma

Is following a weird

trajectory

Doesn’t look “Good”

Has required more visits,

Abx, going to Walmart



Factors that affect wound closure Diabetes

Smoking

Cancer

Obesity

Long term steroid use

Malnutrition

Smoking

Age of the patient

Incontinence of urine

Incontinence of stool

Smoking

Gait disturbance

Limb loss

Neurologic changes

Quadriplegia/Para

Meds: Anti-rejection, NSAIDs

Chemotherapy

Length of time to care

Smoking

Local tissue hypoxia

Put your finger in it..

Help Me Help You

(Proper wound documentation) MEASURE

M = Measure (length x width x depth)

E = Exudate (quality and quality)

A = Appearance (wound bed and surrounding skin)

S = Suffering (pain type and level)

U = Undermining (gap under skin edge)

R = Reevaluation (monitoring of parameters)

E = Edge



Acute Wounds

Common wound questions What solution should be used to clean a

wound?

Tap water vs sterile saline

Should wounds be occluded?

Moist wound healing

When are prophylactic antibiotics used?

Clean wound: no; human bites and deep punctures, yes.



Stepwise Approach

Step 1: Is there adequate profusion?

Step 2:Is nonviable tissue present?

Step 3:Are signs/symptoms of infection

and/or inflammation present?

Step 4: Is edema present?

Step 5: Is the wound microenvironment

conducive to healing?



Stepwise approach (con’t)

Step 6: Is tissue growth optimized?

Step7: Is offloading or pressure relief

appropriate?

Step 8: Is pain controlled?

Step 9: Are host factors optimized?

Chronic Wounds

1) Diabetic foot ulcer (DFU)

2) Arterial origin

3) Venous etiology

4) Pressure injury/ pressure ulcer

Diabetic Foot Ulcers



Arterial Disease

Venous Leg Ulcer (VLU)

Pressure Ulcer/ Injury



Pressure Ulcer/Injury

Make a diagnosis

Words of Wound Wisdom

Diabetes = off load and control blood sugar

Arterial = reestablish flow ASAP

Venous = compression

Pressure = multifactorial, takes a team



Who should be referred to a

Wound Center?

Words of Wisdom from the Nurses

“You have to take the

bandage OFF”

Wound dressings



Dressings

GOAL: Keep it clean and moist; exudate management

If wet, dry it: calcium alginate will absorb moisture

If its dry, wet it: hydrogel, medihoney, autolytic occlusion

Cover it: Foam dressing, kerlex, tubigrip

Resources Scottsdale Wound Management Guide

Diagnosis and Treatment of Peripheral Arterial Disease. DUANE R. HENNION, MD, et al. Am Fam Physician. 2013

Sep 1;88(5):306-310.

Diagnosis and Treatment of Venous Ulcers. LAUREN

COLLINS, MD. Am Fam Physician. 2010 Apr 15;81(8):989-

996.

Diabetic Foot Infections. FASSIL W. GEMECHU, MD, et al.

Am Fam Physician. 2013 Aug 1;88(3):177-184.

Pressure Ulcers: Prevention, Evaluation, and

Management. DANIEL BLUESTEIN, MD, et al. Am Fam

Physician. 2008 Nov 15;78(10):1186-1194.



Questions? Email me [email protected]

Documents

Wound Care 101 - POMA