Urgencias BURNS & WOUNDS: CLINICAL POINTS WOUND CLASSIFICATION A wound can be defined as any physical or chemical event, caused by the interaction of external agents or not, that produces or induces cell necrosis, disturbances in tissue nutrition and disruption of the architecture and normal tissue continuity. All wounds may, however, be classified into open or closed in relation to the integrity or not of the skin or mucous membranes. A wound can be defined as any physical or chemical event, caused by the interaction of external agents or not, that produces or induces cell necrosis, disturbances in tissue nutrition and disruption of the architecture and normal tissue continuity. All wounds may, however, be classified into open or closed in relation to the integrity or not of the skin or mucous membranes. flaps are so severely damaged that there is no doubt about its viability. Whenever there is doubt about the viability of a flap, it is preferable to clean, cut about 3 mm of the edges and suture in place. The use of passive drains such as the Penrose, must consider an ade - quate time of permanence, as well as the irritating effect that they produce locally. . Closed wounds In closed wounds, any tissue can be involved, the skin can be damaged, but do not presents continuity solutions and remains viable. The forces of inertia, backlash and different tissue resistance may cause that some remote structures from the impact site can also be affected. This is particularly true in structures that are confined within bone boxes such as the brain (see TBI), and t issues such as the spleen which often fractures in absence of external signs of trauma. Ruptures and sprains mainly involve muscles, tendons, and ligaments. Signs of this lesions include quick onset inflammation and lameness. Open Wounds Open wounds denote a continuity solution of the skin or mucous membranes. The underlying tissues can be damaged to varying degrees. Open wounds are contaminated at the time of injury, as the traumatic agent or foreign material is inserted into the wound. Further contamination can occur until the wound is closed. Penetrating wounds are those induced by projectiles or sharp objects, which are inserted into an anatomical cavity such as the chest or abdomen, or in the lumen of hollow organs such as the intestinal loops, stomach or bladder. They only have an entry hole. When there is also an exit hole these wounds are defined as puncture wounds. A laceration is a wound created by the tearing of the tissues, in which the edges are irregular. The damage to the skin and the underlying tissues can be extensive but is confined to the path of the traumatic agent. Avulsions are wounds characterized by the detachment of tissues from their insertions. Skin and subcutaneous tissue can be severely avulsed from deeper tissues, varying in extensions even involving the entire trunk of the animal. Many of these 308 REMEVET · Noviembre - Diciembre · AMMVEPE Crush injuries can include various types of accidental injuries. Damage to the superficial and deep tissues is extensive. The severity of injuries caused by compression is determined by two factors; anatomical region involved and nature of force and length of time that region was under pressure. Hernias are defined as the complete or incomplete protrusion of organs or tissues through an abnormal opening in the presence of skin or mucous membranes without solution of continuity. When these tissues protrude through a hole in the skin, it is called evisceration. PRINCIPLES OF TREATMENT The initial process of evaluation involves a physical examination that will determine the type, degree and extent of the various injuries received by the patient and their ability to put life in danger. Some wounds that could endanger the patient’s life, require immediate action, such as penetrating thoracic or open pneumothorax and those involving massive bleeding due to the compromise of the integrity of large vessels such as the femoral.
Download PDF file