SHM's Clinical Quick Talks-Wounds

Pdf Summary
"Wounds" by Dr. Joel Steinberg provides a comprehensive overview of physical injuries involving skin or mucous membrane damage. Causes of wounds include burns, ischemia, neuropathy (often diabetic), pressure sores, venous hypertension, surgery, skin neoplasms, toxic exposures, microbial infections, and trauma (e.g., stab wounds, gunshots, compound fractures).<br /><br />Wound healing is described in four phases:<br />1. Hemostasis: Bleeding stops due to vasoconstriction and platelet actions.<br />2. Inflammatory: Neutrophils clear debris, macrophages promote healing, and lymphocytes release growth factors.<br />3. Proliferative: Fibroblasts produce collagen; new epithelial cells cover the wound.<br />4. Remodeling: Collagen strength is reinforced.<br /><br />Chronic wounds are defined by their failure to heal within 30 to 90 days and often stall in the inflammatory phase despite appropriate treatment. Contributing factors to poor wound healing include diabetes, malignancies, smoking, dementia, poor nutrition, obesity, ischemia, and other metabolic conditions like alcoholism.<br /><br />The prevalence of wounds increases with age and chronic conditions. Approximately 5% of hospitalized patients may have wounds. Diagnostic assessments include measuring wound dimensions (length, width, depth), evaluating wound bed composition (granulation, slough, eschar), and obtaining cultures to identify pathogens. Cause determination is crucial, with specific wound locations hinting at underlying causes (e.g., pressure wounds over boney prominences, ischemic wounds at arterial endpoints).<br /><br />Treatment fundamentals involve maintaining a moist wound environment, reducing microbial load, reversing underlying pathologies, and stimulating healing. Strategies include appropriate dressings, antibiotics, debridement, off-loading pressure, revascularization, counteracting venous hypertension, and using advanced modalities like negative pressure or hyperbaric oxygen.<br /><br />Dr. Steinberg emphasizes that chronic wounds should only be labeled as such after thorough cause determination and standard care treatments have been exhausted.
Asset Subtitle
Joel Steinberg
Keywords
wounds
wound healing
chronic wounds
physical injuries
inflammatory phase
diabetes
pressure sores
treatment
diagnostic assessments
Dr. Joel Steinberg