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Wound evaluation and initial care
1. Wound Evaluation and Initial
Care
Joanne Kramer DVM, DACVS
Dave Wilson DVM, MS, DACVS
Slide 1 www.vmth.missouri.edu
2. Basic Steps
Overall Initial Observation- Hands off
Overall Initial Evaluation- Hands on
minimal
Key History Questions
Initial Wound Evaluation
Initial Wound Care
Any remaining parts of physical exam
Slide 2 www.vmth.missouri.edu
3. Overall Initial Observation
How distressed does the horse appear?
Is the horse markedly lame at a walk?
Are there any marked asymmetries
noted (eg head tilt, joint swelling) aside
from the wounded region?
Slide 3 www.vmth.missouri.edu
4. Overall Initial Observation
Is the horse breathing normally?
Can the horse see?
Does it appear that the horse has been
eating, drinking, urinating and
defecating normally?
Slide 4 www.vmth.missouri.edu
5. Overall Initial Evaluation
Keep the hands on part of the initial
evaluation as minimal as necessary
Temperature, Pulse, Respiration,
Capillary refill time, Membrane
color, Hydration
Any physical palpation or movement
considered necessary
Slide 5 www.vmth.missouri.edu
6. Initial Wound Evaluation
Is this tissue damage likely the result of
a wound or something else (eg tumor)?
What type of wound does it appear to
be (eg laceration, contusion)?
What anatomical structures might be
involved ?
Slide 6 www.vmth.missouri.edu
7. Initial Wound Evaluation
Is immediate veterinary consultation
required ?
– Any abnormalities on initial observation
– Any wounds deeper than skin
– Any wounds on the limb or face
– Unsure of anatomy
Slide 7 www.vmth.missouri.edu
8. Initial Wound Care
Preparing the wound for better
assessment and or initial therapy
– Protect the wound with sterile water
based gel or gauze
– Heavily contaminated wounds may
need the surrounding area cleaned with
light cleaning with gauze and saline or
tap water to reduce large amounts of
dirt etc.
Slide 8 www.vmth.missouri.edu
9. Initial Wound Care
Preparing the wound for better
assessment and or initial therapy
– Protect the wound with sterile water
based gel or gauze
– Clip the hair around the wound
– Aseptically clean the wound and
surrounding tissues
– Change gauze or sterile lube at each
stage of wound preparation
Slide 9 www.vmth.missouri.edu
10. Initial Wound Care
Aseptic cleaning of the wound and
surrounding tissues
– Povidone-iodine or chlorhexidine
surgical scrub rinsed by saline
– Scrub surrounding area first
– Minimize amount of scrub solution
directly in wound. Rinse thoroughly
– Avoid using alcohol or hydrogen
peroxide in open wounds.
Slide 10 www.vmth.missouri.edu
11. Initial Wound Care
Chlorhexidine
– Longer duration of action
– Avoid near eyes or open synovial
structures
– Saline rinses best
Povidone iodine
– Can be used with alcohol rinses but
avoid getting alcohol in the wound
Slide 11 www.vmth.missouri.edu
12. Initial Wound Care
Wound lavage
– If very heavy contamination may initially
use tap water (causes tissue edema)
– Normal saline or lactated ringer solution
typically used
– 8-15 psi ideal pressure. ~35 or 60 ml
syringe through 18 gauge needle
– Take care not to drive contaminants
deeper into wound
Slide 12 www.vmth.missouri.edu
13. Veterinary Decisions after Initial
Wound Evaluation and Care
Are additional diagnostics required? (eg
radiographs, synovial structure
evaluation)
What method of healing is best? (eg
primary intention vs secondary intention)
Development of a care plan
Local therapy (eg bandaging, regional
medications)
Systemic therapy (eg activity
restrictions, medications)
Slide 13 www.vmth.missouri.edu
14. Key History Questions
Did you see how the wound
happened?
Do you know when the wound
happened?
Have any treatments been applied or
medications been given?
Has the horse ever had a tetanus
toxoid vaccine?
Slide 14 www.vmth.missouri.edu