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Wound Evaluation and Initial Care
Joanne Kramer DVM, DACVSDave Wilson DVM, MS, DACVS
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Basic Steps
Overall Initial Observation- Hands off
Overall Initial Evaluation- Hands on minimal
Key History Questions Initial Wound Evaluation Initial Wound CareAny remaining parts of physical exam
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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?
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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?
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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
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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 ?
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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
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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.
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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
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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.
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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
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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
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Veterinary Decisions after Initial Wound Evaluation and CareAre 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)
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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?
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