临床医学 外科 基本外科傷口照料.pdfVIP

基本外科傷口照料 任何傷口均依此原則 hemostasis 5 For Blood loss Avoid hematoma 5 Methods Direct compression(epinephrine) Ligature electrocauterization Wound cleaning 5 For Remove foreign body,bacteria,devital tissue 5 Methods Normal saline in syringe spraying Contaminated w’d: H2O2,soap,iodine followed by normal saline debridement 5 For Remove foreign body,eschar,necrotic tissue 5 Methods Mechanical debridement: surgery,wet dressing,irrigation Chemical debridement: elase,collagenase Autolytic debridement: op-site Local use of antibiotics 5 Bacteria culture: 10 5 5 Using oint or powder neomycin,silver sulfadiazine Wound closure 5 Primary closure 5 Delayed primary closure 5 Secondary intention 5 Graft or flap Selection of wound dressing 5 Purposes Keep moist condition Absorb overt discharge Packing the dead space to avoid infection Remove devital tissue Protect wound Debridement Apply medicine Control odor Selection of wound dressing 5 Gauge or packing strips(iodoform) Outer cover for w’d Packing dead space Apply oint first Selection of wound dressing 5 Coverage with medicine ( sulfa tulla ) New growth cell won’t be removed Selection of wound dressing 5 透明半透性黏性敷料( op site ,tegaderm) 可透水蒸氣及水,可觀察傷口 發炎傷口不可使用 Selection of wound dressing 5 水膠片型敷料( duoderm ) Air不能通過,內含水粒及軟化血纖維原成份 自動清創作用,不黏傷口 不適用於發炎傷口 Selection of wound dressing 5 水液膏型敷料( gelform ) 因會腐蝕skin,所以用來填充dead space debridement Selection of wound dressing 5 吸收滲液的填充敷料(藻膠型填充敷料) 深度有壞死之傷口,會自動清創及吸收滲液