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Wound Assessment Using the LADD SECO Model

Wound Assessment Using the LADD SECO Model. Bryan Levay HSCI 5108: Instructional Media Summer 2013. Overview. Importance of wound care Lecture Describe wounds Activity Evaluation. Importance of wound care. 15 -25% of all diabetics will have an ulcer in their lifetime

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Wound Assessment Using the LADD SECO Model

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  1. Wound Assessment Using the LADD SECO Model Bryan Levay HSCI 5108: Instructional Media Summer2013

  2. Overview • Importance of wound care • Lecture • Describe wounds • Activity • Evaluation

  3. Importance of wound care • 15-25% of all diabetics will have an ulcer in their lifetime • Recurrence rate 40% • Amputation • 85% of lower-extremity amputation are preceded by an ulcer • 5-year mortality rate following a BKA is ~50% • Amputation have varying psychosocial issues accompanying • Most amputations are preventable

  4. Diabetic foot ulceration • Neuropathic • Neuropathy • Deformity • Minor trauma http://www.google.com/url?sa=i&rct=j&q=&source=images&cd=&cad=rja&docid=5WWAQUHnqiWP5M&tbnid=IRw7Ps56D5DayM:&ved=0CAUQjRw&url=http%3A%2F%2Fhealthylogica.blogspot.com%2F2012%2F07%2Fhow-to-prevent-onset-of-diabetic-foot.html&ei=qN21UcKeBYbSyAGlm4GwAQ&bvm=bv.47534661,d.aWc&psig=AFQjCNFBCGpwm1K3C9kDBScAKMg4RE13XQ&ust=1370959653987682

  5. Summary • 2nd-year DO & DPM students • Basic knowledge from previous courses • Objectives • Identify DFU from non-DFU • Verbally and transcribe the wound description with LADD SECO criteria • Be able to explain 7 of 8 components of LADD SECO • Technologies • Computer, MS Word, PPT, Blackboard access

  6. Learning module • 2-hour lecture • Basic information • Intro to LADD SECO • 2-hour activity • 5-item exercise packet • Evaluation

  7. Lecture • Traditional learning • 2-hour • Lecture hall 2 of the HEC at WesternU • Certified Wound Specialist • Reinforce previous knowledge • Introduce LADD SECO http://www.google.com/imgres?q=lecture&um=1&safe=active&client=safari&rls=en&hl=en&biw=1136&bih=712&tbm=isch&tbnid=Uzj6-RhpnC4shM:&imgrefurl=http://www.123rf.com/photo_16614791_orange-cartoon-characters-sit-in-on-a-lecture.html&docid=xWwpmLpX_iephM&imgurl=http://us.123rf.com/400wm/400/400/limbi007/limbi0071211/limbi007121100130/16614791-orange-cartoon-characters-sit-in-on-a-lecture.jpg&w=1200&h=849&ei=6d21UcC0M4PfyQGkwoG4Dg&zoom=1&ved=1t:3588,r:64,s:0,i:280&iact=rc&dur=391&page=4&tbnh=176&tbnw=232&start=50&ndsp=18&tx=93&ty=104

  8. LADD SECO • Location • Aspect • Dimensions • Drainage • Shape • Edge • Color • Other

  9. Location • Where is the wound located? http://www.google.com/imgres?q=anatomical+position&um=1&hl=en&safe=active&client=safari&rls=en&biw=1179&bih=723&tbm=isch&tbnid=w_CNJwmb0KaW6M:&imgrefurl=http://www.cafepress.com/%2Banatomical_position_artwork_large_poster,664782979&docid=R8XU5XjP3Eg2pM&imgurl=http://images.cpcache.com/merchandise/514_400x400_NoPeel.jpg%253Fregion%253Dname:FrontCenter,id:69332470,w:16&w=400&h=400&ei=31ZcUcrULIn8iAequYDIDQ&zoom=1&ved=1t:3588,r:43,s:0,i:218&iact=rc&dur=495&page=2&tbnh=172&tbnw=210&start=21&ndsp=27&tx=111&ty=114

  10. Aspect • What aspect of the body is it located? • Example: Inside, outside, front, rear • Like location, it distinguishes position http://www.google.com/url?sa=i&rct=j&q=views+from+different+angles&source=images&cd=&docid=XRsFkfXk4ShNRM&tbnid=WDoiN7oqcOuxzM:&ved=&url=http%3A%2F%2Fcghub.com%2Fforum%2Fshowthread.php%3Fp%3D151622&ei=PlVcUe-CI6OriAfb5oHoAg&bvm=bv.44697112,d.aGc&psig=AFQjCNGzvb9-1E8hoVgopZaKkehdeedNCw&ust=1365092030944569

  11. Drainage • Is there any drainage coming out? • Example: purulent, serous, blood http://www.google.com/url?sa=i&rct=j&q=purulent+discharge&source=images&cd=&docid=ZYj8KGfawdI-qM&tbnid=ymr9oyULXt1NHM:&ved=0CAUQjRw&url=http%3A%2F%2Fdermatologyoasis.blogspot.com%2F2012_05_01_archive.html&ei=rG9cUZ7UAuquiQeM2YGwCg&bvm=bv.44697112,d.aGc&psig=AFQjCNEL9euCuqyeFIeop9Zibe52hVneVQ&ust=1365098743919879 http://www.google.com/url?sa=i&rct=j&q=weeping+wound+venous+ulcer&source=images&cd=&docid=4UAVnwaAg_dwqM&tbnid=VtJiVBp1fSVS1M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.lymphedemapeople.com%2Fthesite%2Fedema_chronic_venous_insufficiency.htm&ei=13BcUZTxE8ujiAfG1IGQAg&bvm=bv.44697112,d.aGc&psig=AFQjCNE_Ggdh55QilrI0nuwdnd2mVprECw&ust=1365099005423999 http://www.google.com/url?sa=i&rct=j&q=weeping+wound+venous+ulcer&source=images&cd=&docid=uj0onwI6ihIbiM&tbnid=kik_pTRdGHGAoM:&ved=&url=http%3A%2F%2Fwww.worldwidewounds.com%2F2006%2Fseptember%2FHarker%2FWound-Healing-Complications-Limb-Amputation.html&ei=fXBcUaPLBa2SiQezvIH4CQ&bvm=bv.44697112,d.aGc&psig=AFQjCNE_Ggdh55QilrI0nuwdnd2mVprECw&ust=1365099005423999

  12. Dimensions • What are the dimensions of the wound? • Length x Width x Depth • Metric only http://www.google.com/url?sa=i&rct=j&q=measuring+a+wound&source=images&cd=&docid=MV-nhJ1cE3MZ9M&tbnid=sx8JKbQ5v2qwZM:&ved=&url=http%3A%2F%2Fwww.woundstick.com%2Fwoundstick_20cm_product_page.htm&ei=IFdcUcfqOuPMiAe8moHICg&bvm=bv.44697112,d.aGc&psig=AFQjCNEXsIT8lQujSLzpAd4gXCSfvnOoxQ&ust=1365092513327661

  13. Shape • How is the wound shaped? • Example: circular, linear, irregular http://www.google.com/imgres?q=diabetic+ulcer&um=1&hl=en&safe=active&client=safari&rls=en&biw=1179&bih=723&tbm=isch&tbnid=IRw7Ps56D5DayM:&imgrefurl=http://healthylogica.blogspot.com/2012/07/how-to-prevent-onset-of-diabetic-foot.html&docid=5WWAQUHnqiWP5M&imgurl=http://1.bp.blogspot.com/-QUVSBwO1d0I/T_VsHpitZqI/AAAAAAAABiM/kWfCftbE2xc/s1600/How%252BTo%252BPrevent%252BThe%252BOnset%252BOf%252BDiabetic%252BFoot%252BUlcers.jpg&w=800&h=600&ei=D19cUfybOIj_iAeJjIHoDA&zoom=1&ved=1t:3588,r:5,s:0,i:96&iact=rc&dur=827&page=1&tbnh=180&tbnw=242&start=0&ndsp=15&tx=136&ty=102 http://www.google.com/url?sa=i&rct=j&q=irregular+shaped+ulcer&source=images&cd=&docid=cBUvVZzqOrb4HM&tbnid=QY7dy9Nuw3SNXM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.podiatrytoday.com%2Fcase-studies-unusual-wounds%3Fpage%3D3&ei=a15cUZbvFuWTiAfNo4GoDQ&bvm=bv.44697112,d.aGc&psig=AFQjCNGH16I7SCYPPn0bCTtQE9GH--5xYA&ust=1365094360440745 http://www.google.com/url?sa=i&rct=j&q=foot+chainsaw+wound&source=images&cd=&docid=0mLF3V03ARJKmM&tbnid=RjF9mtgaGV777M:&ved=&url=http%3A%2F%2Fwww.bchw.org%2FTech%2520tips%2FSawCertification%2FChain%2520Saw%2520Injuries.htm&ei=HelZUb2YGqzVigLm94DICA&bvm=bv.44442042,d.cGE&psig=AFQjCNEROUCQqJQX-eweOXLExzrydsulkw&ust=1364933277917644

  14. Edge • How does the wound edges appear? • Example: macerated, callused, necrotic http://www.google.com/url?sa=i&rct=j&q=macerated+wound&source=images&cd=&docid=16femcYuqFNmQM&tbnid=Rnvp3I8cXNx9ZM:&ved=0CAUQjRw&url=http%3A%2F%2Fwocn.confex.com%2Fwocn%2F2007AM%2Ftechprogram%2FP2467.HTM&ei=G2FcUf2_GYWfiAfo6oCgAQ&bvm=bv.44697112,d.aGc&psig=AFQjCNFCT-_HFJHCXAiIuczM1cKIz9btcQ&ust=1365095054762175 http://www.google.com/url?sa=i&rct=j&q=hyperkeratotic+rim+ulcer&source=images&cd=&docid=LgvOhMrukma5BM&tbnid=cOUolUH8FVAN3M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.studyblue.com%2Fnotes%2Fnote%2Fn%2Fskin%2Fdeck%2F5281900&ei=7WFcUcHtCOX_iAfxyoHIBw&bvm=bv.44697112,d.aGc&psig=AFQjCNGjLNnoKcbBVq-Hc6TWqrpYnZWlHg&ust=1365095263991005 http://www.google.com/url?sa=i&rct=j&q=necrotic+ulcer&source=images&cd=&docid=u_4IxDraUJXYdM&tbnid=Vk6kEM4qxCX5UM:&ved=0CAUQjRw&url=http%3A%2F%2Fopeni.nlm.nih.gov%2Fdetailedresult.php%3Fimg%3D3105064_pone.0020492.g002%26req%3D4&ei=gWJcUfyICs-5iAeIwYGADA&bvm=bv.44697112,d.aGc&psig=AFQjCNFyoy0NiqcBL7eu-e-nmi_wPituWw&ust=1365095397186211

  15. Color • What is the color of the wound base? • Example: Red, white, yellow, black http://www.google.com/url?sa=i&rct=j&q=venous+ulcer&source=images&cd=&docid=-jNJwK6c6lT2OM&tbnid=ioD9PfVud7j0aM:&ved=0CAUQjRw&url=http%3A%2F%2Fpics8.this-pic.com%2Fkey%2Fdifference%2520between%2520arterial%2520venous%2520ulcers&ei=t_VZUYvTD4epkAXHkYGADw&bvm=bv.44442042,d.dGI&psig=AFQjCNHVgEv36weHpBuYG-OFCPGkjEoVGA&ust=1364936195878872 http://www.google.com/url?sa=i&rct=j&q=ulcer+color&source=images&cd=&docid=H8aN--s8OMZAxM&tbnid=CXePJOwpqHLDCM:&ved=&url=http%3A%2F%2Fwww.skinsight.com%2Fadult%2FaphthousUlcerCankerSore.htm&ei=-WNcUenbFKiiiAff34GYBg&bvm=bv.44697112,d.aGc&psig=AFQjCNFjqwOKYBrw_l6Nn165Gw24E3bUVA&ust=1365095801684734 http://www.google.com/url?sa=i&rct=j&q=yellow+wound&source=images&cd=&docid=sP-KGNu6izdraM&tbnid=1gShQ_ETkvAVpM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.worldwidewounds.com%2F1997%2Fjuly%2FThomas-Guide%2FDress-Select.html&ei=_2VcUZfLMubqiAfQrIGIBQ&bvm=bv.44697112,d.aGc&psig=AFQjCNHJzccSGyEBZN9AVB4cZc_Q48tQ_Q&ust=1365096312735874 http://www.google.com/url?sa=i&rct=j&q=black+wound&source=images&cd=&docid=sP-KGNu6izdraM&tbnid=b4m1zyaq2Tsk1M:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.worldwidewounds.com%2F1997%2Fjuly%2FThomas-Guide%2FDress-Select.html&ei=n2ZcUYD7Ke2tiQf5u4HIDA&bvm=bv.44697112,d.aGc&psig=AFQjCNFl771nUPqSEzYgbLW2fq49PZqu0g&ust=1365096465479103

  16. Other • Other things you notice? • Warmth? • Odor? • Satellite wounds? • Tunneling? • Periwound area?

  17. Activity • 2-hour session • 6-8 students per break out room • 1-2 DPM, 5-6 DO • 5 cases with image • Individual needs to complete • Rounding faculty will provide assistance

  18. Evaluation

  19. Student feedback

  20. References • American Diabetes Association. (2013). Economic Costs of Diabetes in U.S. in 2012. Diabetes Care, 36(4), 1033-1046. doi: 10.2337/dc12-2625 • Armstrong, D. G., Nguyen, H. C., Lavery, L. A., van Schie, C. H. M., Boulton, A. J. M., & Harkless, L. B. (2001). Off-loading the diabetic foot wound: A randomized clinical trial. Diabetes Care, 24(6), 1019-1022. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11375363 • Bryant, R. A., & Nix, D. P. (Eds.). (2003). Acute & chronic wounds: Current management concepts (3 ed.). St. Louis, Missouri: Mosby Elsevier. • Bumpus, K., & Maier, M. A. (2013). The ABC’s of wound care. Current Cardiology Reports. Advance online publication. doi: 10.1007/s11886-013-0346-6 • Carls, G. S., Gibson, T. B., Driver, V. R., Wrobel, J. S., Garoufalis, M. G., DeFrancis, R. R., . . . . Christina, J. R. The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers. Journal of the American Podiatric Medical Association, 101(2), 93-115. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21406693 • Cavanagh, P. R., & Bus, S. A. (2010). Off-loading the diabetic foot for ulcer prevention and healing (Supplemental material). Plastic and Reconstructive Surgery, 127(1S), 248S-256S. doi: 10.1097/PRS.0b013e318202484 • Harkless, L., & Holmes, C. (2004). Linking risk factors: The role of history in predicting outcome. The Diabetic Foot, 7(3), 114-122. Retrieved from http://www.highbeam.com/doc/1G1-124137347.html • Leung, P. C. (2007). Diabetic foot ulcers – a comprehensive review. Surgeon, 5(4), 219-231. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17849958 • Ramsey, S. D., Newton, K., Blough, D., McCulloch, D. K., Sandhu, N., Reiber, G. E., & Wagner, E. H. (1999). Incidence, outcomes, and cost of foot ulcers in patients with diabetics. Diabetes Care, 22(3), 382-387. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10097914 • Rhim, B., & Harkless, L. (2012). Prevention: Can we stop problems before they arise? Seminars in Vascular Surgery, 25(2), 122-128. doi: 10.1053/j.semvascsurg.2012.05.002

  21. Questions?

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