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Primary Care Approach to Wound Management

Learn how to evaluate and diagnose common wounds in primary care, provide basic wound management in the office setting, and properly triage and refer patients to the appropriate providers. Topics covered include wound evaluation, history and physical examination, basic wound care management, debridement, reducing bacterial burden, and wound triage and referral.

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Primary Care Approach to Wound Management

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  1. Kevin Taffe, MD, PhD Primary Care Approach to Wound Management

  2. Objectives • Evaluate and diagnose wounds that are commonly seen in primary care • Provide basic wound management in the office setting • Properly triage and refer patients with wounds to the appropriate provider(s)

  3. Evaluation of wounds

  4. Goals of evaluation

  5. Goals of evaluation (cont’d)

  6. Overview of evaluation “I need a Wound Center referral for a sore on my backside” • Chief complaint History of trauma, pressure, therapies, etc. • History • Physical

  7. Description of wound: general approach

  8. Description of wound: Size

  9. Tunneling and Undermining

  10. Examination of Wound Bed

  11. Wound Drainage

  12. Wound Edges

  13. Periwound Skin: Primary Dermatologic Lesions

  14. Periwound Skin: Infection Periwound inflammation Periwound infection Rubor Calor Dolor • Rubor • Calor • Dolor

  15. Wound Location

  16. Other exam findings

  17. Assessment of Wounds: History

  18. Assessment of Wounds: History • HPI: Location, quality, severity, duration, timing, exacerbating/ relieving factors, associated symptoms. • Ask about dressings and other treatments.

  19. History: Risk factor assessment

  20. Basic Wound Care Managment

  21. Treat the underlying cause

  22. Treat contributing factors

  23. Dressing basics • Remove dead tissue • Reduce bacterial burden • Support/ create moist wound environment • Protect wound bed

  24. Dressings: Debridement

  25. Types of debridement

  26. Reduce bacterial burden

  27. Reduce bacterial burden

  28. Treat infection

  29. Maintain or create a moist wound environment

  30. Maintain or create a moist wound environment

  31. Protect wound bed

  32. Wound triage and referral

  33. Triage

  34. Triage

  35. Triage

  36. Triage

  37. Triage

  38. Dermatology referral

  39. Rheumatology referral

  40. Key take-home points • A detailed history is essential for the diagnosis and treatment of wounds. • The examination of wounds should include a description of all wound characteristics, location, and important supplemental exam findings. • Treatment should be focused on managing the underlying cause, contributing factors, and goal-directed dressing selection. • Chronic wounds do not require urgent referral; consider urgent referral to a Wound Center, ER, dermatologist, or rheumatologist in select cases.

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