Wound care presentation

By
Ramzy Salama PA-C,CWS
What need to be done for this Ulcer?

If it is a blanchable errythema : so it is an
incontinence dermatitis./ possible canditits.
Dressing types that can be applied ;
You can use nystatin ointment as needed.
If it is non – blanchable, so it is stage one
pressure ulcer.
In that case no dressing is indicated at that
time. Pt. just needed the off loading protocol.
What need to be done in the following
situations

Pressure ulcer stage 2

Dressing types that can be applied ;
Hydrogel daily, Hydrocolloid PRN, or Mepilex
PRN
What need to be done in the following
situations

Pressure ulcer /Deep tissue injury( large blister

filled with blood )
Dressing types that can be applied ;
Mepilex PRN + Heelift for off loading
What need to be done for this ulcer?

Pressure ulcer /Deep tissue injury/ pressure

ulcer stage 1.
Dressing types that can be applied ;
Mepilex PRN + off loading protocol. Air
mattress/ repositioning the patient every two
hours using the 30 degree technique.
What need to be done for this ulcer?

Pressure ulcer /Deep tissue injury on the left

buttock/ pressure ulcer stage 1 on the right
buttock
Dressing types that can be applied ;
Mepilex PRN + aggressive off loading
protocol. Air mattress/ repositioning the
patient every two hours using the 30 degree
technique.
What need to be done in the following
situations

Pressure ulcer stage 2

Dressing types that can be applied ;
Hydrogel daily, Hydrocolloid PRN, xeroform or
Mepilex PRN
What need to be done for this ulcer?

Left buttock Pressure ulcer stage 3, Right

buttock ulcer stage 2
Dressing types that can be applied ;
Collagenase ointment daily, Hydrogel daily,
Hydrocolloid PRN, or Mepilex PRN
What need to be done for this ulcer?

Bilateral buttocks DTI /Pressure ulcer .

Debridement is not indicated at this time.
Please call wound care ASAP
Dressing types that can be applied ;
Mepilex ( Foan wound dressing for cushioning )
Start the off loading protocol and call for an
air mattress
What need to be done for this ulcer?

Bilateral buttocks DTI /Pressure ulcer .

Debridement is not indicated at this time.
Please call wound care ASAP
Dressing types that can be applied ;
Mepilex ( Foan wound dressing for cushioning )
Start the off loading protocol and call for an
air mattress
What need to be done for this ulcer?

Eschar on the sacral and left buttock

,Unstageable Pressure ulcer .
Debridement is indicated at this time. Please
call wound care ASAP
Dressing types that can be applied ;
Hydrocolloid + 4x4 + Bordered gauze
Start the off loading protocol and call for an
air mattress
What need to be done for this ulcer?

Necrotic ( Slough) unstageable sacral pressure

ulcer and Right buttock stage 2 pressure ulcer.
Debridement is indicated at this time. Please
call wound care ASAP
Dressing types that can be applied ;
Collagenase ointment + 4x4 + Bordered gauze
Start the off loading protocol and call for an
air mattress
What need to be done for this ulcer?

Necrotic sacral Pressure ulcer stage 4 with

exposed bone.
Debridement is indicated at this time. Please
call wound care ASAP
Dressing types that can be applied ;
Hydrogel daily + 4x4 + Bordered gauze
Start the off loading protocol and call for an
air mattress
What need to be done for this ulcer?

Necrotic/ infected / undermining right buttock

Pressure ulcer stage 4.
Debridement is indicated at this time. Please
call wound care ASAP
Dressing types that can be applied ;
Hydrogel daily OR iodoform packing + 4x4 +
Bordered gauze. Start the off loading protocol
and call for an air mattress
What need to be done for this ulcer ?

Sacral Pressure ulcer stage 4 with exposed

muscles , Pt. is S/P excisional debridement.
Dressing types that can be applied ;
Hydrogel daily + 4x4 + Bordered gauze.
Preferably wound vac dressing placement.
Start the off loading protocol and call for an
air mattress
What need to be done for this ulcer ?

Dry stable Eschar on the heel ,Unstageable

Pressure ulcer .
Debridement is contraindicated at this time.
Dressing types that can be applied ;
ABD Pads or betadine + abd Pads + Heelift for
off loading and monitoring for deterioration.
What need to be done in the following
situations

Dry stable Eschar on the heel ,Unstageable

Pressure ulcer .
Debridement is contraindicated at this time.
Dressing types that can be applied ;
ABD Pads or betadine + abd Pads + Heelift for
off loading and monitering for deterioration.
What need to be done for this Ulcer?

Dry gangrene of the whole right foot,; arterial

ischemic ulcer .
Please DO NOT call wound care, But call
Podiatry and vascular teams
Dressing types that can be applied ; betadine
+ ABD Pads + Kerlix .
Monitoring for deterioration( Wet gangrene)
What need to be done for this Ulcer?

Right anterior tibial necrotic arterial ischemic

ulcer (Complex wound ) with osteomyelitis (
Exposed bone)
Please call wound care consult.
Dressing types that can be applied ; Hydrogel+
+ ABD Pads + Kerlix .
What need to be done for this ulcer?

Necrotic ischemic left lower extremity .

Patient has vascular issue ( Critical lime
ischemia)
Please do not call call wound care. But call
vascular ASAP
Dressing types that can be applied ;
Xeroform 5” x9” + ABD pads + kerlix .
What need to be done for this Ulcer?

Dry stable Eschar ( Dry gangrene) left 3 rd

arterial ischemic ulcer .
Please DO NOT call wound care, But call
Podiatry and vascular teams
Dressing types that can be applied ; betadine
+ ABD Pads + Kerlix .
Monitoring for deterioration( Wet gangrene)
What need to be done for this ulcer?

LLE necrotic/ infected non healing ulcer

needed debridement. Please call wound care
ASAP.
Dressing types that can be applied ;
Hydrocolloid for autolytic debridement Q 48
hrs. OR xeroform daily dressing changes.
What need to be done for this Ulcer?

If your patient develops a sudden onset of

blue and cold toes. Please notify the treating
team to call vascular team stat,
No dressing is needed at that time . This is an
ischemic leg .
What need to be done for this ulcer?

RLE necrotic ulcer needed debridement. Please

call wound care ASAP.
Dressing types that can be applied ;
Hydrocolloid for autolytic debridement Q 48
hrs. OR xeroform daily dressing changes.
What need to be done in the following
situations

Partial thickness venous stasis ulcer

Dressing types that can be applied ;
xeroform + ABD pads + kerlix +ACE bandage
daily
What need to be done for this Ulcer?

Full tickness granulated venous stasis ulcer.

Dressing types that can be applied ;
xeroform +4x4 + ABD pads + Kerlix + ACE
bandage for compression
Or hydrogel +oil emulsion + 4x4 ABD pads +
Kerlix + ACE bandage for compression
What need to be done for this patient?

Left lower extremity lymphedema

Patient needed to be referred to a lymphedema
Center .
What need to be done for this Ulcer?

Superfacial wound (Open blister)

Dressing types that can be applied ;
xeroform +4x4 + bordered gauze
Or hydrogel +oil emulsion + 4x4 + bordered
gauze.
Or silvadene cream 1% + bordered gauze
What need to be done for this wound?

Right BKA stump surgical wound.

Please call wound care ASAP.
Dressing types that can be applied ;
Hydrogel + oil emulsion ( Adaptic) +strile
4x4 + bordered gauze + Kerlix . Preferably
;Wound vac dressing ( negative pressure
therapy)
What need to be done for this ulcer?

Necrotic / infected / non healing left hand

full thickness burn ulcer.
Please do not call call wound care. But call
plastic ASAP
Dressing types that can be applied ;
Xeroform 5” x9” OR collagenase ointment OR
iodosorb gel + 4x4 gauze + kerlix
What need to be done for this wound?

Midline abdominal surgical site infection

which is no longer will heal by primary
intention. It will heal by secondary intention.
Please call wound care ASAP. Staples need to
be removed and examine the wound to see if
the fascia is intact or not.
Dressing types that can be applied ;
4x4 gauze + Bordered gauze or ABD pads+
tape for absorption .
What need to be done for this wound?

Midline abdominal surgical site infection

which is no longer will heal by primary
intention. It will heal by secondary intention.
Please call wound care ASAP. Staples were
removed and the fascia was intact.
Dressing types that can be applied ;
Wound vac dressing ( negative pressure
therapy)
What need to be done for this wound?

Right forearm surgical full thickness surgical

wound.
Please call wound care ASAP.
Dressing types that can be applied ;
1-Iodoform packing dressing daily after
irrigation with normal saline.
2-Wound vac dressing ( negative pressure
therapy) q 48 hours.
What need to be done for this wound?

Abdominal C-Section surgical site infection

which is no longer will heal by primary
intention. It will heal by secondary intention.
Please call wound care ASAP.
Dressing types that can be applied ;
Hydrogel + strile 4x4 + bordered gauze.
Preferably ;Wound vac dressing ( negative
pressure therapy)
What need to be done for this wound?

Abdominal C-Section surgical site infection .

Please call wound care ASAP.
Dressing types that can be applied ;
Iodoform packing + strile 4x4 + bordered gauze.
Preferably ;Wound vac dressing ( negative
pressure therapy)
What need to be done for this ulcer?

This is a right breast fungated mass

Debridement is contraindicated because of the
bleeding issues. Please call wound care ,but be
very careful cleaning the mass with normal
saline. TAB to dry DO NOT RUB.
Dressing types that can be applied ;
Xeroform ( non -adherent wound dressing ) +
ABD pads + tape Q 48 hours & PRN.
What need to be done for this ulcer?

This is an upper back fungated mass

Debridement is contraindicated at this time.
Please Do not call wound care ,but call Surgery
Dressing types that can be applied ;
Xeroform ( non -adherent wound dressing ) +
ABD pads daily and PRN.
What need to be done for this patient?

This is a necrotizing fasciitis patient.

Serial surgical debridement is indicated at this
time to save the patient’s life.
Surgical team and the wound care team is on
the case already.
Dressing types that can be applied ;
Wound vac dressing ( Negative pressure
wound therapy.
What need to be done for this patient?

This is the same necrotizing fasciitis patient in

the previous slide after 5.5 months of negative
pressure wound therapy.
Dressing types that can be applied ;
Xeroform daily dressing changes and PRN.
What need to be done for this patient?

This is a necrotizing fasciitis of the perineal

area( Fournier’s gangarene) patient.
Serial surgical debridement is indicated at this
time to save the patient’s life.
Surgical team and the wound care team is on
the case already.
Dressing types that can be applied ;
Wound vac dressing ( Negative pressure
wound therapy
What need to be done for this patient?

This is the same patient in the previous slide

with necrotizing fasciitis of the perineal area
( Fournier’s gangrene) patient.
This picture was taken after 18 days of using
negative pressure wound therapy.
What need to be done for this patient?

This is the same patient in the previous slide

with necrotizing fasciitis of the perineal area
( Fournier’s gangrene) patient.
This picture was taken after 28 days from the
initial presentation. Patient underwent a skin
graft placement to his scrotum and a tertiary
closure of his abdominal wound.