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January 15, 2004
Happy New Year !
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Sponsor's message:
"Change your life in one week"...Wound Management Certification Seminar
Test your knowledge...
What is a healing ridge?….(answer)
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Wound Care Education Institute presents
Wound Care Certification Course
One week seminar, CEU's, and exam
for "WCC" Wound Care Certified Credentials.
click here for details
"...One of the best educational experiences I have ever had"
Carol K. RN, Aurora, IL
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New questions sent by readers.
Please e-mail your answers. See previous questions and answers below.
| If you
know of any patients who are interested in being part of advanced wound care
clinical trials, please visit this new offering by a non-profit
organization. It's a free service that can potentially connect patients to
appropriate clinical trials.
Click here
for more information. |
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Hello:
I am currently being treated to heal skin ulcerations on both of my feet. I
have sickle cell anemia and I am 30 years old. I am searching for more
information on prevention and treatment for these painful ulcerations.
Michael,
Omaha, NE |
Archived emails can not be replied
to. |
I am trying
to find out if Aescin (from horse chestnut) is used in North America for the
treatment of CVI and its associated symptoms such as stasis dermatitis.
Apparently it is being used in Europe with good results. If so what products
are available in Canada containing aescin for this use?
Thanks
JB |
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HELLO, WE ARE SEARCHING FOR INFO ON THE LATEST
STRATIGIES IN THE CARE OF WOUNDS SEEN IN THE EMEERGENCY DEPT. IE:
LACERATIONS , PUNCTURES, AVULSIONS, ABRASIONS.
WE ARE INTERESTED IN THE APPROPRIATE CLEANSING FOR SUCH WOUNDS . ANY INFO
WOULD BE APPRECIATED.
THANKS
MELISSA NOLDY RN NORHT ARUNDEL HOSPITAL GLEN BURNIE MD |
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Job Available:
Location: San Diego, California
Edgemoor Hospital
Distinct Part, Long Term Care Facility
County of San Diego
Clinical Nurse Specialist needed with a
background in wound care and/or infection control to oversee care for 175
residents with a focus on skin integrity and wound prevention.
Please contact Karin Berntsen at 619 956-2939. |
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I am having no luck trying to close a pressure
ulcer on a patients hip. It is undermined by about 0.5cm circumferentially,
and is about 0.5 cm deep. the wound bed only has small amount of yellow
slough since debriding with collagenase, moderate exudate, using iodosorb
and hydrofiber dressings but no improvement, any suggestions?
Jill |
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Can you site a specific government regulation as
to how and when to photograph wounds?
Rose J. Paul, PT
Director of Rehabilitation Services
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Hi, I am a 41 year old male quadraplegic that
has developed a small pressure sore on my lower buttock. It started out like
a pimple and has slowly increased in size. Its only about 3mm wide and maybe
2ml deep. My problem I believe is its in a crease and this is keeping it
from healing. Have been cleaning with saline and coating with Carrington gel
and covering with gause. Very little if any drainage. I know its not much
yet but seems to have halted its healing And any suggestions are
appreciated.
Thanks
Tim p.s. if anyone would like to email I'm
Tstra25593@aol.com |
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I have a diabetic foot ulcer that occurred
overnight and has been with me for about a month. I had one on the other
foot that stayeed with me for years until it eventually had to be operated
on and the fifth toe and bone were ampitated and a slice of the foot was
removed. I went to Illinois Bone and Joint and they put the foot in a full
cast. The same day I went to the emergency room and had it cut off because
of swelling. I have conjestive
heart failure and my circulation is poor. My feet ane legs automatically
swell and I live wearing compression socks. Anyway, Illinois Bone and Joint
wants to put the cast back on and I refused. Is there another treatment? I
have an elevated shoe that has me walking on my heel. I have a "diaper" I
wear on the foot to absord drainage. the compression sock over it, a half
cast that I wear on the bottom of the foot that goes around the outside of
the leg and calf (that the emertencdy roomn invented fter taking the full
cast off)and then wear a sock over it. Any recommendations? Any referals in
the Park Ridge, IL area? Thanks, Steve Daniels |
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Submit your new question to the group right now: wounds@medicaledu.com
Sign up with our Email Service to see replies.
Previous email questions & their replies are listed
below. Remember, replies have not been validated for accuracy or truthfulness.
Hi,
My dad has got an ulcer half way between his knee & ankle. He has bad
circulation as he had a blood clot 5 years ago, we are just wondering if you
can recommend any web sites or any treatments which will help reduce the
size of the ulcer. It is about the 5cent piece size. It gets a crusty scab
and causes a lot of pain.
Your help will be much appreciated
Many thanks
Jessica |
Some
are caused by bad veins, and some are caused by bad arteries. Your physician
or physical therapist needs to do a thorough evaluation to decide which it
is, as the treatment will differ. Most are "venous", or from bad veins. The
most effective treatment for these will be some form of compression
bandaging/wrapping/stockings. The exact form that will be best for your
father is best decided by a physician or physical therapist with specialized
training in wound management. Compression alone can heal about 70% of these,
and most of the rest can heal with compression in conjunction with certain
other treatments such as electrical stimulation, Jobst Compression pumps, or
"Vacuum Assisted Closure". Check on www.aawm.org/specialists.html to see
where the nearest Certified Wound Specialist is to you.
Bryan Gibby, MSPT, CWS
----
Has he seen a Doctor and had it evaluated?
Normally, that crust should be debrided and the wound covered and moist for
better healing, but it should be evaluated. Some Podiatrists are wonderful
at this, and in California at least, they are licensed to treat below the
knee.
Terrigene Schmidt RN BA
-----
Dear Jessica:
Check out the Diapulse Wound Treatment System at www.diapulse.com I have had
tremendous success using this machine on venous stasis ulcers and all other
types of chronic wounds.
Please be advised that I do not have any financial interest in Diapulse. I
keep making this recommendation simply because I know that it works from
reviewing the medical literature and from professional experience. Good
luck.
Thomas A. Sharon, R.N., M.P.H.
---
Sounds like your father has a venous leg
ulcer due to his history of DVT and poor circulation. Get in touch with a
leg ulcer clinic. He needs to have an ABPI to determine wether he would be
suitable for compression bandaging which is the recommended treatment for
venous ulcers. If it is venous in origin it will not heal without
compression. A site you may want to visit
is www.worldwidewounds.com
Janine Michaelides SRN.ONC.DIPHe (WOUND CARE)
---
It sounds like he probably has a venous
insufficiency ulcer. With this type of wound, compression is necessary
for healing.
There are a number of options, and a wound specialist will be able to
determine the appropriate type, and apply it. However,
you can only do this if the arterial circulation is good. That must be
tested first. For a certified specialist in your area, go to www.aawm.org
and www.wocn.org.
Renee C., MSPT, MPH, CWS |
I am a community nurse, I have a client with
venous ulcer, over-granulation is present recently. I would like to know how
to manage the over-granulation. Is hydrocolloid works?
Flora |
Actually, hydrocolloids are known to promote hypergranulation, so don't use
it for this person. Two things really help hypergranulation. First,
compression helps keep it down. Since this is a venous ulcer, compression is
crucial for healing. If that's not enough, silver nitrate can be used to
take down the hypergranulation.
Renee C, MSPT, MPH, CWS---
I have good results using silver nitrate to
cauterize and then using a foam dressing. This may take several treatments.
Sunny, CWOCN
---
Hi
As far as I know, a small dose of corticosteroid topical application for few
days after scrapping of hypergranulated area is useful in controlling in
hypergranulation. In my experience, for some patients if use hydrocolloids,
it will aggravate hypergranulation.
Thanks
Tessy, wound care practitioner
----
For over-granulation or hypergranulated
wound, you can try the foam dressing, Polymem (known as the pink drsg.) or
Allevyn. That seems to work very well in my experience besides the silver
nitrate applicator and less pain. Hope this help.
Tong, RN
---
Flora,
Get to a wound care specialist. He needs silver nitrate to get the wound
back to skin level.
JLG RN,BSN,CWOCN
---
Over-granulation, or hypergranulation, also
known as "proud flesh" is basically too much of a good thing. The most
recent literature I have read says that occlusive dressing such a
hydrocolloids should be avoided. These wounds actually should be left open
to air for about 20-30 minutes 2-3 times a day, then dress with whatever
ointment you are using and cover specifically with a foam pad dressing. Hope
this helps.
Lee
---
Is the overgranulation red and beefy in
appearance? Could be infection in tissues or increased bacterial burden.
Acticoat is excellent for this type of problem.
Also silicone dressings will help reduce overgranulation, but you might also
need to consider silver nitrate treatment
LB (ET Nurse) |
I have found your website very helpful in
developing an education program for nurses working at the large aged care
facility where I work in Sydney. I am interested in innovative education
tools/techniques that enhances nurses understanding of how to prevent
pressure ulcer development. Do you have any resources/contacts?
Thank you |
The
National Pressure Ulcer Advisory Panel has a lot of information, including
posters, on pressure ulcer prevention. They have some good slide sets as
well, on staging and other
issues. www.npuap.org
Renee C., MSPT, MPH, CWS---
Have you tried the Joanna Briggs Institute
website. It contains a large number of best practice guidelines. I'm sure
that there is something in regard to pressure ulcer prevention.
There is also a circular published by NSW Health in pressure ulcer
prevention.
Hope this helps.
Martin EN
Assessor and Workplace Trainer
---
I have nothing innovative I'm afraid.
However, the best educational tool for pressure ulcer prevention is the
time-tested proverbial sledge hammer.
Pound this into the minds of your students until it becomes a mantra:
Zero tolerance for bedsores!!!
Make certain your patients are turned and repositioned every two hours seven
days per week around the clock without fail.
If you prevent the pressure, you will prevent the pressure ulcer.
How come nobody seems to get it? Forgive me. I've been fighting this battle
for two decades and I'm a little frustrated. You can find some valuable
clinical insights and links at the National Pressure Ulcer Advisory Panel
(USA) website at http://www.npuap.org/Default.htm
Thomas A. Sharon, R.N., M.P.H.
---
I am the Coordinator of the Wound Care Unit
here at Destiny: Future Quest in Oklahoma. I have a Wound care training
program that I would be happy to share with you if you will send me your
name and address of where to mail the information. There will be no charge
for the information. Thank you……..
Janalene Eaton,LPN Wound Care Coordinator.
Janalene.Eaton@dfqhugo.com
---
The Australian Wound Management Association (AWMA)
has produced guidelines for the prediction and prevention of pressure ulcers
in Australia for use in situations such as yours. They can be downloaded for
free from the AWMA website (www.awma.com.au) or purchased as booklets from
the association. You should also contact your state wound management
association (contact details on the AWMA site too) and see what support they
may be able to offer you
Greg Duncan
Wound Management Lecturer & Researcher, Monash University, Melbourne
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summary page was compiled from emails submitted to the Wound Care Information
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