Lacerations: Recognizing and Preventing Complications (Nursing)

00:01 Any laceration has a risk for complication.

00:05 So I wanted to go over the main categories of complications.

00:08 I'm going to talk about what you should look for, how we treat it and how you can prevent it.

00:14 So for example, let's start with infection.

00:16 You know the early signs of infection are going to be increasing pain, increasing redness and warmth or even purulent drainage.

00:23 Now how we would treat that is if you've got that purulent drainage, we're going to culture it and see if we can figure out what is growing in there.

00:29 We would likely give antibiotics and if we have to, they might possibly reopen the wound and drain out that pus and then go on with treatment.

00:39 So how do we prevent this? As part of the healthcare team, we make sure the cleansing we do is thorough and proper, and we consider the use of prophylactic antibiotics for any wound or laceration that could be infected. Now, dehiscence is an ugly word and it is ugly to see.

00:56 That's when a wound has separated or pulled apart.

00:59 Now, this can be caused because there's a deep infection in there.

01:02 There might be the tension on the skin is what caused it.

01:05 Or maybe they had sutures pop out or come out earlier than we wanted to.

01:11 It can even be caused by poor technique.

01:13 But let's hope that never happens.

01:15 Now, how do we manage this? If you have that. Well, this would be something you would contact a health care provider about and let them know. But you want to have your information in order so you can let them know what you're assessing and what you're seeing. But once this happens, you're going to do a wound assessment.

01:31 And then they're going to consider whether they're going to reclose it or just use secondary intention, which means not closing it.

01:37 You're just going to let that wound heal with it open.

01:40 So how do we prevent that? Well, make sure we picked appropriate and proper closure technique.

01:46 Make sure that we try to reduce tension on that wound as much as possible, and give appropriate limitations for their activity based on their wound.

01:55 Now, when it comes to hemorrhage or hematoma, obviously this is high risk.

01:58 So you're going to be on the lookout for signs like expanding or swelling that could indicate that there's bleeding going on underneath where that wound is closed.

02:08 The patient might report increasing pain.

02:10 You might also see bleeding through the dressing.

02:13 Remember any liquid on that dressing, whether it's bleeding or purulent drainage or whatever it is you want to document, how much of it there is and the time that that has developed. Now, if we're going to manage bleeding specifically and try direct pressure, obviously, if that's possible, if the bleeding can't be stopped with direct pressure, they might need surgical intervention, reopen that and ligate or close off that vessel.

02:39 So how do we prevent it? Make sure that we do adequate hemostasis.

02:43 We make sure that is happening in the first place.

02:46 And then if we have to, we're going to use pressure dressings to help us try and cause that hemostasis. Now, what about scarring? This is something that a lot of patients are concerned about.

02:56 Now keloid formation we're talking about this is really irregular.

02:59 Fibrous tissue can be formed at the site of the scar.

03:02 So you're going to want to ask the patient if they've ever had any challenges with keloids forming. Or we don't also want a hypertrophic scar.

03:09 Just another name for that.

03:11 So if a patient has a history of keloid formation, you're going to want to know that and let the healthcare provider also be aware of that.

03:19 How do we manage the poor cosmetic results? You can use things like silicone sheets, gel steroid injections, maybe even do a scar revision, but that's going to be later on down the road.

03:30 The prevention is that they have appropriate and proper wound edge approximation.

03:34 You bring those back together in a way that's going to make a clean and small line.

03:40 So also keeping an eye on tension is going to be critically important too, to make sure that wound stays together and you minimize the risk of having a big scar.

03:50 Neurovascular compromise is a risk of a complication for any type of wound.

03:55 So that means that you're not getting adequate blood supply to that tissue.

04:00 So the signs may be the patient will tell you, oh, the pain is getting worse.

04:03 They might have tingling or numbness as a paresthesia.

04:07 The color of the tissue will be paler or you'll have pallor.

04:11 Pulselessness. You might not be able to feel a pulse there.

04:14 Now, this is a weird one.

04:15 This last one. And I debated whether I should even put it in here, but it's kind of fun. It's seen in compartment syndrome, and it's called poikilothermia.

04:24 Right? Try that one at dinner tonight.

04:26 See what people think. But if the patient is having compartment syndrome, they'll lose the ability to have normal thermoregulation.

04:34 That's poikilothermia. so keep that one in mind.

04:38 But really, what you're most often looking for increasing in pain, tingling and numbness changes in the color and the pulse being weaker or absent.

04:48 Now what do we do? Well, you've got to remove the constrictive dressing.

04:52 And if it's compartment syndrome, they might actually have to make an incision in the tissue to relieve that pressure that's being caused by that swollen tissue.

05:01 How do we prevent it? Our careful assessment keeping an eye on it, making sure the dressings are appropriate.

05:07 We apply them and we do frequent monitoring.

05:12 Now, if there's a foreign body, we're looking for things like persistent pain, inflammation or swelling and that it's just not healing.

05:19 How do we manage it? Well, this may even happen after the patient has been discharged from an emergency department.

05:26 They may need imaging or exploration so they can remove that foreign body.

05:31 How do we prevent it? Make sure you do as thorough an exploration as you can in this site and the time that you've seen in the emergency department, make sure you have adequate lighting and irrigate that wound well.

05:42 Now for looking for tendon or nerve injury, they're going to have functional deficits or sensory changes. It was something to their hand.

05:49 They may say they might not be able to grip or they can't hang on to things.

05:54 So if this happens, we would refer them to surgery for assessment and possible repair.

06:00 How do we prevent it, that initial assessment that you do.

06:04 And make sure that if you have any question, you encourage the health care provider to have a surgical consultation.