Chemotherapy has been a routine in Surgical Department in the place i work. There's many types and many regimes of chemotherapy used here. Chemotherapy when given to patient, it has many aims that works differently for each different regime.
First of all, types of chemo can be divide into 2 main group :
1. Curative -----------> i) neoadjuvant ii) adjuvant
2. Palliative
Curative chemo used with the aim to treat the cancer and to reduce the size of tumor or to be given after a surgical intervention with the aim of preventing the recurrence of the tumor. Basically to get rid of the tumor.
Palliative chemo is used just to reduce the activity or aggressiveness of the tumor without any intention to treat the cancer fully. Used when the cancer already have metastasis. Basically just to increase the life expectancy of a patient.
Neoadjuvant chemo - given before any surgery done, given with the aim to shrink the primary tumor so that when the tumor reduce in size, it can be surgically removed.
Adjuvant chemo - given after any surgery to remove the tumor is done, with the aim of reducing the % of recurrence and also to reduce any new tumor growth.
Types of chemo drugs :
i) alkylating agents
ii) antimetabolites
iii) anthracyclines
iv) alkaloids
v) topoisomerase inhibitors, etc etc.
They all function by effecting on the cell divison and DNA synthesis and function.
Types of Chemo Regime commonly used in my place :
1. For Breast CA -------------> i) FAC - Folinic acid
Adriamycin/Doxorubicin
Cyclophosphamide
ii) FEC - Folinic acid
Epirubicin
Cyclophosphamide
2. For Colorectal CA ---------> i) FOLFIRI - Folinic acid ( Leucovorin)
5-Fluorouracil
Irinotecan
ii) FOLFOX - Folinic acid
5-Fluorouracil
Oxaliplatin
iii) De Gramont - Folinic acid
5-Fluorouracil
iv) Mayo - Folinic acid
5-Fluorouracil
** Folinic Acid - i) works to increase the efficacy of the chemo drug to kill the cancel cell
ii) also works as protector of healthy cells from the chemo effect
(always give folinic acid before giving chemo drugs, especially Fluorouracil)
Complications or Side effects of Chemo Treatment -- affects on all the healthy fast dividing cells of body
Divided into local and systemic
i) Local - skin erythema, pain , dry mouth, vomitting, nausea, reduce appetite, allergic locally, alopecia
ii) Systemic - reduce immunity (neutropenia) , induce anemia ( effect on bone marrow fx)
tendency to bleed ( thrombocytopenia)
GIT effect - constipation @ diarrhea
infertility
fatigue
secondary neoplasm ( AML after chemo treatment)
Can also be cardiotoxicity, hepatotoxicity, nephrotoxicity, ototoxicity and also encephalopathy
Monday, January 24, 2011
Saturday, January 22, 2011
Mode of Oxygen Delivery
We can divide the mode of O2 delivery into 2 types ;
1. Fixed ---- i) Intubation ii) High Flow Mask (HFM) @ Venturi Mask
2. Non-fixed ---- i) Nasal Prong ii) Face Mask
Fixed - the amount of O2 concentration that is given to the patient is fixed as the patient do not need to put effort to breath.
Non-fixed - the amount of O2 concentration given to patient is not fixed as patient breath in the room air together with the O2 given, so the amount of O2 inhale varies with the patient's breathing effort
1. Nasal Prong - can give up to 3L/m of O2 and also up to 30% of O2 concentration
2.Face Mask - can give up to 12-15L/m of O2 and can give up to 40-50% of O2 concentration
3. HFM - can give up to 15L/m with fixed O2 concentration of 40-60%
4. Intubation - gives a fixed O2 concentration of 100%
Factors that influence the delivery of O2 to tissue ;
1. Hb amount
2. O2 saturation
3. Tissue perfussion
** Any mistakes, plz let me noe so that i can make the changes... thx
1. Fixed ---- i) Intubation ii) High Flow Mask (HFM) @ Venturi Mask
2. Non-fixed ---- i) Nasal Prong ii) Face Mask
Fixed - the amount of O2 concentration that is given to the patient is fixed as the patient do not need to put effort to breath.
Non-fixed - the amount of O2 concentration given to patient is not fixed as patient breath in the room air together with the O2 given, so the amount of O2 inhale varies with the patient's breathing effort
1. Nasal Prong - can give up to 3L/m of O2 and also up to 30% of O2 concentration
2.Face Mask - can give up to 12-15L/m of O2 and can give up to 40-50% of O2 concentration
3. HFM - can give up to 15L/m with fixed O2 concentration of 40-60%
4. Intubation - gives a fixed O2 concentration of 100%
Factors that influence the delivery of O2 to tissue ;
1. Hb amount
2. O2 saturation
3. Tissue perfussion
** Any mistakes, plz let me noe so that i can make the changes... thx
SSI @ Surgical Side Infection@ Surgical Wound
This is a very favorite question of my Surgeon,(MR.Selvan) almost all new houseman will be asked to answer this question.
Basically, the surgical wounds can be categorized into 4 types :
1.Clean wound - a superficial wound, which do not enter into any hollow organ ( respiratory, GIT, urinary system)
** Only 2% rate of infection from this type of wound
***Antibiotics given for this wound if --> immunocompromised ; can cause catosphoric* event which involves CNS or CVS ; use of implant/foreign bodies; (I forgot the 4th factor..huhu)
2. Clean contaminated wound - wound that enter into hollow organs ( respiratory, GIT, urinary) without any spillage(pus, bile)
**Rate if infection is 6-9%
3. Contaminated wound - wound that enter into hollow organs ( repiratory, GIT, urinary) with contact with spillage ( pus,bile,feces)
**Rate of infection is 13-20%
4. Dirty wound - wound that already has pus, abcess or any trauma wound which already contaminated
**Rate of infection is 40%
There's 2 website that tells in detail about all the wounds, check out this 2 sites;
1. Overview of surgical site infection
2. Surgical dressings
If there is any mistakes on the material above, please let me know so that i can correct it.. heheh ;)
Basically, the surgical wounds can be categorized into 4 types :
1.Clean wound - a superficial wound, which do not enter into any hollow organ ( respiratory, GIT, urinary system)
** Only 2% rate of infection from this type of wound
***Antibiotics given for this wound if --> immunocompromised ; can cause catosphoric* event which involves CNS or CVS ; use of implant/foreign bodies; (I forgot the 4th factor..huhu)
2. Clean contaminated wound - wound that enter into hollow organs ( respiratory, GIT, urinary) without any spillage(pus, bile)
**Rate if infection is 6-9%
3. Contaminated wound - wound that enter into hollow organs ( repiratory, GIT, urinary) with contact with spillage ( pus,bile,feces)
**Rate of infection is 13-20%
4. Dirty wound - wound that already has pus, abcess or any trauma wound which already contaminated
**Rate of infection is 40%
There's 2 website that tells in detail about all the wounds, check out this 2 sites;
1. Overview of surgical site infection
2. Surgical dressings
If there is any mistakes on the material above, please let me know so that i can correct it.. heheh ;)
Post Operation Complications/Fever
There's some main factors tat cause complication/fever postoperatively and we can use this mnemonic to easily remember the source of complications/fever.
"5 W's"
1. Wind - complication from respiratory system, usually segmental atelectasis occurs, as patient usually not breathing well after op and this lead to reduce mucous secretion and will form mucous plug in the alveolar which will cause collapse of the alveolar, known as segmental atelectasis. Tis can further lead to pneumonia if the mucous plug get infected.
TO PREVENT THIS - encourage chest physio , encourage incentive spirometry, prop up patient to about 30 degree and also to give adequate anlgesic if needed so that, patient can breath and expand the lungs pain free.
** One way to check if the analgesic is adequate or patient is improving with chest physio is to ask patient to cough, if the patient is able to cough and with increasing trend, it means patient is recovering well with our treatments** (told to me by my MO)
2. Water - urinary tract infection, usually happen cause of CBD, to remove asap.
3. Wein @ Vein - thrombophlebitis , DVT, PE
4. Wound - surgical side infection ( infection at the operation site, wound breakdown, etc)
5. What else - to check for other cause other than the 4 above, usually like drug fever, blood tranfusion reaction, etc)
* Atelectasis happens in 48 hours
* UTI happens in 3-4 days post Op
* SSI and thrombophlebitis also 3-4 days post Op
What to look if patient develop fever postoperatively:
1. check lungs
2. check surgical wound side
3. check cathether side ( CBD, Branullas, CVL)
4. skin for rashes
5. joint for inflammations.
Non-infectious cause of Postoperative fever:
1. Drug fever will have increase Eosinophilia
2. Hematoma with increase temperature and leukocytosis
3. Gout
4. Transfusion reaction
5. DVT @ PE
"5 W's"
1. Wind - complication from respiratory system, usually segmental atelectasis occurs, as patient usually not breathing well after op and this lead to reduce mucous secretion and will form mucous plug in the alveolar which will cause collapse of the alveolar, known as segmental atelectasis. Tis can further lead to pneumonia if the mucous plug get infected.
TO PREVENT THIS - encourage chest physio , encourage incentive spirometry, prop up patient to about 30 degree and also to give adequate anlgesic if needed so that, patient can breath and expand the lungs pain free.
** One way to check if the analgesic is adequate or patient is improving with chest physio is to ask patient to cough, if the patient is able to cough and with increasing trend, it means patient is recovering well with our treatments** (told to me by my MO)
2. Water - urinary tract infection, usually happen cause of CBD, to remove asap.
3. Wein @ Vein - thrombophlebitis , DVT, PE
4. Wound - surgical side infection ( infection at the operation site, wound breakdown, etc)
5. What else - to check for other cause other than the 4 above, usually like drug fever, blood tranfusion reaction, etc)
* Atelectasis happens in 48 hours
* UTI happens in 3-4 days post Op
* SSI and thrombophlebitis also 3-4 days post Op
What to look if patient develop fever postoperatively:
1. check lungs
2. check surgical wound side
3. check cathether side ( CBD, Branullas, CVL)
4. skin for rashes
5. joint for inflammations.
Non-infectious cause of Postoperative fever:
1. Drug fever will have increase Eosinophilia
2. Hematoma with increase temperature and leukocytosis
3. Gout
4. Transfusion reaction
5. DVT @ PE
Types of Bleeding
Theres many types of bleeding, i will share the common 2 set of types of bleeding that mentioned frequently in surgical posting.
First
TYPES OF BLEEDING FROM WOUND
1.Primary bleeding - bleeding that occurs immediately following an injury.
2.Reactionary bleeding - bleeding that occurs after first 48 hours of injury, happens usually due to displaced clot in the vessel (postoperative)
3. Secondary bleeding - bleeding that happens after 8-14 days when the wound become infected and erode a vessel.
SECOND
TYPES OF BLEEDING IN Gastrointestinal Tract.
1. Overt bleeding - bleeding that can be seen with naked eyes in the stool.
2.Occult bleeding - bleeding that cant be seen with naked eyes, need to do stool test to confirm it.
3.Obscure bleeding - there's bleeding in the GIT, but cant find the origin of bleeding.
First
TYPES OF BLEEDING FROM WOUND
1.Primary bleeding - bleeding that occurs immediately following an injury.
2.Reactionary bleeding - bleeding that occurs after first 48 hours of injury, happens usually due to displaced clot in the vessel (postoperative)
3. Secondary bleeding - bleeding that happens after 8-14 days when the wound become infected and erode a vessel.
SECOND
TYPES OF BLEEDING IN Gastrointestinal Tract.
1. Overt bleeding - bleeding that can be seen with naked eyes in the stool.
2.Occult bleeding - bleeding that cant be seen with naked eyes, need to do stool test to confirm it.
3.Obscure bleeding - there's bleeding in the GIT, but cant find the origin of bleeding.
Types of Shock
According to the international classification, there's 4 types of shock :
i) Hypovolemic
ii) Cardiogenic
iii) Distributive
iv) Obstructive
We can grade the severity of the shock.This approximates to the effective loss of blood volume. The blood volume does not have to actually be lost from the circulation as an expansion in the volume of the circulatory system (e.g. in septic shock) will render the patient proportionally hypovolaemic.
Grade 1 - loss up to 15% ( ~750ml) ----> mild resting tachycardia
Grade 2 - loss from 15%-30% ( 750-1500ml) ----> moderate tachycardia and narrow pulse pressure
Grade 3 - loss from 30%-40%(1500-2000ml) ----> the compensatory mechanisms begin to fail and
hypotension, tachycardia and low urine output (<0.5ml/kg/hr>.
Grade 4 - loss from 40%-50%(2000-2500ml) ---->profound hypotension will develop and if prolonged will
cause end-organ damage and death
Now the types of shock.
1. Hypovolemic - due to insufficient circulating volume caused by hemorrhage, internal bleeding, severe burns and high output fistula
2. Cardiogenic - due to failure of the muscle of heart to pump efficiently due to MI, arrhythimias, CHF.
3. Distributive - a form of 'relative hypovolemic' due to dilation of blood vessel which diminishes systemic vascular resistance.
eg i) Septic Shock - sepsis with hypotension despite fluid resuscitation, due to vasodilation that caused by systemic infection which usually caused by Gram -ve (E.coli, proteus, Klebsiella) and Gram +ve ( pneumococci, streptococci)
ii) Anaphylactic shock - allergen causing release if histames -> vasodilation and increase capillary permeability-> hypotension.
iii) Neurogenic shock - due to trauma to the spinal cord -> loss of autonomic and motor reflex below the injury level -> no symphatetic action so lead to vessel wall relax uncontrollably, lead to reduce peripheral vascular resistance -> hypotension.
4. Obstructive - when flow of blood is obstructed which impedes the circulation.
eg) i) Cardiac tamponade or constrictive pericarditis - prevent inflow of blood into heart
ii) Tension pneumothorax - increase intrathoracic pressure, reduce blood flow into heart.
iii) Massive PE , Aortic stenosis.
Management of SHOCK
MAIN AIM IS TO RESTORE NORMAL TISSUE PERFUSION
1.Establish Airway and O2 delivery
2.Fluid resuscitation - 2 large 16 size branulla, run Normal Saline@Hartmann fast over 10 mins, 30 mins, 1 hour and then reassess the BP, pulse, urine output.
3. Give adequate analgesic for pain management.
4.Treat mechanical cause if any ( tension pneumothorax, pericardial tamponade)
5. Blood transfusion if indicated
6.Inotropes if indicated
7.Vasopressin if indicated
8.Early antibiotics and rapid identification of infection in septic shock.**
** SIGN to LOOK in Hypotension or blood loss.
1. BP -- reducing trend or less than 90/60( according to my boss, dont just follow the 90/60 rules, always see the dynamics of the BP trend)
2.Pulse -- tachycardic shows that there's insufficient fluid in circulation.
3. Check urine output -- always maintain 30-50 cc/h
4. Check Hb level, if less than 8gm.. always think of tranfusing blood.
5. Do rectal examination in case there's GIT bleed.
i) Hypovolemic
ii) Cardiogenic
iii) Distributive
iv) Obstructive
We can grade the severity of the shock.This approximates to the effective loss of blood volume. The blood volume does not have to actually be lost from the circulation as an expansion in the volume of the circulatory system (e.g. in septic shock) will render the patient proportionally hypovolaemic.
Grade 1 - loss up to 15% ( ~750ml) ----> mild resting tachycardia
Grade 2 - loss from 15%-30% ( 750-1500ml) ----> moderate tachycardia and narrow pulse pressure
Grade 3 - loss from 30%-40%(1500-2000ml) ----> the compensatory mechanisms begin to fail and
hypotension, tachycardia and low urine output (<0.5ml/kg/hr>.
Grade 4 - loss from 40%-50%(2000-2500ml) ---->profound hypotension will develop and if prolonged will
cause end-organ damage and death
Now the types of shock.
1. Hypovolemic - due to insufficient circulating volume caused by hemorrhage, internal bleeding, severe burns and high output fistula
2. Cardiogenic - due to failure of the muscle of heart to pump efficiently due to MI, arrhythimias, CHF.
3. Distributive - a form of 'relative hypovolemic' due to dilation of blood vessel which diminishes systemic vascular resistance.
eg i) Septic Shock - sepsis with hypotension despite fluid resuscitation, due to vasodilation that caused by systemic infection which usually caused by Gram -ve (E.coli, proteus, Klebsiella) and Gram +ve ( pneumococci, streptococci)
ii) Anaphylactic shock - allergen causing release if histames -> vasodilation and increase capillary permeability-> hypotension.
iii) Neurogenic shock - due to trauma to the spinal cord -> loss of autonomic and motor reflex below the injury level -> no symphatetic action so lead to vessel wall relax uncontrollably, lead to reduce peripheral vascular resistance -> hypotension.
4. Obstructive - when flow of blood is obstructed which impedes the circulation.
eg) i) Cardiac tamponade or constrictive pericarditis - prevent inflow of blood into heart
ii) Tension pneumothorax - increase intrathoracic pressure, reduce blood flow into heart.
iii) Massive PE , Aortic stenosis.
Management of SHOCK
MAIN AIM IS TO RESTORE NORMAL TISSUE PERFUSION
1.Establish Airway and O2 delivery
2.Fluid resuscitation - 2 large 16 size branulla, run Normal Saline@Hartmann fast over 10 mins, 30 mins, 1 hour and then reassess the BP, pulse, urine output.
3. Give adequate analgesic for pain management.
4.Treat mechanical cause if any ( tension pneumothorax, pericardial tamponade)
5. Blood transfusion if indicated
6.Inotropes if indicated
7.Vasopressin if indicated
8.Early antibiotics and rapid identification of infection in septic shock.**
** SIGN to LOOK in Hypotension or blood loss.
1. BP -- reducing trend or less than 90/60( according to my boss, dont just follow the 90/60 rules, always see the dynamics of the BP trend)
2.Pulse -- tachycardic shows that there's insufficient fluid in circulation.
3. Check urine output -- always maintain 30-50 cc/h
4. Check Hb level, if less than 8gm.. always think of tranfusing blood.
5. Do rectal examination in case there's GIT bleed.
Long Hiatus
Its been a while since last i wrote here.. blame it to the hectic work and also too much of jalan jalan around Ipoh during my free time.. LOL.
Neway.. now i m done with my 1st posting, Surgery, which went well and i really learned alot from all the bosses there. Next stop is O&G.. hopefully tis also will be a good posting for me. Since i m in my end posting off, so i decided to update the blog and share all my pending infos with all of you..
Sorry for the delay... ;)
Neway.. now i m done with my 1st posting, Surgery, which went well and i really learned alot from all the bosses there. Next stop is O&G.. hopefully tis also will be a good posting for me. Since i m in my end posting off, so i decided to update the blog and share all my pending infos with all of you..
Sorry for the delay... ;)
Thursday, October 21, 2010
SIRS
Systemic Inflammatory Response Syndrome (SIRS) - is an inflammatory state affecting the whole body, frequently a response of the immune system to infection.
SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines. SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection
Criteria for SIRS are
Fever and leukocytosis are features of the acute-phase reaction, while tachycardia is often the initial sign of hemodynamic compromise. Tachypnea may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.
Complication of SIRS
SIRS is frequently complicated by failure of one or more organs or organ systems. The complications of SIRS include: Some other terms that we need to noe and differentiate it :
i) Sepsis = SIRS + known@suspected infection @ SIRS + Bacteremia
ii) Septicemia = presence of bacteria in blood(bacteremia) + severe infection with septic sign*
iii) Septic Shock = reduce tissue perfusion and reduced O2 delivery due to infection and sepsis and the MAIN criterias are 1- evidence of infection ( +ve blood culture) 2-refractory hypotension ( hypo despite adequate fluid resuscitation...BP<90..wbc>12000 ... 3-HR>90 ... 4-temp>38C ... 5-cold peripheries
iv) Severe Shock = septic shock + MODs(multiple organ dysfx) and not recovering despite treatment
Management of Septic Shock
[OVERS]
1 Oxygen therapy - put the patient with Nasal prog or FaceMask or Ventimask
2.Volume resuscitation - set 2 large branula (16G) and run fluid thru it
3.Early antibiotics - wide spectrum antibitics IV
4,Rapid sauce identification - and wound infected or do a septic workour asap
5.Support for major org dysfx - monitor patient vital sign .. brain, heart, kidney, lung, liver, intestine..
SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines. SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection
Criteria for SIRS are
- Body temperature less than 36°C or greater than 38°C
- Heart rate greater than 90 beats per minute
- Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
- White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10% immature neutrophils (band forms)
Fever and leukocytosis are features of the acute-phase reaction, while tachycardia is often the initial sign of hemodynamic compromise. Tachypnea may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.
Complication of SIRS
SIRS is frequently complicated by failure of one or more organs or organ systems. The complications of SIRS include: Some other terms that we need to noe and differentiate it :
i) Sepsis = SIRS + known@suspected infection @ SIRS + Bacteremia
ii) Septicemia = presence of bacteria in blood(bacteremia) + severe infection with septic sign*
iii) Septic Shock = reduce tissue perfusion and reduced O2 delivery due to infection and sepsis and the MAIN criterias are 1- evidence of infection ( +ve blood culture) 2-refractory hypotension ( hypo despite adequate fluid resuscitation...BP<90..wbc>12000 ... 3-HR>90 ... 4-temp>38C ... 5-cold peripheries
iv) Severe Shock = septic shock + MODs(multiple organ dysfx) and not recovering despite treatment
Management of Septic Shock
[OVERS]
1 Oxygen therapy - put the patient with Nasal prog or FaceMask or Ventimask
2.Volume resuscitation - set 2 large branula (16G) and run fluid thru it
3.Early antibiotics - wide spectrum antibitics IV
4,Rapid sauce identification - and wound infected or do a septic workour asap
5.Support for major org dysfx - monitor patient vital sign .. brain, heart, kidney, lung, liver, intestine..
Wednesday, October 20, 2010
Bubonocele
Bubonocele - An inguinal hernia, especially one in which the knuckle of intestine has not yet emerged from the external abdominal ring @ incomplete inguinal hernia ( bubonocele..actually its a old term it seems... told by a surgeon when assisted her in a Hernioplasty .. )
Saturday, October 16, 2010
Wound
Mechanism of wound healing has 4 stages :
1.Haemostasis -
Upon injury to the skin, a set of complex biochemical events takes place in a closely orchestrated cascade to repair the damage.Within minutes post-injury, platelets (thrombocytes) aggregate at the injury site to form a fibrin clot. This clot acts to control active bleeding (hemostasis)
2. Inflammatory
In the inflammatory phase, bacteria and debris are phagocytosed and removed, and factors are released that cause the migration and division of cells involved in the proliferative phase. We can see the 5 inflammation sign on the wound at tis stage. (red,warm,painful, edematous and loss of fx)
3.Proliferative @ Granulation
The proliferative phase is characterized by angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction. In angiogenesis, new blood vessels are formed by vascular endothelial cells. In fibroplasia and granulation tissue formation, fibroblasts grow and form a new, provisional extracellular matrix (ECM) by excreting collagen and fibronectin. Concurrently, re-epithelialization of the epidermis occurs, in which epithelial cells proliferate and 'crawl' atop the wound bed, providing cover for the new tissue
4. Maturation @ Remodeling
In the maturation and remodeling phase, collagen is remodeled and realigned along tension lines and cells that are no longer needed are removed by apoptosis
CLASSIFICATION OF SURGICAL WOUND
Thrs 4 types of surgical wound ;-
1. Clean
2. Clean Contaminated
3. Contaminated
4. Dirty
CLASS I/CLEAN WOUNDS--an uninfected surgical wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Surgical wound incisions that are made after nonpenetrating (ie, blunt) trauma should be included in this category if they meet the criteria.
CLASS II/CLEAN-CONTAMINATED WOUNDS--a surgical wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, surgical procedures involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection is encountered and no major break in technique occurs
CLASS III/CONTAMINATED WOUNDS--open, fresh, accidental wounds. In addition, surgical procedures in which a major break in sterile technique occurs (eg, open cardiac massage) or there is gross spillage from the gastrointestinal tract and incisions in which acute, nonpurulent inflammation is encountered are included in this category.
CLASS IV/DIRTY OR INFECTED WOUNDS--old traumatic wounds with retained or devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the wound before the surgical procedure
Have a look at tis table.. its more easy to understand the classifications, click the below link
Surgical Wound Classification [4]
1.Haemostasis -
Upon injury to the skin, a set of complex biochemical events takes place in a closely orchestrated cascade to repair the damage.Within minutes post-injury, platelets (thrombocytes) aggregate at the injury site to form a fibrin clot. This clot acts to control active bleeding (hemostasis)
2. Inflammatory
In the inflammatory phase, bacteria and debris are phagocytosed and removed, and factors are released that cause the migration and division of cells involved in the proliferative phase. We can see the 5 inflammation sign on the wound at tis stage. (red,warm,painful, edematous and loss of fx)
3.Proliferative @ Granulation
The proliferative phase is characterized by angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction. In angiogenesis, new blood vessels are formed by vascular endothelial cells. In fibroplasia and granulation tissue formation, fibroblasts grow and form a new, provisional extracellular matrix (ECM) by excreting collagen and fibronectin. Concurrently, re-epithelialization of the epidermis occurs, in which epithelial cells proliferate and 'crawl' atop the wound bed, providing cover for the new tissue
4. Maturation @ Remodeling
In the maturation and remodeling phase, collagen is remodeled and realigned along tension lines and cells that are no longer needed are removed by apoptosis
CLASSIFICATION OF SURGICAL WOUND
Thrs 4 types of surgical wound ;-
1. Clean
2. Clean Contaminated
3. Contaminated
4. Dirty
CLASS I/CLEAN WOUNDS--an uninfected surgical wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. In addition, clean wounds are primarily closed and, if necessary, drained with closed drainage. Surgical wound incisions that are made after nonpenetrating (ie, blunt) trauma should be included in this category if they meet the criteria.
CLASS II/CLEAN-CONTAMINATED WOUNDS--a surgical wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination. Specifically, surgical procedures involving the biliary tract, appendix, vagina, and oropharynx are included in this category, provided no evidence of infection is encountered and no major break in technique occurs
CLASS III/CONTAMINATED WOUNDS--open, fresh, accidental wounds. In addition, surgical procedures in which a major break in sterile technique occurs (eg, open cardiac massage) or there is gross spillage from the gastrointestinal tract and incisions in which acute, nonpurulent inflammation is encountered are included in this category.
CLASS IV/DIRTY OR INFECTED WOUNDS--old traumatic wounds with retained or devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the wound before the surgical procedure
Have a look at tis table.. its more easy to understand the classifications, click the below link
Surgical Wound Classification [4]
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