Portfolio on M104

Clinical Management and High Risk Pregnancies

I. INTRODUCTION
II. COMPLICATIONS DURING PREGNANCY

Some women experience health problems during pregnancy. These

complications can involve the mother's health, the fetus's health, or both.
Even women who were healthy before getting pregnant can experience
complications. These complications may make the pregnancy a high-risk
pregnancy.

Getting early and regular prenatal care can help decrease the risk for
problems by enabling health care providers to diagnose, treat, or manage
conditions before they become serious.

Some common complications of pregnancy include, but are not limited to, the
following:

HIGH BLOOD PRESSURE

 High blood pressure, also called hypertension, occurs when arteries carrying
blood from the heart to the body organs are narrowed. This causes pressure to
increase in the arteries. In pregnancy, this can make it hard for blood to reach the
placenta, which provides nutrients and oxygen to the fetus. Reduced blood flow
can slow the growth of the fetus and place the mother at greater risk of preterm
labor and preeclampsia.

 Women who have high blood pressure before they get pregnant will continue to
have to monitor and control it, with medications if necessary, throughout their
pregnancy.

 High blood pressure that develops in pregnancy is called gestational

hypertension. Typically, gestational hypertension occurs during the second half
of pregnancy and goes away after delivery.

GESTATIONAL DIABETES

 Gestational diabetes occurs when a woman who didn't have diabetes before
pregnancy develops the condition during pregnancy.

 Normally, the body digests parts of your food into a sugar called glucose.
Glucose is your body's main source of energy. After digestion, the glucose
moves into your blood to give your body energy.

 To get the glucose out of your blood and into the cells of your body, your
pancreas makes a hormone called insulin. In gestational diabetes, hormonal
changes from pregnancy cause the body to either not make enough insulin, or
not use it normally. Instead, the glucose builds up in your blood, causing diabetes,
otherwise known as high blood sugar.
  Managing gestational diabetes, by following a treatment plan outlined by a health
care provider, is the best way to reduce or prevent problems associated with high
blood sugar during pregnancy. If not controlled, it can lead to high blood pressure
from preeclampsia and having a large infant, which increases the risk for
cesarean delivery.

INFECTIONS

 Infections, including some sexually transmitted infections (STIs), may occur

during pregnancy and/or delivery and may lead to complications for the pregnant
woman, the pregnancy, and the baby after delivery.

 Some infections can pass from mother to infant during delivery when the infant
passes through the birth canal; other infections can infect a fetus during the
pregnancy. Many of these infections can be prevented or treated with appropriate
preconception, prenatal, and postpartum follow-up care.

Some infections in pregnancy can cause or contribute to:

 Pregnancy loss/miscarriage (before 20 weeks of pregnancy)

 Ectopic pregnancy (when the embryo implants outside of the uterus, usually in a

fallopian tube)

 Preterm labor and delivery (before 37 completed weeks of pregnancy)

 Low birth weight

 Birth defects, including blindness, deafness, bone deformities, and intellectual

disability

 Stillbirth (at or after 20 weeks of pregnancy)

 Illness in the newborn period (first month of life)

 Newborn death

 Maternal health complications

 PREECLAMPSIA

 Preeclampsia is a serious medical condition that can lead to preterm delivery and
death. Its cause is unknown, but some women are at an increased risk. Risk
factors include:

 First pregnancies

 Preeclampsia in a previous pregnancy

 Existing conditions such as high blood pressure, diabetes, kidney disease, and

systemic lupus erythematosus

 Being 35 years of age or older

 Carrying two or more fetuses

 Obesity

PRETERM LABOR

 Preterm labor is labor that begins before 37 weeks of pregnancy. Any infant born
before 37 weeks is at an increased risk for health problems, in most cases
because organs such as the lungs and brain finish their development in the final
weeks before a full-term delivery (39 to 40 weeks).

 Certain conditions increase the risk for preterm labor, including infections,
developing a shortened cervix, or previous preterm births.

 Progesterone, a hormone produced naturally during pregnancy, may be used to

help prevent preterm birth in certain women. A 2003 study led by NICHD
researchers found that progesterone supplementation to women at high risk for
preterm delivery due to a prior preterm birth reduces the risk of a subsequent
preterm birth by one third.

PREGNANCY LOSS/ MISCARRIAGE

 Miscarriage is the term used to describe a pregnancy loss from natural causes
before 20 weeks.

 Signs can include vaginal spotting or bleeding, cramping, or fluid or tissue

passing from the vagina. However, bleeding from the vagina does not mean that
a miscarriage will happen or is happening. Women experiencing this sign at any
point in their pregnancy should contact their health care provider.
 STILLBIRTH
 The loss of pregnancy after the 20th week of pregnancy is called a stillbirth. In
approximately half of all reported cases, health care providers can find no cause
for the loss.

 However, health conditions that can contribute to stillbirth include chromosomal
abnormalities, placental problems, poor fetal growth, chronic health issues of the
mother, and infection.

OTHER COMPLICATIONS:

HYPEREMESIS GRAVIDARUM

 Although having some nausea and vomiting is normal during pregnancy,

particularly in the first trimester, some women experience more severe symptoms
that last into the third trimester.

 Women with hyperemesis gravidarum experience nausea that does not go away,
weight loss, reduced appetite, dehydration, and feeling faint.

 Affected women may need to be hospitalized so that they can receive fluids and
nutrients. Some women feel better after their 20th week of pregnancy, while
others experience the symptoms throughout their pregnancy.

IRON DEFICIENCY ANEMIA

 Pregnant women need more iron than normal for the increased amount of blood
they produce during pregnancy.

 Iron-deficiency anemia—when the body doesn't have enough iron—is somewhat

common during pregnancy and is associated with preterm birth and low birth
weight. Symptoms of a deficiency in iron include feeling tired or faint,
experiencing shortness of breath, and becoming pale. ACOG recommends 27
milligrams of iron daily (found in most prenatal vitamins) to reduce the risk for
iron-deficiency anemia. Some women may need extra iron through iron
supplements. Your health care provider may screen you for iron-deficiency
anemia and, if you have it, may recommend iron supplements.
 III. COMPLICATIONS DURING LABOR AND DELIVERY

Each pregnancy and delivery is different, and problems may arise.

If complications occur, providers may assist by monitoring the situation closely and
intervening, as necessary.

Some of the more common complications are:

 Labor that does not progress.

Sometimes contractions weaken, the cervix does not dilate enough or in a timely
manner, or the infant's descent in the birth canal does not proceed smoothly. If labor is
not progressing, a health care provider may give the woman medications to increase
contractions and speed up labor, or the woman may need a cesarean delivery. 3

 Perineal tears.

A woman's vagina and the surrounding tissues are likely to tear during the delivery
process. Sometimes these tears heal on their own. If a tear is more serious or the
woman has had an episiotomy (a surgical cut between the vagina and anus), her
provider will help repair the tear using stitches.4,5

 Problems with the umbilical cord.

The umbilical cord may get caught on an arm or leg as the infant travels through the
birth canal. Typically, a provider intervenes if the cord becomes wrapped around the
infant's neck, is compressed, or comes out before the infant.5

 Abnormal heart rate of the baby.

Many times, an abnormal heart rate during labor does not mean that there is a problem.
A health care provider will likely ask the woman to switch positions to help the infant get
more blood flow. In certain instances, such as when test results show a larger problem,
delivery might have to happen right away. In this situation, the woman is more likely to
need an emergency cesarean delivery, or the health care provider may need to do an
episiotomy to widen the vaginal opening for delivery.6

 Water breaking early.

Labor usually starts on its own within 24 hours of the woman's water breaking. If not,
and if the pregnancy is at or near term, the provider will likely induce labor. If a pregnant
woman's water breaks before 34 weeks of pregnancy, the woman will be monitored in
the hospital. Infection can become a major concern if the woman's water breaks early
and labor does not begin on its own.7,8

 Perinatal asphyxia.
This condition occurs when the fetus does not get enough oxygen in the uterus or the
infant does not get enough oxygen during labor or delivery or just after birth.3,4

 Shoulder dystocia.

In this situation, the infant's head has come out of the vagina, but one of the shoulders
becomes stuck.5

 Excessive bleeding.

If delivery results in tears to the uterus, or if the uterus does not contract to deliver the
placenta, heavy bleeding can result. Worldwide, such bleeding is a leading cause of
maternal death.9 NICHD has supported studies to investigate the use of misoprostol to
reduce bleeding, especially in resource-poor settings.

Delivery may also require a provider's special attention when the pregnancy lasts more
than 42 weeks, when the woman had a C-section in a previous pregnancy, or when she
is older than a certain age.

IV. COMPLICATIONS DURING POSTPARTUM PERIOD

Women may experience a wide range of postpartum problems, some more serious than others
and each with its own symptoms. Some of the more common problems include:

 Postpartum infections, (including uterine, bladder, or kidney infections)

 Excessive bleeding after delivery
 Pain in the perineal area (between the vagina and the rectum)
 Vaginal discharge
 Breast problems, such as swollen breasts, infection and clogged ducts
 Stretch marks
 Hemorrhoids and constipation
 Urinary or fecal (stool) incontinence
 Hair loss
 Postpartum depression
 Discomfort during sex
 Difficulty regaining your pre-pregnancy shape

Postpartum Hemorrhage

Although some bleeding is normal immediately after delivery, heavy bleeding or hemorrhage
occurs in just 2% of births, most often after long labors, multiple births or when the uterus has
become infected.
Postpartum hemorrhage is the third most common cause of maternal death in childbirth. It
usually happens because the uterus fails to properly contract after the placenta has been
delivered, or because of tears in the uterus, cervix or vagina. Soon after the baby and placenta
have been delivered, you will be monitored to make sure the uterus is contracting as it should. If
bleeding is severe, your midwife or doctor may massage your uterus to help it contract, or you
may be given a synthetic hormone called oxytocin to help stimulate contractions. He or she will
likely perform a pelvic exam to find the cause of the hemorrhage, and your blood may be tested
for infection and anemia. If the blood loss is excessive, a blood transfusion may be
recommended.

If hemorrhage begins a week or two after delivery, it may be caused by a piece of the
placenta that has remained in the uterus. If so, the tissue will be removed surgically.
Once you are home, report any heavy bleeding to your doctor immediately.

However, if you have a lump that does not respond quickly to home treatment, consult
your doctor.

Uterine Infections

Normally, the placenta separates from the uterine wall during delivery and is expelled
from the vagina within 20 minutes after giving birth. If pieces of the placenta remain in
the uterus (called retained placenta), it can lead to infection.

An infection of the amniotic sac (the bag of water surrounding the baby) during labor
may lead to a postpartum infection of the uterus. Flu-like symptoms accompanied by
a high fever; rapid heart rate; abnormally high white blood-cell count; swollen, tender
uterus; and foul-smelling discharge usually indicate uterine infection. When the tissues
surrounding the uterus also are infected, pain and fever can be severe. Uterine
infections usually can be treated with a course of intravenous antibiotics, which are
used to prevent potentially dangerous complications such as toxic shock

Infection of C-section Incision

Follow your health-care provider's instructions about caring for your C-section incision.
Consult your doctor if you see signs of infection, such as red, swollen skin or draining
pus. Resist the urge to scratch. Try lotion to ease itching.

Kidney Infections

A kidney infection, which can occur if bacteria spread from the bladder, includes
symptoms such as urinary frequency, a strong urge to urinate, high fever, a generally
sick feeling, pain in the lower back or side, constipation and painful urination. Once a
kidney infection is diagnosed, a course of antibiotics -- either intravenous or oral --
usually is prescribed. Patients are instructed to drink plenty of fluids, and are asked to
give urine samples at the beginning and end of treatment to screen for any remaining
bacteria.
Be sure to report any unexplained fever that develops in the early weeks after delivery
to your doctor. This could be a sign of postpartum infection.

Perineal Pain

For women who delivered vaginally, pain in the perineum (the area between the rectum
and vagina) is quite common. These tender tissues may have stretched or torn during
delivery, causing them to feel swollen, bruised and sore. This discomfort may also be
aggravated by an episiotomy, an incision sometimes made in the perineum during
delivery to keep the vagina from ripping.

As your body heals in the weeks following childbirth, the discomfort should lessen. Sitz
baths, cold packs or warm water applied to the area with a squirt bottle or sponge can
help avoid infection and reduce tenderness. It's also important to wipe yourself from
front to back after a bowel movement to avoid infecting the perineum with germs from
the rectum.

If sitting is uncomfortable, you may want to purchase a doughnut-shaped pillow at your

local drugstore to help ease the pressure on your perineum. A prescription or over-the-
counter pain reliever (non-aspirin, if you're breast-feeding) also can help.

When you feel up to it, pelvic floor exercises (often called Kegel exercises) can help
restore strength to your vaginal muscles and help the healing process along. If you have
increasing or persistent pain in the vaginal area, however, discontinue the exercise and
alert your doctor.

Vaginal Discharge (Lochia)

A bloody, initially heavy, discharge from the vagina is common for the first several
weeks after delivery. This discharge, which consists of blood and the remains of the
placenta, is called lochia. For the first few days after childbirth, the discharge is bright
red and may include clots of blood. The flow will eventually lighten, as will its color --
gradually turning pink, then white or yellow before stopping altogether. The bright red
discharge may return at times, such as after breast-feeding or too-vigorous exercise,
but its volume generally slows considerably in about 10 to 14 days.

Swollen (Engorged) Breasts

When your milk comes in (about two to four days after delivery), your breasts may
become very large, hard and sore. This engorgement will ease once you establish a
breast-feeding pattern or, if you're not breast-feeding, once your body stops producing
milk (usually less than three days if your baby is not suckling).

You can ease the discomfort of engorgement by wearing a well-fitting support bra and
applying ice packs to your breasts. If you are breast-feeding, you can relieve some of
the pressure by expressing -- either manually or with a breast pump -- small amounts of
milk. If you are not nursing your baby, avoid hot showers and expressing any milk. This
will only confuse your body into producing more milk to compensate. Oral pain relievers
can help you endure the discomfort until your milk supply dries up.

Mastitis

Mastitis, or breast infection, usually is indicated by a tender, reddened area on the

breast (the entire breast may also be involved). Breast infections -- which can be
brought on by bacteria and lowered defenses resulting from stress, exhaustion or
cracked nipples -- may be accompanied by fever,
chills, fatigue, headache and/or nausea and vomiting. Any of these symptoms should be
reported to your doctor, who may recommend treatment with antibiotics.

If you have a breast infection, you may continue to nurse from both breasts. Mastitis
does not affect your breast milk. It's also important to rest and drink plenty of fluids.
Warm, wet towels applied to the affected area may help alleviate discomfort; and cold
compresses applied after nursing can help reduce congestion in your breast. You may
also want to avoid constricting bras and clothing.

Clogged Ducts

Clogged milk ducts, which can cause redness, pain, swelling or a lump in the breast,
can mimic mastitis. However, unlike breast infections, caked, clogged or plugged ducts
are not accompanied by flu-like symptoms.

Breast massage; frequent nursing until the breast is emptied; and warm, moist packs
applied to the sore area several times a day may solve the problem. However, if you
have a lump that does not respond quickly to home treatment, consult your doctor.

Stretch Marks

Stretch marks are the striations that appear on many women's breasts, thighs, hips
and abdomen during pregnancy. These reddish marks, which are caused by hormonal
changes and stretching skin, may become more noticeable after delivery. Although they
may never disappear completely, they will fade considerably over time. While many
women purchase special creams, lotions and oils to help prevent and erase stretch
marks, there is little evidence that they work. About half of women develop stretch
marks during pregnancy, regardless of whether or not they have used any topical
ointments.

Hemorrhoids and Constipation

Hemorrhoids and constipation, which can be aggravated by the pressure of

the enlarged uterus and fetus on the lower abdomen veins, are both quite common in
pregnant and postpartum women. Over-the-counter ointments and sprays,
accompanied by a diet rich in fiber and fluids, usually can help reduce constipation and
the swelling of hemorrhoids. Warm sitz baths followed by a cold compress also can
offer some relief. An inflatable, donut-shaped pillow, which can be purchased at any
drugstore, can help ease discomfort caused by sitting.

Do not use laxatives, suppositories or enemas without asking your doctor, especially if
you've had an episiotomy or have stitches in the perineal area.

Urinary and Fecal Incontinence

Urinary incontinence and, less commonly, fecal incontinence, plague some new
mothers shortly after giving birth.

The inadvertent passage of urine, especially when laughing, coughing or straining,

usually is caused by the stretching of the base of the bladder during pregnancy and
delivery. Usually, time is all that's needed to return your muscle tone to normal. You
may hasten the process by doing Kegel exercises.

In the meantime, wear protective undergarments or sanitary napkins. If the problem

persists, talk to your doctor, who may be able to prescribe medication to relieve the
problem. If you experience pain or burning, or have an uncomfortable urgency to urinate,
tell your doctor. This could be a sign of a bladder infection.

Lack of bowel control often is attributed to the stretching and weakening of pelvic
muscles, tearing of the perineum, and nerve injury to the sphincter muscles around
the anus during delivery. It is most common in women who have had a prolonged
labor followed by a vaginal birth.

Although fecal incontinence usually disappears after several months, talk with your
doctor about exercises to help you regain control of your bowels. Fecal incontinence
that does not resolve itself over time may require surgical repair.

Hair Loss

That lustrous sheen that pregnancy brought to your hair may fade by the time your baby
is 6 months old. You'll likely notice hair loss as well. During pregnancy, skyrocketing
hormones prevent the normal, almost imperceptible daily loss of hair. Several months
after delivery (or when breast-feeding slows or ceases), many women begin to fear the
worst as they watch their hair fall out at an alarming rate. Rest assured, the hair you're
losing is only equivalent to the hair you would have shed during pregnancy had your
hormones not stepped in. Generally, the sudden change in hair volume is temporary
and not noticeable to others.

Postpartum Depression

Most women experience a case of the "baby blues" after the birth of their child.
Changes in hormone levels, combined with the new responsibility of caring for
a newborn, make many new mothers feel anxious, overwhelmed or angry. For most,
this moodiness and mild depression go away within several days or weeks.

Longer lasting or more severe depression is classified as postpartum depression (PPD),

a condition that affects 10% to 20% of women who have just given birth. PPD, which
usually becomes apparent two weeks to three months after delivery, is characterized by
intense feelings of anxiety or despair. Lack of sleep, shifts in hormone levels and
physical pain after childbirth can all contribute to PPD, making it difficult for some
women to cope with their new role and overcome their sense of loneliness, fear or even
guilt.

The first step in treating postpartum depression is enlisting the support of family and
close friends. Share your feelings with them, and get their help in caring for your infant.
Be sure to discuss any PPD symptoms with your doctor, who can prescribe medication
or recommend support groups to help you better cope with these new and unfamiliar
emotions.

If your depression is combined with lack of interest in the baby, suicidal or violent
thoughts, hallucinations or abnormal behavior, get immediate medical attention. These
symptoms could indicate a more serious condition called postpartum psychosis.

Discomfort During Sex

You can resume sexual activity once you feel comfortable -- both physically and
emotionally. After a vaginal birth, it's best to postpone intercourse until the vaginal tissue
heals completely, usually four to six weeks (less if you didn't have an episiotomy). After
a cesarean birth, you doctor will probably advise you to wait six weeks.

You may find sex to be physically uncomfortable, even painful, for up to three months
after delivery, particularly if you are breast-feeding. Because breast-feeding reduces
levels of the hormone estrogen in the body, your vagina may be unusually dry during
the postpartum period. A water-based lubricant can help relieve some of the discomfort.
Tenderness at the location of an episiotomy also is not uncommon for weeks or months
after giving birth.

Even after your body heals, you may find that you are less interested in sex than you
were before your baby arrived. Physical exhaustion accompanied by new distractions
and emotional changes can take their toll on your libido. Many women battle feelings of
unattractiveness in the postpartum period, and some find it more difficult to achieve
orgasm. Breast-feeding can also change how you and your partner perceive sexual
intimacy. Sharing your feelings with your partner and recognizing that these issues
usually are temporary may help you deal with them more easily.

Regaining your pre-pregnancy shape

Exercise is one of the best ways to lose post-pregnancy weight, regain your energy
level, relieve stress, and restore your muscle strength. Unless you've had a cesarean
delivery, difficult birth or pregnancy complications (in which case, you should talk with
your doctor), you can usually resume moderate exercise once you feel up to it. If you
exercised before and during pregnancy, you have a head start on postpartum fitness,
but don't expect to jump immediately back into a vigorous exercise program.

Brisk walking and swimming are excellent exercise and good ways to build up to more
intense activities. Because of the risk of bacteria entering the healing tissue of the
vagina, however, you should not swim for the first three weeks after delivery.

Toning and strengthening exercises, such as sit ups or leg lifts, are one of the best
ways to jumpstart your postpartum program. Light, repetitive weight-lifting also can help
your body get back into pre-pregnancy shape. But remember, take it slow and focus
more on long-term health than on short-term results.

Many health and fitness clubs, hospitals and local community colleges also offer
postpartum exercise classes. In addition to providing specially designed exercises,
these classes can be a great way to network with other new mothers and get the
support you need to stick with an exercise program.

Call Your Doctor If:

Continue to be aware of any unusual changes in your body in the days and weeks after delivery.
Call your doctor immediately if you experience any of the following symptoms. They could
indicate a serious postpartum complication.

 Vaginal bleeding heavier than your normal period.

 Increasing or persistent pain in the vaginal or perineal area.
 Fever over 100.4 degrees F.
 Sore breasts that are hot to the touch.
 Pain, swelling or tenderness in your legs.
 Cough or chest pain.
 Pain or burning when urinating, or a persistent and sudden urge to urinate.
 Nausea and/or vomiting.
 You feel depressed, have a lack of interest in your baby, or have suicidal or violent
thoughts or hallucinations.
 V. OPERATIVE OBSTETRICS
i. ANALGESIA AND ANESTHESIA

analgesia: a state of pain relief; an agent for lessening pain.

anesthesia: a type of medication that results in partial or complete elimination

of pain sensation; numbing a tooth is an example of local anesthesia; general
anesthesia produces partial or complete unconsciousness.

General Considerations
General anesthesia (GA) is the state produced when a patient receives medications to
produce amnesia and analgesia with or without reversible muscle paralysis. An
anesthetized patient can be thought of as being in a controlled, reversible state of
unconsciousness. Anesthesia enables a patient to tolerate surgical procedures that
would otherwise inflict unbearable pain, potentiate extreme physiologic exacerbations,
and result in unpleasant memories.
The combination of anesthetic agents used for general anesthesia often leaves a
patient with the following clinical constellation: [1]
1. Unarousable to painful stimuli
2. Unable to remember what happened (amnesia)
3. Unable to maintain adequate airway protection and/or spontaneous ventilation as
a result of muscle paralysis
4. Cardiovascular changes secondary to stimulant/depressant effects of anesthetic
agents

General anesthesia

General anesthesia is induced and maintained using a combination of intravenous and

inhaled agents. A point worth noting is that general anesthesia may not always be the
best choice; depending on a patient’s clinical presentation, local or regional
anesthesia may be more appropriate. [2, 3, 4]
Anesthesia providers are responsible for assessing all factors that influence a patient's
medical condition and selecting the optimal anesthetic technique accordingly.
Advantages of general anesthesia include the following:
 Reduces intraoperative patient awareness and recall [5]
 Allows use of muscle relaxants
 Facilitates complete control of the airway, breathing, and circulation
 Can be used in cases of sensitivity to local anesthetic agent
 Can be administered without moving the patient from the supine position
  Can be adapted easily to procedures of unpredictable duration or extent
 Can be administered rapidly and is reversible
Disadvantages of general anesthesia include the following:
 Requires, at minimum, some degree of preoperative patient preparation
 Requires increased complexity of care and associated costs
 Requires some degree of preoperative patient preparation
 May induce physiologic fluctuations that require active intervention
 Associated with less serious complications such as nausea and vomiting, sore
throat, headache, and shivering
 Associated with malignant hyperthermia, an exceedingly rare, inherited muscular
condition in which exposure to some (but not all) general anesthetic agents
results in acute and potentially lethal temperature rise, hypercarbia, metabolic
acidosis, and hyperkalemia
With modern advances in medications, monitoring technology, and safety systems, as
well as highly educated anesthesia providers, the risk caused by anesthesia to a patient
undergoing routine surgery is extremely remote. Mortality attributable to general
anesthesia is said to occur at rates of less than 1:100,000. Minor adverse events occur
at more frequent rates, even in previously healthy patients. The more commonly
encountered adverse events related to anesthesia include:
 Vomiting
 Nausea
 Sore throat
 Incisional site pain
 Emergence delirium (in children)
Preoperative Period
A general anesthetic can be broken down into three distinct phases, the pre-, intra-, and
post-operative periods.
The pre-operative phase involves patient preparation from the time surgery is scheduled
until the patient enters the operating room.

Preparation for general anesthesia

Safe and efficient anesthetic practices require certified personnel, appropriate

medications and equipment, and an optimized patient.

Minimum requirements for general anesthesia

Minimum infrastructure requirements for general anesthesia include a well-lit space of

adequate size; a source of pressurized oxygen (most commonly piped in); an effective
suction device; standard ASA (American Society of Anesthesiologists) monitors,
continuous EKG monitoring, blood pressure (minimum 5-minute intervals), continuous
pulse oximetry, capnography, temperature; and inspired and exhaled concentrations of
oxygen and applicable anesthetic agents. [6]
Beyond this, some equipment is needed to deliver the anesthetic agent. This may be as
simple as needles and syringes, if the drugs are to be administered entirely
intravenously. In most circumstances, this means the availability of a properly serviced
and maintained anesthetic gas delivery machine.
An array of routine and emergency drugs, advanced airway management equipment, a
cardiac defibrillator, and a recovery room staffed by properly trained individuals is
required when general anesthesia is delivered. When agents known to trigger malignant
hyperthermia are used, medications to treat this condition, including dantrolene sodium,
must be immediately available.

Preparing the patient

A thorough preoperative plan should ensue prior to induction of general anesthesia and,
ideally, in advance of the operative day.
Preoperative anesthesia evaluation allows for obtainment of indicated laboratory tests,
imaging procedures, or additional medical consultations when warranted. Complete
history should be attained with attention to any new, ongoing, or worsening medical
conditions, previous personal or familial adverse reactions to general anesthetics,
assessment of functional cardiac and pulmonary states, and allergy and medication
history. Preoperative evaluation also helps to relieve anxiety of the unknown surgical
environment for patients and their families as well as reduce the likelihood of same-day
case cancellation. Overall, this process allows for optimization of the patient in the
perioperative setting. [7]
Physical examination associated with preoperative evaluations allow anesthesia
providers to focus specifically on expected airway conditions, including mouth opening,
loose or problematic dentition, limitations in neck range of motion, neck anatomy, and
Mallampati presentations (see below). By combining all factors, an appropriate plan for
intubation can be outlined and extra steps, if necessary, can be taken to prepare for
fiberoptic bronchoscopy, video laryngoscopy, or various other difficult airway
interventions.

Airway management

Possible or definite difficulties with airway management include the following:

 Small or receding jaw
 Small mouth opening
 Large overbite
 History of difficult intubation and/or mask ventilation
 Extremes of obesity
 Prominent maxillary teeth
 Short neck and thick neck
 Limited neck extension
 Poor dentition
 Tumors of the head and neck
 Facial trauma
 Interdental fixation
 Hard cervical collar
 Unstable neck or atlantoaxial instability
 Halo traction
 Microtia or mid-facial hypoplasia
Various scoring systems have been created using orofacial measurements to predict
difficult intubation. The most widely used is the Mallampati score, which identifies
patients in whom the pharynx is not well visualized through the open mouth.
The Mallampati assessment is ideally performed when the patient is seated with the
mouth open and the tongue protruding without phonating. In many patients intubated for
emergent indications, this type of assessment is not possible. A crude assessment can
be performed with the patient in the supine position to gain an appreciation of the size of
the mouth opening and the likelihood that the tongue and oropharynx may be factors in
successful intubation (see image below).

Mallampati classification.

High Mallampati scores have been shown to be predictive of difficult

intubations. [8] However, no one scoring system is fully predictive and providers should
also anticipate the unexpected difficult airway.
In addition to intubation during surgery, some patients may require unanticipated early
postoperative intubation. A large-scale study of 109,636 adult patients undergoing non-
emergent, non-cardiac surgery identified risk factors for postoperative intubation.
Independent predictors include patient comorbidities such as chronic obstructive
pulmonary disease, insulin-dependent diabetes, active congestive heart failure, and
hypertension. Severity of surgery is also an identified risk factor. Half of unanticipated
tracheal intubations occurred within the first 3 days after surgery and were
independently associated with a 9-fold increase in mortality. [9]
When suspicion of an adverse event is high but a similar anesthetic technique must be
used again, obtaining records and previous anesthetic records from previous operations
or from other institutions may be necessary.
Other requirements

For induction of general anesthesia, it is important that the patient is properly fasted to
prevent untoward events such as pulmonary aspiration. Of course, emergency cases
are not delayed until fasting times are met. Patients should be instructed as to the ASA
guidelines on perioperative fasting. Unnecessarily long fasting times should be avoided
to reduce dehydration, postinduction hypotension, and patient dissatisfaction.
 Published guidelines recommend that solid food (including gum or candy) should
be avoided for 6 hours prior to the induction of anesthesia. [10]
 Clear fluids (e.g., water, Pedialyte, Gatorade) should be avoided for 2-4 hours
prior to the induction of anesthesia.It is however preferable to consume clear
liquids in advance of surgery to reduce dehydration. [11]
Table. (Open Table in a new window)

American Society of Anesthesiology Preoperative NPO Guidelines

Food NPO requirement Example

Clear Liquids 2 hours Apple juice, water (NO orange juice)

Breast Milk 4 hours Unfortified

Infant Formula 6 hours Unfortified

Non-Human Milk 6 hours Almond milk, soy milk, unfortified

Light Meal 6 hours Tea and toast (no added fats, like butter)

Full Meal 8 hours Fatty meal

Patients should continue to take regularly scheduled medications up to and including

the morning of surgery. Exceptions may include the following:
 Anticoagulants to avoid increased surgical bleeding
 Oral hypoglycemics (e.g., metformin is an oral hypoglycemic agent that is
associated with the development of metabolic acidosis under general anesthesia)
 Monoamine oxidase inhibitors
 Certain anti-hypertensive agents (e.g., ACE inhibitors) that may promote
anesthesia induced hypotension
  Beta blocker therapy should be continued perioperatively for high-risk patients
undergoing major noncardiac surgery [12]
 Many non-prescription medications, herbal supplements, vitamins can interfere
with anesthesia and surgery, especially those with anticoagulant properties (e.g.,
garlic)
Recent catastrophes under anesthesia have focused attention on the interaction
between non-prescribed medications and anesthetic drugs, including interactions with
vitamins, herbal preparations, traditional remedies, and food supplements. Good
information on the exact content of these supplement preparations is often hard to
obtain. [13]

Premedication

This stage, which is usually conducted in the surgical ward or in a preoperative holding
area, originated in the early days of anesthesia, when morphine and scopolamine were
routinely administered to make the inhalation of highly pungent ether and chloroform
vapors more tolerable.
The goal of premedication is to have the patient arrive in the operating room in a calm,
relaxed frame of mind. The most commonly used premedication is midazolam, a short-
acting benzodiazepine that has the benefit of providing antegrade amnesia. Oral
midazolam syrup is often given to children to facilitate calm separation from their
parents prior to anesthesia.
In anticipation of surgical pain, nonsteroidal anti-inflammatory drugs or acetaminophen
can be administered preemptively. When a history of gastroesophageal reflux exists, H2
blockers and antacids may be administered.
Intraoperative Period

Induction

Induction of anesthesia can be accomplished by inhalation of anesthetic gases or by

use of intravenous agents, or both.
For the most part, contemporary practice dictates that adult patients and most children
aged at least 10 years be induced with intravenous drugs, this being a rapid and
minimally unpleasant experience for the patient. However, sevoflurane, a well-tolerated
anesthetic vapor, allows for elective inhalation induction of anesthesia in adults. In
addition to the induction drug, most patients receive an injection of an opioid analgesic.
Induction agents and opioids work synergistically to induce anesthesia. In addition,
anticipation of events that are about to occur, such as endotracheal intubation and
incision of the skin, generally raises the blood pressure and heart rate of the patient.
Opioid analgesia helps reduce this undesirable response, which can prove catastrophic
in patients with severe cardiac disease.
The next step of the induction process is securing the airway. This may be a simple
matter of manually holding the patient's jaw such that his or her natural breathing is
unimpeded by the tongue, or it may demand the insertion of a prosthetic airway device
such as a laryngeal mask airway or endotracheal tube. [14] Various factors are
considered when making this decision. The major decision is whether the patient
requires placement of an endotracheal tube. Potential indications for endotracheal
intubation under general anesthesia may include the following:
 Potential for airway contamination (full stomach, gastroesophageal [GE] reflux,
gastrointestinal [GI] or pharyngeal bleeding)
 Surgical need for muscle relaxation
 Predictable difficulty with endotracheal intubation or airway access (eg, lateral or
prone patient position)
 Surgery of the mouth or face
 Prolonged surgical procedure
If surgery is taking place in the abdomen or thorax, an intermediate or long-acting
muscle relaxant drug is administered in addition to the induction agent and opioid. This
paralyzes muscles indiscriminately, including the muscles of breathing. Therefore, the
patient's lungs must be ventilated under pressure, necessitating an endotracheal tube.
Persons who, for anatomic reasons, are likely to be difficult to intubate are usually
intubated electively at the beginning of the procedure, using a flexible or rigid
videoscope or another advanced airway tool.

Maintenance of anesthesia

For the duration of the procedure, a plane of anesthesia is maintained using either
continuous inhalation or intravenous agents, either alone or in combination. For certain
cases, it is preferable to use a total intravenous anesthetic (e.g., scoliosis surgery).
Most commonly, maintenance of anesthesia is performed by continuous inhalation of
anesthetic gases. These may be inhaled as the patient breathes spontaneously or
delivered under pressure by each mechanical breath of a ventilator.
The maintenance phase is usually the most stable part of the anesthesia. However,
understanding that anesthesia is a continuum of different depths is important. A level of
anesthesia that is satisfactory for surgery to the skin of an extremity, for example, would
be inadequate for major abdominal surgery.
Appropriate levels of anesthesia must be chosen both for the planned procedure and for
its various stages. In complex plastic surgery, for example, a considerable period of
time may elapse between the completion of the induction of anesthetic and the incision
of the skin. During the period of skin preparation, urinary catheter insertion, and marking
incision lines with a pen, the patient is not receiving any noxious stimulus. This requires
a very light level of anesthesia, which must be converted rapidly to a deeper level just
before the incision is made. As the procedure progresses, the level of anesthesia is
adjusted to provide the minimum amount of anesthesia that is necessary to ensure
adequate anesthetic depth. This requires experience and judgment. The specialty of
anesthesiology is working to develop reliable methods to avoid cases of awareness
under anesthesia.
Excessive anesthetic depth, on the other hand, is associated with decreased heart rate
and blood pressure, and, if carried to extremes, can jeopardize perfusion to vital organs.
Short of these serious misadventures, excessive depth results in slower awakening and
more adverse effects.
As the surgical procedure draws to a close, the patient's emergence from anesthesia is
planned. Experience and close communication with the surgeon enable the anesthesia
provider to predict the time when the operation will be complete.
Excess muscle relaxation is reversed using specific drugs and an adequate long-acting
opioid analgesic for continued analgesia in the post-operative period. Removal of a
placed airway management device is performed only after the patient has met a long list
of extubation criteria.
Thermoregulation may also prove challenging during general anesthesia as the normal
shivering thermogenesis is blunted in addition to drug-induced vasodilation. Use of
forced air warmers in addition to warming the external environment can be helpful. In
cases with neonates, the room should be pre-warmed in addition to using forced air
warmers and external heat lamps. Severe hypothermia may result in coagulopathy,
delayed awakening, or arrhythmia.

Commonly Used Anesthetic Drugs

Numerous choices exist for every aspect of anesthetic care; the way in which they are
sequenced depends partially on the personal preference of the person administering
them.
Induction agents
Propofol, a non-barbiturate intravenous anesthetic, has displaced barbiturates in many
anesthesia practices.
 The use of propofol is associated with less postoperative nausea and vomiting
and a more rapid return of cognition.
 In addition to being an excellent induction agent, propofol can be administered by
slow intravenous infusion instead of inhaled anesthetic agents to maintain the
anesthesia.
 Among its disadvantages are the facts that it often causes pain on injection and
that it is prepared in a lipid emulsion, which, if not handled using meticulous
aseptic precautions, can be a medium for rapid bacterial growth.
Anesthetic inhalation agents (gases)
These are highly potent chlorofluorocarbons, which are delivered with precision from
vaporizers and directly into the patient's inhaled gas stream. They may be mixed with
nitrous oxide, a much weaker but nonetheless useful anesthetic gas.
In the late 1990s, desflurane and sevoflurane came into use. These inhaled anesthetics
are much more maneuverable than their predecessors and are associated with a more
rapid emergence from anesthesia.
Anesthesia can also be induced by inhalation of a vapor. Based on its chemical profile,
sevoflurane is most commonly used for this purpose. Inhalation agents are delivered by
a vaporizer that converts liquid anesthetic to gas for inhalation. Each gas requires its
own unique vaporizer to deliver a predetermined concentration that varies based on the
chemical property of the agent in use. The required concentration (dose) of anesthesia
gases varies based mostly by patient age and to a lesser degree on other physiological
patient factors.
Traditional opioid analgesics
Morphine, meperidine, and hydromorphone are widely used in anesthesia as well as in
emergency departments, surgical wards, and obstetric suites.
In addition, anesthesia providers have at their disposal a range of synthetic opioids,
which, in general, cause less fluctuation in blood pressure and are shorter acting. These
include fentanyl, sufentanil, and remifentanil.
Muscle relaxants
Succinylcholine, a rapid-onset, short-acting depolarizing muscle relaxant, has
traditionally been the drug of choice when rapid muscle relaxation is needed.
Non-depolarizing muscle relaxants are most commonly used that provide reversible
inhibition at the neuromuscular junction. The typical duration of action of single
administration is between 30 and 60 minutes but varies by medication and is
significantly prolonged in continuous or repeated administration.
Muscle relaxants generally are excreted by the kidney, but some preparations are
broken down by plasma enzymes and can be used safely in patients with partial or
complete renal failure.
Newly available is sugammadex, the reversal agent for non-depolarizing muscle
relaxants that binds to the active drug resulting in inhibition of action. [15]

Positioning

When inducing general anesthesia, patients can no longer protect their airway, provide
effective respiratory effort, or protect themselves from injury. For these reason, ideal
positioning for general anesthesia is extremely important and can help prevent potential
injuries and devastating consequences.
Positioning for induction of general anesthesia
When inducing general anesthesia, the patient is no longer able to protect their airway
or provide an effective respiratory effort. The goal of care is to provide adequate
ventilation and oxygenation during general anesthesia. Patients are evaluated in the
preoperative period for the signs of difficult mask ventilation and/or intubation.
Positioning is especially important in morbidly obese patients. The body habitus of these
patients can make them difficult to ventilate and intubate.
Ideal masking and intubating position is called the "sniffing" position. This is obtained by
lifting the patients chin upward (when supine) so as to look, from a profile view, that the
patient is sniffing the air. Doing this in addition with lifting the mandible forward (to
remove the tongue from the oropharynx) facilitates easiest mask ventilation.
In obese patients, it is often difficult to mask ventilate and intubate owing to their body
habitus. When mask ventilating, even with perfect technique, there is often excess
tissue on the chest wall, which will make it difficult to properly ventilate at low pressures,
so as not to inflate the stomach with air during attempted ventilation. Often, obese
patients are ramped at a 30° angle to help improve the mask ventilation and intubation.
When attempting intubation, the goal of positioning is to align the tragus of the ear with
the level of the sternum. This improves intubating conditions and creates direct
visualization of the vocal cords when performing direct laryngoscopy.
Positioning during general anesthesia
When a patient is under general anesthesia, all protective reflexes are lost, so providers
must be very careful to position the patient. The primary concerns of positioning are
ocular injuries, peripheral nerve injuries, musculoskeletal injuries, and skin injuries. [16]
Initially after induction of anesthesia, eyelids should be gently taped down in a closed
position. This helps prevent corneal injury by accidental scratching of the cornea.
Another ocular injury that can be made less likely during surgical positioning is to
prevent ocular venous congestion, which can cause perioperative vision loss. This is
often seen in prone patient who develops increased ocular pressure either through
mechanical force on the eye or increased venous congestion, especially prevalent in
long surgeries for which there is major blood loss (e.g., scoliosis).
Another concern during general anesthesia is peripheral nerve injuries. The most
common peripheral nerve injuries are ulnar nerve, common peroneal nerve, and
brachial plexus injuries. These can be prevented with appropriate positioning, padding,
and vigilance during general anesthesia. The arms should be at less than 90° in relation
to the body. Gel/foam padding should be used for superficial nerves (e.g., ulnar nerve in
the ulnar groove-lateral epicondyle of elbow). Prevent positioning up against hard
objects (e.g., metal, plastic). Prevent hyperextension/flexion of the spine or neck.
Postoperative Period
After awakening, patients typically recover in the post anesthesia care unit (PACU). In
more critically ill patients, recovery may occur directly in the intensive care unit.
Patients recover in the recovery unit until they have met PACU discharge criteria. The
criteria for discharge from phase 1 to phase 2 of PACU are often based on the (modified)
Aldrete score, which includes adequate activity, circulation, consciousness oxygen
saturation, and maintenance of respiration.
Phase 2 of PACU should be met prior to discharging the patient home. This includes the
ability to maintain appropriate surgical site dressings, adequate pain control,
normothermia, ambulation ability, absence of nausea, and omitting and stable vital
signs.
All patients undergoing a general anesthetic at minimum must have a post-operative
note that documents many of these items (institution dependent). Ideally, the patient
should be queried after return to baseline cognition when more clandestine issues may
be addressed (e.g., corneal abrasions and extremely rarely, awareness under
anesthesia).

Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled,

temporary loss of sensation or awareness that is induced for medical purposes. It may
include analgesia (relief from or prevention of pain), paralysis (muscle
relaxation), amnesia (loss of memory), or unconsciousness. A patient under the effects
of anesthetic drugs is referred to as being anesthetized.
Anesthesia enables the painless performance of medical procedure that would
otherwise cause severe or intolerable pain to an unanesthetized patient, or would
otherwise be technically unfeasible. Three broad categories of anesthesia exist:

 General anesthesia suppresses central nervous system activity and results in

unconsciousness and total lack of sensation. A patient receiving general anesthesia
can lose consciousness with either intravenous agents or inhalation agents.
 Sedation suppresses the central nervous system to a lesser degree, inhibiting
both anxiety and creation of long-term memories without resulting in
unconsciousness.
 Regional and local anesthesia, which blocks transmission of nerve impulses from a
specific part of the body. Depending on the situation, this may be used either on its
own (in which case the patient remains conscious), or in combination with general
anesthesia or sedation. Drugs can be targeted at peripheral nerves to anesthetize
 an isolated part of the body only, such as numbing a tooth for dental work or using
a nerve block to inhibit sensation in an entire limb. Alternatively, epidural, spinal
anesthesia, or a combined technique can be performed in the region of the central
nervous system itself, suppressing all incoming sensation from nerves outside the
area of the block.
In preparing for a medical procedure, the clinician chooses one or more drugs to
achieve the types and degree of anesthesia characteristics appropriate for the type of
procedure and the particular patient. The types of drugs used include general
anesthetics, local anesthetics, hypnotics, sedatives, neuromuscular-blocking
drugs, narcotics, and analgesics.
The risks of complications during or after anesthesia are often difficult to separate from
those of the procedure for which anesthesia is being administered, but in the main they
are related to three factors: the health of the patient, the complexity (and stress) of the
procedure itself, and the anaesthetic technique. Of these factors, the health of the
patient has the greatest impact. Major perioperative risks can include death, heart
attack, and pulmonary embolism whereas minor risks can include postoperative nausea
and vomiting and hospital readmission. Some conditions, like local
anesthetic toxicity, airway trauma or malignant hyperthermia, can be more directly
attributed to specific anesthetic drugs and techniques.

Medical uses[edit]
The purpose of anesthesia can be distilled down to three basic goals or endpoints: [2]:236

 hypnosis (a temporary loss of consciousness and with it a loss of memory. In a

pharmacological context, the word hypnosis usually has this technical meaning, in
contrast to its more familiar lay or psychological meaning of an altered state of
consciousness not necessarily caused by drugs—see hypnosis).
 analgesia (lack of sensation which also blunts autonomic reflexes)
 muscle relaxation
Different types of anesthesia affect the endpoints differently. Regional anesthesia, for
instance, affects analgesia; benzodiazepine-type sedatives (used for sedation, or
"twilight anesthesia") favor amnesia; and general anesthetics can affect all of the
endpoints. The goal of anesthesia is to achieve the endpoints required for the given
surgical procedure with the least risk to the patient.
The anesthetic area of an operating room
To achieve the goals of anesthesia, drugs act on different but interconnected parts of
the nervous system. Hypnosis, for instance, is generated through actions on the nuclei
in the brain and is similar to the activation of sleep. The effect is to make people
less aware and less reactive to noxious stimuli.[2]:245
Loss of memory (amnesia) is created by action of drugs on multiple (but specific)
regions of the brain. Memories are created as either declarative or non-
declarative memories in several stages (short-term, long-term, long-lasting) the strength
of which is determined by the strength of connections between neurons termed synaptic
plasticity.[2]:246 Each anesthetic produces amnesia through unique effects on memory
formation at variable doses. Inhalational anesthetics will reliably produce amnesia
through general suppression of the nuclei at doses below those required for loss of
consciousness. Drugs like midazolam produce amnesia through different pathways by
blocking the formation of long-term memories.[2]:249
Tied closely to the concepts of amnesia and hypnosis is the concept of consciousness.
Consciousness is the higher order process that synthesizes information. For instance,
the "sun" conjures up feelings, memories and a sensation of warmth rather than a
description of a round, orange warm ball seen in the sky for part of a 24-hour cycle.
Likewise, a person can have dreams (a state of subjective consciousness) during
anesthetic or have consciousness of the procedure despite having no indication of it
under anesthetic. It is estimated that 22% of people dream during general
anesthesia and 1 or 2 cases per 1000 have some consciousness termed "awareness
during general anesthesia".[2]:253

ii. OPERATIVE CARE PRINCIPLES

iii. DRESSING AND WOUND CARE

iv. 7 Types Of Wound Dressings & When To Use Each

v.
vi. When it comes to wound healing, it is vital to ensure that healing is as
fast and effective as possible, for this using the right dressing is crucial.
The type of dressing used for dressing a wound should always depend
on various factors, including the type of injury, the size, location, and
severity.
vii. At CLH, we have a range of different wound dressings on offer, each of
which is ideal for treating different wounds. From hydrogel and
hydrocolloid to alginate dressings, we have a wide range of options on
offer.
viii. To make the process of choosing the right wound dressing for the
injury, that little bit easier, we have put together the guide below,
 detailing what each of the seven most commonly used wound
dressings should be used for.
ix. 1. Hydrocolloid

x.
xi. Hydrocolloid dressings can be used on burns, wounds that are emitting
liquid, necrotic wounds, pressure ulcers, and venous ulcers. These are
non-breathable dressings that are self-adhesive and require no taping.
The flexible material that they are made from makes them comfortable
to wear and suitable for even the most sensitive of skin types.
xii. How these dressings work is by creating moist conditions which help to
heal certain wounds; the surface is coated with a substance which
contains polysaccharides and other polymers which absorb water and
form a gel, keeping the wound clean, protecting it from infection, and
helping it to heal more quickly.
xiii. Hydrocolloid dressings are impermeable to bacteria, which is what
makes them so effective at preventing infections. They are also long-
lasting, biodegradable, and easy to apply.
xiv. SEE HYDROCOLLOID DRESSING PRODUCTS
xv. 2. Hydrogel

xvi.
xvii. Hydrogel can be used for a range of wounds that are leaking little or no
fluid, and are painful or necrotic wounds, or are pressure ulcers or
donor sites. Hydrogel can also be used for second-degree burns and
infected wounds.
xviii. Hydrogel dressings are designed to maximise patient comfort and
reduce pain while helping to heal wounds or burns and fight infection.
The cooling gel in products like Burn Soothe are what makes them so
effective at reducing pain and speeding up the healing process.
xix. SEE HYDROGEL DRESSING PRODUCTS
xx. 3. Alginate
xxi.
xxii. Alginate dressings are made to offer effective protection for wounds
that have high amounts of drainage, and burns, venous ulcers, packing
wounds, and higher state pressure ulcers. These dressings absorb
excess liquid and create a gel that helps to heal the wound or burn
more quickly. Containing sodium and seaweed fibres, these dressings
are able to absorb high amounts of fluid, plus they are biodegradable
after use.
xxiii. These dressings require changing around every two days, sometimes
more, due to the amount of liquid that they absorb and the nature of
the wound. Changing them too often could cause too much dryness or
could lead to bacteria penetrating the wound. These should only be
used for wet wounds with high liquid drainage; else they can hinder
healing by drying out wounds too quickly.
xxiv. SEE ALGINATE DRESSING PRODUCTS
xxv. 4. Collagen
xxvi. Collagen dressings can be used for chronic wounds or stalled wounds,
pressure sores, transplant sites, surgical wounds, ulcers, burns, or
injuries with a large surface area. These dressings act as a scaffolding
for new cells to grow and can be highly effective when it comes to
healing.
xxvii. Collagen dressings encourage the wound healing process in a range
of ways; these include by helping to remove dead tissue, aiding the
growth of new blood vessels, and helping to bring the wound edges
together, effectively speeding up healing.
xxviii. 5. Foam

xxix.
xxx. For wounds of varying degrees of severity, foam dressings can work
incredibly well, as well as for injuries that exhibit odours. Foam
dressings absorb exudates from the wound’s surface, creating an
environment that promotes faster healing.
xxxi. These dressings allow water vapour to enter, keeping the area moist,
promoting faster healing, but prevent bacteria from entering the
affected area. These dressings come in various sizes and shapes, as
well as in a range of adhesive and non-adhesive options.
xxxii. SEE FOAM DRESSING PRODUCTS
xxxiii. 6. Transparent

xxxiv.
xxxv. Transparent dressings are useful for when medical professionals or
carers want to monitor wound healing, as these dressings cover the
wound with a clear film. These make identifying potential complications
 much easier, such as by making infections easier to spot at an earlier
time. For this reason, these kinds of dressings are often used on
surgical incision sites, on burns and ulcers, and on IV sites.
xxxvi. These dressings are breathable but impermeable to bacteria, helping
to keep the wound clean and dry, preventing infection and speeding up
healing. They are also flexible, which makes them comfortable to wear.
xxxvii. SEE TRANSPARENT DRESSING PRODUCTS
xxxviii. 7. Cloth

xxxix.
xl. Cloth dressings are the most commonly used dressings, often used to
protect open wounds or areas of broken skin. They are suitable for
minor injuries such as grazes, cuts or areas of delicate skin.
xli. These dressings come in all shapes and sizes, from small coverings
for fingers to larger ones for wounds across wider areas of the body.
As well as pre-cut dressings, these also come in a roll option that is
made to be cut to size.

There are a variety of types of wound care dressings that serve many purposes
depending on the wound. What Are The Different Types of Wound…

There are a variety of types of wound care dressings that serve many purposes
depending on the wound.

What Are The Different Types of Wound Care Dressings?

One Source for Every Dressing

Choosing the proper wound dressing assists with wound healing

Whenever you have a wound, whether it’s a minor cut or a major incision, it’s crucial to
care for it properly. Part of the process includes wound care dressings. There are a
variety of options when it comes to dressings, and to determine which is the best and
most effective depends on what sort of wound you have.

A doctor or other medical professional will examine the wound and determine what is
necessary to keep it free from complications and to assist with healing. The dressing
options will also depend on where the wound is, how large it is and other related factors.
What is a wound care dressing?

A dressing is used by a doctor, caregiver and/or patient to help a wound heal and
prevent further issues like infection or complications. Dressings are designed to be in
direct contact with the wound, which is different from a bandage that holds the dressing
in place.

Dressings serve a variety of purposes depending on the type, severity and position of
the wound. Aside from the major function of reducing the risk of infection, dressings are
also important to help:

Stop bleeding and start clotting so the wound can heal

Absorb any excess blood, plasma or other fluids
Wound debridement
Begin the healing process

What type of wound care dressing is right for my wound?

Hydrocolloid:

Hydrocolloid dressings are used on burns, light to moderately draining wounds, necrotic
wounds, under compression wraps, pressure ulcers and venous ulcers.

Hydrogel:

This type of dressing is for wounds with little to no excess fluid, painful wounds, necrotic
wounds, pressure ulcers, donor sites, second degree or higher burns and infected
wounds.

Alginate:

Alginate dressings are used for moderate to high amounts of wound drainage, venous
ulcers, packing wounds and pressure ulcers in stage III or IV.

Collagen:

A collagen dressing can be used for chronic or stalled wounds, ulcers, bed sores,
transplant sites, surgical wounds, second degree or higher burns and wounds with large
surface areas.

In addition to the wound product categories listed above, there are other wound
dressings available, such as foams and compression in addition to secondary and cover
dressings like wraps, gauze and tape.
xlii. OPERATIVE PROCEDURES