Many rehabilitation professionals feel uncomfortable discussing wound care. Why is this? It could be:
- Lack of familiarity with the examination process.
- Uncertainty around interpretation of findings.
- Difficulty choosing between available treatments.
In many cases, the “yuck factor” of the subject matter keeps them away.
No matter the excuse, rehab professionals need to understand wound management and its components in order to properly incorporate these factors into our examinations and interventions.
Why Do Rehab Professionals Need an Understanding of Wound Care?
As a rehab professional, you spend a lot of time working with the general population. With this direct access, it is vital to understand certain patient examination criteria in order to provide either the appropriate treatment or a referral to an appropriate clinician.
For instance, compare the characteristics of the inflammatory phase of healing with those of infection. The signs and symptoms of both these diagnoses have a lot in common. Both have pain with palpation, an increase in local temperature, an increase in edema, and an increase in local erythema. If a person presents with intact skin but these signs are present, you would have to determine whether the person has an infection or is in the inflammatory phase of healing.
The one distinguishing difference between these diagnoses is that the inflammatory phase of healing occurs in the first 14 days following an injury. If a patient has these symptoms following an injury, an infection is possible, but it is most likely the normal healing process.
Let’s look at a particular patient scenario.
“Jason,” a 42-year-old male with a past medical history of insulin-dependent diabetes mellitus, obesity, and hypertension, comes to see you about his ankle. He has a two-week history of erythema to purplish hue and the following symptoms:
- Increase in temperature
- Edema to right lateral malleoli that extends the entire foot to five inches superior to lateral malleoli
- Decreased ability to bear weight
- Noted increase in lethargy
Jason is unsure of the cause of the injury.
At first glance, one might think that Jason is presenting with the signs of a possible ankle sprain, but a practitioner with a knowledge of wound care will recognize that these could also be the signs of possible necrotizing fasciitis. In fact, if Jason were my patient, I would lean toward a diagnosis of necrotizing fasciitis based on Jason’s two-week history of symptoms, the increase in lethargy, the purplish hue of the area, and the development of the blisters.
One diagnosis, the ankle sprain, can easily be treated with physical therapy while the other, the necrotizing fasciitis, requires that Jason be sent to the emergency room for proper surgical intervention. It’s crucial to know the difference.
Wound management knowledge is more than just addressing patients with integumentary issues. It requires us to know enough about the integument that we can properly assess our findings. All rehabilitation professionals should have a basic knowledge of wound management. If you need to brush up on your wound care skills or need a foundation in wound management, make sure to check out my MedBridge courses, “Wound Care Basic Training: Parts 1 and 2.”