- Symptoms of the Wound fever
- Reasons of the Wound fever
- Treatment of the Wound fever
The wound fever is characterized by development of the certain clinical picture which is shown both local, and general changes in an organism. Depending on conditions of drawing a wound divide into deliberate (operating rooms) and accidental. Operational wounds are pure (aseptichny) as are put with the sterile tool in the conditions of the operating room. Accidental wounds are always initially infected — extent of their infection depends as on conditions in which the wound, and was got from character of the hurting tool.
Consecutive infection — in addition joins a wound surface in the absence of an aseptic bandage or is repeatedly brought at non-compliance with rules of an asepsis and antiseptics.
Symptoms of the Wound fever:
The symptoms of an infection described still by the ancient Roman doctor Aoulous Cornet-liusom Selsous (! century AD) signs of a wound fever, such as Rubor (redness), Tumor (tumor), Calor (heat) and Dolor (pain), and remain today decisive symptoms for its recognition. They are expression of fight of immune system against the got microorganisms which can be compared to run a naper; races between development of antibodies and reproduction of microbes. The general symptoms are fever and a fever, a leukocytosis, and also increase in regional lymph nodes, and it is necessary to find out the fever reasons.
The earlier the diagnosis of an infection, the better, naturally, perspective of its timely elimination is made. But just recognition of the beginning infection is accompanied by the greatest difficulties as unambiguous symptoms still are absent. Preservation of the local center of irritation, the increased temperature, a resistant leukocytosis and the amplifying pain in a wound are the signs setting thinking seriously.
Reasons of the Wound fever:
The phenomenon of an infection represents the difficult, depending on many contributing factors process. Crucial importance to start development of an infection have first of all an appearance, pathogenicity and virulence, and also quantity of the microorganisms which got to a wound. Microorganisms find a certain environment which to a greater or lesser extent corresponds to living conditions, necessary for them, in a wound. Therefore a condition of a wound (extent of pollution, amount of the destroyed fabric, blood supply conditions, etc.), the age of a wound and its origin are other important contributing factors. Osobe-io the large role is played with how quickly at this condition of a wound local protective mechanisms can work and how effective they will be.
It in turn depends on the general immune status of the corresponding organism. Already weakened immune system, the worsened general state, certain disbolism, malignant tumors, old age, bad food, etc. always exert negative impact on an immune response at the expense of what favorable conditions for the intruded microorganisms are created.
Viruses, fungi and bacteria can be contagiums. In the prevailing number of cases the speech, however, goes about bacteria.
Bacteria represent only unicells at which internal cell structure differs in small differentiation. The bacterium consists of "a kernel equivalent" with genetic material, and also cytoplasms with the ribosomes, various enzymes and plasmids which are carriers of factors of resistance. The outside cell wall can be covered with the capsule of various structure which if necessary can protect a bacterium from drying or from cells devourers.
Treatment of the Wound fever:
Prevention of a wound fever comes down to the maximum prevention of planting of a wound microorganisms while treatment concentrates on cardinal reduction of the microflora which is available in a wound and on destruction of the got bacteria. At the same time practical actions for prevention and treatment should be considered not separately, and within the complete concept demanding coordinate actions from all who participate in processing of a wound.
Priority action is strict maintenance of an asepsis. It is necessary premises of preoperative preparation, the operation and postoperative actions, and also processings of open wounds at all acute and chronic wounds.
Already clinically contaminated wounds should be processed only in aseptic conditions too. Not to mention that it is necessary to prevent further consecutive infections, such wounds represent a tank of extremely virulent microorganisms which distribution can be prevented only by means of a comprehensive asepsis.
Other actions for prevention and treatment of a wound fever in turn depend on a condition of a wound and demand adequate actions. At contaminated wounds with primary healing it is necessary to provide bystry outflow of a secret due to opening of seams and the corresponding drainage of a wound. At all for the second time the healing wounds for example traumatic caused and also at chronic ulcerations surgical treatment of a wound moves to the forefront: necroses and impractical fabrics need to be removed, widely to open wound pockets, to take foreign bodys. Blood supply of fabric with an adequate supply of oxygen which is necessary for operation of local protective mechanisms of an organism is at the same time provided to these.
If in view of specific conditions surgical treatment of a wound is impossible, reasonable physical cleaning of a wound with use of water dressings and if necessary using enzymatic drugs.
Antiseptics. Topical administration of antiseptic drugs as "an action for destruction of microbes" is always complicated by a number of special problems. Efficiency of these drugs is usually quite limited, but they have the strong side effects which are slowing down a wound repair. Among these side effects it is necessary to mention first of all the cytotoxicity expressed in various degree in relation to immunocompetent cells (granulocytes, lymphocytes and macrophages), and also fibroblasts (disturbance of formation of granulyatsionny fabric) and epithelium cells, allergization, development of resistance, pain, and also coloring of a wound which strongly complicates observation of its state.
If for local disinfection of a wound antiseptic agents are used, they have to correspond to a number of requirements. Even in difficult conditions of use, for example in the presence of native human blood, they have to have high bacterial action against a wide range of microorganisms, have to be transferred by fabric and to be toxicological safe and should not cause pains. Besides, the risk of complications as a result of their absorption has to be excluded. At last in view of a large amount of side effects it is necessary to refuse completely "preventive" use of antiseptic agents in the absence of clinical signs of an infection.
When using solutions for washing of wounds it is necessary to watch their portability too. It is proved that even 3% solution of peroxide of hydrogen has the cytotoxic potential therefore, especially at prolonged use, it is necessary to weigh possible advantage and risk carefully. On the contrary, do not give side effects of rinsing by solution of Ringer which, besides, supplies cells with important electrolytes, such as sodium, potassium and calcium. According to modern data it favors to proliferation of cells and by that to healing.
Antibiotics. With topical use of antibiotics the same problems, as are accompanied by antiseptic agents. Thanks to existence in a wound of various diffusion barriers, for example necroses and pus, actually infectious agents get into depth with great difficulty. It in turn increases danger of development of resistance. While on a surface of a wound high concentration of antibiotics is created, with a depth it becomes less. At the same time in depth still there are microorganisms which can gain resistance as they will not be killed at once.
One more serious lack of external use of antibiotics is emergence of contact allergies first of all at often practiced their prolonged use at chronic wounds, for example at venous ulcers. Besides, some antibiotics suppress proliferation and epithelization of wounds.
There are some more reasons for which topical use of antibiotics is a subject of fierce disputes now, and in many cases in general it is not recommended any more. On the contrary, clinically acceptable method at clinical implication of infections is system introduction of antibiotics according to data of identification of species of a microorganism and check of resistance. As at acute infections seldom at once there is an identification of species of the activator, the immediate initiation of treatment by an antibiotic with a broad spectrum of activity is recommended. If on an antibiogramma resistance of the activator becomes clear, therapy can be corrected as appropriate