Acute and Chronic Wound Care for Health Care Professionals (Wound05)

Venue: The George Washington University Medical Center

Location: Washington, District Of Columbia, United States

Event Date/Time: Jun 23, 2005 End Date/Time: Jun 26, 2005
Registration Date: Jun 17, 2005
Early Registration Date: May 22, 2005
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Twenty years of extraordinary advances in both acute and chronic wound management have redefined what constitutes 'basic knowledge' in the wound management arena. Because of these changes, it is now possible for healthcare providers at multiple levels to increase their scope-of-practice. The results are earlier recognition, intervention and decreased morbidity for the wound care patient. However, due to the characteristics of individual clinical practices it may have been quite some time since you treated certain conditions such as a diabetic foot, venous stasis or lymphedema, for example. So, this four-day course is designed to examine many of those advances and discuss the ways in which the clinicians' roles have evolved in the treatment of acute and chronic wound and to allow participants to select from multiple concurrent hands-on workshop sessions that will best suit their needs.


Introduction to Problem Wound Management: Normal vs. Abnormal Healing
In order to explore advances in wound management and changes in scope-of-practice, one must first revisit the basic assumptions as to what constitutes 'normal' and 'abnormal' healing. In this lecture, the general nature of cellular and chemical interactions in normal healing will be reviewed. The role of assessing, staging or grading the wounds, initially and on an ongoing basis will be stressed. At the completion of this lecture, participants will be prepared to carefully assess type (acute or chronic), etiology, and the grading or staging of a wound. Participants will also learn to perform an appropriate ongoing wound assessment and have a general understanding of the systematic approach to the wound care patient.

Introduction to Hyperbaric Medicine
The proper context of hyperbaric medicine in the arsenal of today's clinician is often misunderstood. These lectures will focus on the history and benefits of diving and hyperbaric medicine from ancient through modern times. Examples of monoplace, multi-place, and transportation chambers will be discussed. The advantages and disadvantages of each chamber will be examined, both in the treatment of divers and all other hyperbaric oxygen therapy patients. The physics involved in the gas laws and their relevance to the physiology of the human body will be detailed. The physiological benefits provided by hyperbaric oxygen treatment will be explained along with a detailed explanation of its approved uses.

Venous Stasis Wound Management
As the general population ages, venous leg ulcers become more common despite advances in medical care. These ulcers are frequently associated with pain and a decreased quality of life. At the completion of this lecture, participants will be prepared to assess leg ulcers, recognize the risk factors for the development of venous insufficiency and venous ulcers, and distinguish them from other etiologies. Participants will also learn how to select appropriate medical treatment and understand the differences in options for compression bandages and other adjunctive therapies.

Management of the Diabetic Foot
The end-stage complications of diabetic neuropathy, bone deformity (Charcot foot), and vascular disease are diabetic foot ulcerations and amputations. Increases in mortality rates due to these complications, have lead health care providers to enhance treatment and prevention measures. The ultimate goal in the management of the diabetic foot is to improve the patients' quality of life. This lecture will describe the causes, means of assessment and classifications of diabetic foot wounds. Different methods of neuropathy assessment and the risks associated with amputation will also be explored.

Management of the Ischemic Wound
A general knowledge deficit exists among health care providers regarding arterial disease and associated complications. Arterial ulcers are but one of the complications of arterial insufficiency; this lecture will address how these ulcers are to be evaluated and what adjunctive management techniques may be applicable. Participants will learn how to identify and quantify the presence of arterial occlusive disease by means of patient history and detailed physical examination with concomitant vascular and clinical laboratory studies. Participants will also learn how to identify the characteristics of arterial ulcers and to recognize the best methods to improve arterial circulation.

Chronic Wound Infection: Diagnosis and Treatment / Understanding Lab Values
The diagnosis and management of infection is an essential activity during the ongoing care of a chronic wound. In order to assist clinicians in better evaluating their own approaches to chronic wound care, this lecture has been designed to provide the most current diagnostic and management guidelines in the care of infected chronic wounds. The participant will learn how to diagnose infection in a chronic wound based on a detailed assessment of local and systemic host factors that alter the response to bacteria burden, findings on inflammatory soft tissue, and culture results. The participants will also learn how to understand the differences between the various assessment methods available to them.

Alternative Topical Therapies
As stakeholders in the healthcare industry place more emphasis on evidence-based medicine, clinicians and third-party reimbursement providers are demanding clinical studies to prove the efficacy of certain treatment modalities. Alternative therapy studies are limited in number. Additionally, many exist in the early phase of study or may actually be well investigated but not widely accepted or known. There are, however, a variety of reasons why alternative therapies are generally becoming more accepted in today's healthcare arena. Two of the most notable include: 1) Traditional medicine has been perceived by many as being incomplete or not providing the most favorable outcomes with chronic conditions and illnesses. 2) Healthcare costs have escalated dramatically, giving rise to patients seeking alternative, less expensive methods for improving chronic disease. Before deciding if a particular alternative therapy is appropriate for wound care, it must be determined that the therapy supports the basic principles of wound management including the control and elimination of causative factors, provision of systemic support to reduce existing and potential cofactors, and maintenance of the physiologic local wound environment.

Principles and Practices of Acute Wound Management
Many approaches to acute wound care exist. This lecture will establish a commonality of language in the description of wounds, examine the underlying concepts of acute wound care and explore the guiding principles behind the three concurrent views of acute wound management practiced at The George Washington University Department of Emergency Medicine. The guiding principles of acute wound management include: 1)"Wound Repair" is not to be viewed as a point in time, but on a continuum. As providers, what we do for patients, and why, is determined by an event's cause, initial presentation and estimation of what will happen when that patient leaves the clinical setting. 2) The clinician must view a wound as an artist views a canvas. Thinking algorithmically about acute wound management is essential. However, there are those situations which call for a certain degree of "lateral thinking". 3) The final outcome of almost all wounds is not predetermined prior to the patient's arrival in the clinical setting. As clinicians, we exert a tremendous influence on outcomes as much by our attitude as our actions.

Recognition and Management of Common Orthopedic Injuries
Clinicians at all levels must be aware of the significant overlap between wound management and orthopedics. "Open" orthopedic injuries present with associated wounds and many wounds often have concurrent orthopedic injuries including: open fractures, joints and/or dislocations, tendon lacerations, amputations, or even abrasions masking underlying orthopedic trauma. This set of lectures will examine some of the more common upper and lower extremity orthopedic injuries seen in the acute care setting. The participants will gain an understanding of the recognition, assessment and treatment of such injuries.

Recognition and Management of Hand Injuries
Hand injuries are among the most common and debilitating injuries seen in the acute care setting. Accurate assessment, prompt treatment and suitable follow-up are essential components in minimizing the potential long-term disability caused by such events. Before a clinician can provide proper treatment and follow-up, they must have an accurate understanding of the underlying anatomy and perform an appropriate examination. This lecture will be divided into three parts: a review of the anatomic intricacies of the hand, a description of a focused examination and a discussion of typical and atypical case presentations.

Recognition and Management of Head and Facial Injuries
Facial and head injuries are commonly seen in the acute care setting. The anatomical position alone makes this area a virtual 'magnet' for trauma. These injuries happen as a result of motor vehicle accidents, work-related events, assaults, athletic, recreational or domestic activities. The assessment and repair of this area can be both intimidating and complex. The goal of this lecture is to provide the clinician with a rationale for defining what constitutes "simple" or "complex" wounds and for assessing, repairing or referring those wounds.

Ultrasound in Wound Management
The use of ultrasound in the wound management arena has increased significantly in the past ten years. This can be attributed to its relative low cost, ease of use and measurable clinical benefits. While this won't replace the standard x-ray, CT Scan or MRI, it is a useful adjunct technology for the wound care clinician. This lecture will cover the numerous diagnostic and treatment capabilities of ultrasound.

Acute Minor Burn Management
Even minor burns can be debilitating injuries resulting in scarring and dysfunction. The key to minimizing any disability is to initiate prompt treatment and appropriate follow-up. Acute burn management includes rapid pain relief, measures aimed at halting the progression of tissue damage, identifying patients meeting hospitalization criteria and implementing procedures to promote wound healing and infection control. This lecture will give participants the clinical tools needed to perform appropriate burn management in the acute care setting.

Treatment of Common Acute Wound Infections
Acute wound infections can occur regardless of the mechanism of injury, age, general health of the patient, time to repair, or treatment rendered. There are, however, many factors that contribute to local infections that can be decreased significantly or eliminated altogether. The result is a significant reduction of the rate of infection in the clinical environment. This lecture will discuss the common causes, treatment modalities and various methods of prevention of acute wound infections.

Assessment and Treatment of Mammalian, Reptilian and Marine Bites
About half of all persons in the United States will incur a mammalian, reptilian or marine bite at some point in their lifetime. Most recipients of bites do not request medical attention but there are a variety of reasons why someone would need to seek care. Three critical components will be covered in this lecture, regarding effective treatment of bites: 1) Basic epidemiology and various presentations of bites. 2) Common bacteria found in bite wounds and the most suitable antibiotic choices for treatment. 3) An organized approach to the management of bite wounds.

Establishing a Regional Wound Center
As demographics change and the population continues to increase in number and median age, the prevalence of chronic wounds also continues to grow. The inevitability of healthcare providers at all levels to increase their scope-of-practice and become more versed in wound management is apparent. There comes a point, however, when a wound goes beyond the scope-of-practice of the primary physician. Since treatment of the chronic wound is generally not the centerpiece of a specialty practice, the clinician may view the wound as a complication at best or even a source of frustration. The patient is then sent from physician to physician due to a lack of referral guidelines and expertise with chronic wound management. A regional wound center consolidates the patient's care and reduces costs by building a multidisciplinary wound healing team. This lecture examines the significant benefits and considerable difficulties of establishing such a center.

Pharmacology and Uses of Local Anesthetics
The relief of pain during wound preparation and repair is vital to providing competent care. To be medically effective, substances used in pain control should be temporary in nature and relatively safe. Pharmacologic and clinical considerations of direct interest to the practitioner include the means by which anesthesia is achieved, the duration and depth of anesthesia, the type and probability of agent induced reactions, the potential for drug or disease state interactions and, ultimately, which is the best agent, dosage and route of administration for a particular case. At the conclusion of this lecture, the participant will understand the necessary considerations when using local and regional anesthesia in the clinical environment.


After completion of this program, participants should be able to:

--Demonstrate appropriate knowledge, evaluation and management strategies for acute and chronic wound care patients.
--Identify ways of effectively integrating their practice with a regional wound care center.
--Identify common and uncommon presentations of acute and chronic wounds.
--Demonstrate effective techniques and skills that can dramatically improve the wound care patient's outcome.


Additional Information

Enrollment Fee The registration fee for this 4-day hands-on wound care course is $675 for physicians and $575 for physician assistants, nurse practitioners and other allied health care professions. Full payment is required with the completed registration form to reserve a place in the course. If you register on or after May 23, 2005 please add $100 to the registration fee. The registration fee for all attendees includes reprints of slides, speaker presentations, continental breakfast each day, and refreshment breaks. All registration forms, with payment, must be received by the Office of CEHP before June 17, 2005; however, enrollment space in general sessions and skills workshops is limited and may be filled at an earlier date. Early registration is strongly encouraged. Written confirmation of registration is mailed within one week of receipt of your completed form and full payment.