Each issue of Wounds International features a typical day in the life of a different wound care clinician from around the world. This series looks at the variety of techniques that are required in different settings and asks clinicians about the type of conditions they work in, the types of wounds they see and the challenges that they face when providing wound care to patients.

This issue features Valerie Winberg, nurse practitioner at the Chatham-Kent Health Alliance in Chatham, Ontario, Canada.

Can you describe where you practice?
I'm currently a nurse practitioner in the fast-track area of an emergency department. I am also involved in wound care education and private wound care consultation.

Can you explain the make-up of your team?
The fast-track area is staffed by one or two nurse practitioners and a registered practical nurse who assists with patient flow and performs any necessary patient care. There are physicians to support the fast-track area as well.
We also have a homecare case manager available for patients requiring assistance with home dressing changes or basic home care.

What types of wounds do you regularly see?
Rashes are one of the most common wounds we encounter as well as many acute wounds, such as laceration repairs, crush injuries, road rash, burns, skin tears, and animal and human bites.
We also see a high incidence of lower limb cellulitis and post-operative complications as well as wound infection, dehiscence and exudate management issues.

Diabetic foot and lower leg ulcers are common as well. There are no wound clinics in the area, so advanced wound care lacks consistency.

What are the main types of equipment, dressings and techniques that you use on a day-to-day basis?
The hospital operates on a med-buy programme (healthcare products at reduced prices) so there is a formulary for advanced dressing products. It includes standard items for providing wound care - a gel, an alginate, a silver alginate, adhesive and non-adhesive foam, silver-impregnated foam, a film, a high compression system and a composite dressing, as well as a variety of stoma products. Negative pressure wound therapy is also available, but is not usually needed in the emergency department.

What is the most unusual wound you have seen recently and how did you manage it?
I recently saw a 96-year-old male patient who presented with a large tumour growing from his head (8cm x 6cm x 5cm), which was crawling with maggots. I tweezed away as many maggots as I could (100 or so), took a punch biopsy of the site and covered the tumour with betadine gauze. I then treated him with intravenous (IV) antibiotics and gave him an urgent referral to the cancer clinic.

Do you feel your practice has any unique obstacles that hamper your work?
The emergency department provides unique obstacles in that patients rarely have a previous history to refer to. Patients also tend to present in a state of distress, which can make it difficult for them to concentrate and cooperate with treatment.

Many patients lack a regular community provider so they haven't had routine care for many years. A lot of the time I'm not just managing patients' wounds, but also advising them about their follow-up.

What equipment/resource/education would make the most difference to your everyday work?
It is very different working as a wound care clinician in a rural setting rather than in a large teaching hospital or massive urban centre. I do not have access to much expensive diagnostic equipment, financial aid for research or interdisciplinary teams. It is often just myself and whoever else I can find that has an interest in understanding more about chronic and complicated wounds.

There is a universal need for basic wound and skin care education at all levels of health care. If we could meet that need then perhaps we could prevent some of the more advanced wound cases that clinicians like myself have to deal with.