Transcript Skin Wounds Classifications-

Skin Wounds Classification
Soft Tissue Injuries
o Trauma that happens to the skin is visually
exposed
o Categorized as a skin wound
o Defined as a break in the continuity of the soft
parts of body structures caused by a trauma to
these tissues
o Mechanical forces include:
o Friction, scraping, compression, tearing, cutting,
penetrating
Abrasion
o Skin scraped against a
rough surface
o Several layers of skin
are torn loose or totally
removed
o Usually more painful
than a deeper cut b/c
scraping of skin
exposes millions of
nerve endings
Abrasion—Treatment
o Wash wound to remove all dirt and debris
o Soap and water or hydrogen peroxide
o Scrub wound if particles of dirt, rocks, or tar
embedded
o Leave open to air, unless oozing of fluid or
blood
o Apply antibiotic ointment to inhibit infections
o Scrapes scab over quickly
Abrasion—Treatment
o Loose skin flaps my form natural dressing; if
flap dirty remove with clean nail clippers
o Check on date of last tetanus immunization
o Watch for signs of infection
o Seek medical attention if any of following:
o Pain increases after several days
o Redness/red streaks appear beyond edges of
wound
o Swelling
o Purulent drainage
Laceration
• Flesh irregularly torn; cut or tear in the skin
• Minimal bleeding, minimal pain, & no
numbness or tingling
• Cuts ≤ 0.25” (6mm) deep and 0.5” (1.3cm)
long & have smooth, edges can be treated at
home
• Deeper lacerations should be treated by
physician (stitches)
Laceration
Laceration
Laceration—Treatment
o Cleaned with soap and water
o Irrigate with clean water to remove debris
o Do NOT use alcohol, iodine, or peroxide as it
may cause further damage and slow healing
process
o Stop bleeding
o Cover wound with sterile gauze
o Apply direct & constant pressure (15min+)
Laceration—Treatment
o Once wound cleaned,
antibiotic ointment may
be applied to reduce risk
of infection & aid healing
o Change sterile dressing
daily as needed
o Bruising and swelling are
normal
o Apply ice to site
o Elevate area above level of
heart
o Contact a physician if:
o Laceration more than 0.25”
(6mm) deep and 0.5” (1.3cm)
long
o The wound is in area where
wound by be opened by
simple movement of body
part
o Wound on face, eyelids, or
lips
o Deep cuts on palm, finger,
elbow or knee
o Loss of sensation or ROM of
body part as result of cut
Laceration—Treatment
Stitches
Steri-Strips®
Avulsion
o Layers of skin torn off completely or only flap
of skin remains
o Same mechanism as laceration, but to extent
that tissue is completely ripped from it’s
source
o May be considerable bleeding
Avulsion—Treatment
o Clean wound with soap and water
o If flap of skin remains connected replace skin
in its original position
o If deep avulsion, seek medical attention for
stitches
o If large piece of skin torn off place in plastic
bag and put on ice
o Skin should not get frozen or soaked in water
o Take skin in plastic bag to doctor; may be able to save
and replace torn-off piece
Puncture Wound
o Penetration of skin by sharp object
o Nails, tacks, ice picks, knives, teeth, needles
o May be small in diameter and not seem
serious
o Do require treatment by physician
o Can become infected easily b/c dirt and germs
carried deep in the tissue
Puncture Wound—Treatment
o Find out if part of object that caused wound still
in the wound
o i.e. lead from a pencil
o Determine if other tissues have been injured by
the object
o Blood vessels, nerves, tendons, ligaments, bones,
internal organs
o Prevent infections
o Bacterial skin infections, tetanus, infections in deeper
structures (bones and joints)
Puncture Wound—Treatment
o Risk of infections increases if:
o wound was exposed to soil (may contain
tetanus or other bacteria)
o went through sole of shoe (↑ risk of bacterial
infection that is difficult to treat)
o injected into skin under high pressure
o i.e. nail from nail gun, paint from highpressure paint sprayer
o Physician should be consulted if object
penetrated deeply
Contusion
o A blow compresses or crushes
the skin surface and produces
bleeding under the skin
o Does not break skin
o Bruising due to injury to blood vessels
o Most mild and respond well to RICE
Contusion—Signs & Symptoms
o Swelling
o Pain to touch
o Redness
o Ecchymosis
o accumulation of blood
in skin & subcutaneous
tissue more than one cm
in diameter
o General term=bruising
o Result of bleeding;
clotting or bleeding
disorders
o Bluish lesion at earliest
stages of onset
Contusion—Treatment
o Careful monitoring
o Anti-inflammatory oral medications
o Compressive dressing
o Ice
o Modalities to ↓ ecchymosis, ↓ swelling, ↑ ROM
o Myositis ossificans: calcification that forms
within muscle
o Requires surgical intervention
Blister
o Continuous rubbing over the
surface of the skin causes a
collection of fluid below or
within the epidermal layer
Blister—Treatment
o Wash area thoroughly
o Use sterile blade to cut
small hole in blister
o Squeeze out clear fluid
o Do not remove skin
o Prevention:
o
o
o
o
Wear work gloves
Break in new shoes
Petroleum jelly/skin lube
Adhesive bandage
Incision
o Skin has been sharply cut
o Surgical cut made in skin or flesh
Incision—Treatment
o Remove bandage day after surgery; replace
daily or as needed
o Normal for edges of healing incision to be
slightly red
o Call physician if:
o redness increases/spreads more than half an inch
o pus in incision
o more than mildly tender or painful
Incision—
Treatment
o Keep incision clean & dry for several days
after surgery
o Non-absorbable sutures or staples must be
kept dry until doctor removes
o Steri-strips® should be kept dry 4-5 days
o On face, hands, arms: take showers or tub
baths along as affected area stays dry
Wound Care
o Irrigate with clean, cool water to wash away
foreign particles
o Gentle wash with mild soap (superficial cuts
only)
o Minor cuts/abrasions should be washed, dried
with sterile gauze sponge, and treated with
first aid cream
o Apply dry, sterile bandage, large enough to
cover entire injury
Wound Care
o Clean bandage should be applied daily
o Athlete should be instructed on how to clean
& manage wound
o Athlete should check for signs of infection:
o Redness
o Swelling
o Increased pain
o Oozing of pus
o Increase body temperature
Skin Infections
o Skin always has some amount of bacteria,
fungus, and viruses living on it
o Skin infections occur when there are breaks
in the skin and the organisms have
uncontrolled growth
o It is more important to understand the
potential for infection rather than placing a
name on the skin problem
Skin Infections
o Bacteria—can be cured
o Staphlococcus
o Including MRSA & Impetigo
o Streptococcus
o Fungal—can be cured
o Ringworm
o Viral—cannot be cured, but can be treated
o Herpes
o Warts
o Molluscum contagiosum
When to Worry
o Lesions with an irregular
border
o Raised skin lesions
o “wet” or “moist” lesions
o Lesions that have
different colors within
the lesion
o Bright red colored lesions
are more of a problem
compared to faded lesions
o Lesions that are warmer
compared to other skin
o Inflammation & irritation
around skin lesion
o Prior history of infectious
skin lesion
o Skin abrasions
o Deeper or more traumatic
break in skin, higher risk
for subsequent infection
Skin Infections
o The right antibiotic is required to cure a
specific bacterial skin infection
o Antibiotics for bacteria will not improve
fungal or viral infections
o Bacterial infections can be the fastest growing
infections
o Thus the most easily spread among athletes
Staph
o Infection caused by
Staphylococcus bacteria
o About 25% of people
normally carry staph in
the nose, mouth,
genitals, and anal areas
o Infection begins with a
little cut gets infected
with bacteria
o Range from a simple
boil to antibioticresistant infections to
flesh-eating infections
o Difference is:
o the strength of the
infection
o How deep it goes
o How fast it spreads
o How treatable it is with
antibiotics
MRSA
o Methicillin resistant Staphylococcus aureus
o Resistant to certain antibiotics most are skin
infections
o Methicillin, oxacillin, penicillin, amoxicillin
o More severe or potentially life-threatening
occur most frequently among patients in
healthcare settings
Symptoms of MRSA
Skin Infections
o Appear as pustules or boils
o Red
o Swollen
o Painful
o Pus or other drainage
o First look like spider bites or
bumps
o Occur at sites of visible skin
trauma
Severe Infections
o Potentially life-threatening
o Blood stream infections
o Surgical site infections
o Pneumonia
o Signs & symptoms vary by
type and stage of infections
Causes of MRSA
o Spread by having
contact with someone’s
skin infection or
personal items they’ve
used
o Spread in places where
people are in close
contact
o Close skin-to-skin
contact
o Openings in the skin
(cuts or abrasions)
o Contaminated items &
surfaces
o Crowded living
conditions
o Poor hygiene
Personal Prevention of MRSA
o Good hygiene
o Keep hands clean—wash with soap and water
thoroughly
o Keep cuts and scrapes clean & covered with a
bandage
o Avoid contact with other’s wounds/bandages
o Avoid sharing personal items i.e. towels, razors
Prevention of MRSA in
Athletics
o Practice good personal
hygiene
o Keep hands clean
o Shower after exercise
o Do not share soap or
towels
o Wash uniform & clothing
o Take care of your skin
o Cover abrasions/cuts
o Change bandages regularly
o Do not share items that
come in contact with
your skin
o Towels & razors
o Ointments
o Take precautions with
common surfaces &
equipment
o Use barrier between skin
& surface (towel,
clothing)
Diagnosis & Testing of MRSA
o Culture must be obtained
o Small biopsy of skin
o Drainage from infected site
o Blood
o Urine
o Sent to microbiology laboratroy
o Tested for S. aureus infection
o Determine which antibiotics will be effective
Treatment of MRSA
o Antibiotic to drain infection
o DO NOT attempt to treat yourself!
o Includes popping, draining, using disinfectants on
area
o If you think you have an infection:
o Cover affected skin
o Wash hands
o Contact physician
MRSA Statistics
o 2005: estimated 94,360 people develop serious
MRSA infection
o Approx 18,650 person died during hospital stay
related to these serious MRSA infections
o About 85% of all invasive MRSA infections were
associated with healthcare (2/3 outside of
hospital)
o About 14% of all infections occurred in persons
without obvious exposures to healthcare
MRSA
MRSA
MRSA
MRSA
Impetigo
o Mild itching & soreness
o Eruption of small vesicles and/or pustules that
rupture to form honey-colored crusts
o Combo of 2 bacteria that spread rapidly when
athletes in close contact with one another
o Responds rapidly to proper treatment
o Thorough cleansing of crusted area
o Application of topical antibacterial agent
Impetigo—Causes
o Caused by streptococcus (strep) or
staphylococcus (staph) bacteria
o MRSA becoming common cause
o May occur on skin where there is no visible
break
o Most common in children, particularly
unhealthy living conditions
o Infection carried in fluid that oozes from
blisters
Impetigo—Symptoms
o Single or many blisters filled with pus
o Easy to pop
o When broken leave a reddish raw-looking base
o Itching blister
o Filled with yellow or honey-colored fluid
o Oozing and crusting over
o Rash
o Skin lesions on face, lips, arms, or legs
o Swollen lymph nodes near infection
Impetigo
Folliculitis
o Inflammation of a hair follicle
o Starts when hair particles damaged by friction
o Clothing, blockage of follicle, shaving
o Frequently become infected
o Bacteria Staphylococcus (staph)
o Painless or tender pustule (pimple)
o May crust over
o Rash or itching
Folliculitis
Ringworm
o Skin infection caused
by fungus (not a worm
)
o Fungi thrive in warm,
moist areas
o Often several patches at
once
o Contagious
o Symptoms:
o Itchy, red, raised scaly
patches that may blister
and ooze
o Patches often have
sharply-defined edges
o Redder around outside;
normal skin tone in
center
o Skin appear unusually
dark or light
Ringworm Types
o Body—tinea corporis
o Scalp—tinea capitis
o Groin—tinea cruris (jock itch)
o Feet—tinea pedis (athlete’s foot)
Ringworm
Herpes Gladitorium (Viral)
o Caused by herpes simplex
virus Type 1
o Spread by direct skin-toskin contact
o Lesions/sores appear
within 8 days after
exposure
o Appear as cluster of
blisters
o Diagnosis upon
appearance
Cauliflower Ear
o Deformity of outer ear
o Caused by accumulation of blood beneath the
external surface of ear & underlying cartilage
o Blunt trauma to ear to cause hematoma or
bruising of tissue to develop into this
deformity
o Seen in wrestlers, rugby players, boxers
Cauliflower Ear
o Painful & physically deforming
o Fluid accumulates beneath skin surface of ear
o Underlying cartilage is deprived of blood
supply & nutrients necessary for normal
functioning
o If fluid not removed hardening of tissues &
keloid formation results
o Gives ear shriveled & deformed appearance
Cauliflower Ear Treatment
o ICE
o See physician—often necessary for fluid to be
aspirated
o Drained with needle
o Placement of custom-made, form fitting
compression dressing made of hardened
casting material
o Worn 3-5 days continuously
o Athlete return to activity wearing both device and
appropriate headgear
Cauliflower Ear
Cleaning & Disinfecting
o Cleaners
o Products used to remove
soil, dirt, dust, organic
matter, & germs
(bacteria, viruses, fungi)
o Work by washing
surface to lift dirt &
germs off surfaces so thy
can be rinsed away with
water
o Sanitizers
o Used to reduce germs from
surfaces but not totally get
rid of them
o reduce germs to level
considered safe
o Disinfectants
o Chemical products that
destroy or inactivate germs
& prevent them from
growing
o No effect on dirt, soil, or
dust
Which one to use?
o Disinfectants effective against staph most
likely also effective vs. MRSA
o Products readily available from grocery/retail
stores
o Check product label
o List of germs that product destroys
o Use disinfectants that are registered by the
EPA
o Check for EPA registration number on product
label for confirmation
How should cleaners &
disinfectans be used?
o Read the label first. Each cleaner and disinfectant
has instructions on the label that tell you
important facts:
o How to apply the product to a surface
o How long you need to leave it on the surface to be
effective
o If the surface needs to be cleaned first and rinsed
after using
o If the disinfectant is safe for the surface
o Whether the product requires dilution with water
before using
o Precautions you should take when applying the
product (wearing gloves or apron)
Disinfection Guidelines
o All floor and wall padding in athletic areas
should be washed daily (if athletic area is
used)
o Separate mop head/buckets should be used for
each activity area, locker room, and restroom.
o Mop heads & buckets should be cleaned regularly
o Towels/linens laundered on premises should
be washed with detergent at a minimum of
160٥F & dried in hot dryer
Disinfection Guidelines
o CAUTION! If clean athletic gear is dumped
into a dirty laundry bag or gym bag, the gear
immediately becomes a source of infection
o Liquid (not bar) soap should be readily
available and provided by wall dispenser close
to sinks & next to showers
o Sports equipment should be cleaned regularly
o Balls, racket grips, bats, gloves
Disinfection Guidelines—
Wrestling Room & Mats
o Mat surfaces with small holes or tears should
be repaired with mat tape.
o Mat surfaces should be replaced promptly
when there are large holes or surfaces are
excessively worn
o Both sides of the mats should be cleaned
thoroughly before and after each use for
practices and meets
Maximize Athletic Success!
Minimize Risk of Infection!