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Skin Wounds

Classification

Chapter 16 (pages 328-332)

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
o

Skin scraped against


a rough surface
Several layers of
skin are torn loose
or totally removed
Usually more painful
than a deeper cut
b/c scraping of skin
exposes millions of
nerve endings

AbrasionTreatment
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

AbrasionTreatment
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

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

LacerationTreatment
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+)

LacerationTreatment
o

Once wound cleaned,


antibiotic ointment
may be applied to
reduce risk of infection
& aid healing
Change sterile
dressing daily as
needed
Bruising and swelling
are normal
o Apply ice to site
o Elevate area above level
of heart

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

LacerationTreatment
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 its source
o May be considerable bleeding

AvulsionTreatment
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

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

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
high-pressure paint sprayer
o Physician should be consulted if object
penetrated deeply

Contusion
oA

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

ContusionSigns &
Symptoms
o
o
o

Swelling
Pain to touch
Redness

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

ContusionTreatment
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

BlisterTreatment
o
o

o
o

Wash area
thoroughly
Use sterile blade to
cut small hole in
blister
Squeeze out clear
fluid
Do not remove skin

Prevention:
o Wear work gloves
o Break in new shoes
o Petroleum jelly/skin
lube
o Adhesive bandage

Incision
o Skin

has been sharply cut


o Surgical cut made in skin or flesh

IncisionTreatment
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

Care of Open Wounds


Chart

in Arnheimp 928

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

Bacteriacan be cured
o Staphlococcus
o Including MRSA & Impetigo

o Streptococcus
o

Fungalcan be cured
o Ringworm

Viralcannot be cured, but can be treated


o Herpes
o Warts
o Molluscum contagiosum

When to Worry
o
o
o
o

Lesions with an
irregular border
Raised skin lesions
wet or moist
lesions
Lesions that have
different colors within
the lesion
Bright red colored
lesions are more of a
problem compared to
faded lesions

o
o

Lesions that are


warmer compared to
other skin
Inflammation &
irritation around skin
lesion
Prior history of
infectious skin lesion
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
About 25% of people
normally carry staph
in the nose, mouth,
genitals, and anal
areas
Infection begins with
a little cut gets
infected with
bacteria

Range from a simple


boil to antibioticresistant infections
to flesh-eating
infections
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 lifethreatening occur most frequently


among patients in healthcare settings

Symptoms of MRSA
Skin Infections
o
o
o
o
o
o
o

Appear as pustules or
boils
Red
Swollen
Painful
Pus or other drainage
First look like spider
bites or bumps
Occur at sites of
visible skin trauma

Severe Infections
o

Potentially lifethreatening
o Blood stream infections
o Surgical site infections
o Pneumonia

Signs & symptoms vary


by type and stage of
infections

Causes of MRSA
o

Spread by having
contact with
someones skin
infection or
personal items
theyve used
Spread in places
where people are
in close contact

o
o

o
o
o

Close skin-to-skin
contact
Openings in the
skin (cuts or
abrasions)
Contaminated items
& surfaces
Crowded living
conditions
Poor hygiene

Personal Prevention of
MRSA
o Good hygiene
o Keep

hands cleanwash with soap


and water thoroughly
o Keep cuts and scrapes clean &
covered with a bandage
o Avoid contact with others
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

Do not share items


that come in contact
with your skin
o Towels & razors
o Ointments

Take care of your skin

Take precautions with


common surfaces &
equipment

o Cover abrasions/cuts
o Change bandages
regularly

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

ImpetigoCauses
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

ImpetigoSymptoms
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

o
o
o

Skin infection
caused by fungus
(not a worm )
Fungi thrive in
warm, moist areas
Often several
patches at once
Contagious

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 Bodytinea

corporis
o Scalptinea capitis
o Grointinea cruris (jock itch)
o Feettinea pedis (athletes foot)

Ringworm

Herpes Gladitorium
(Viral)
Caused by herpes
o
o
o

o
o

simplex virus Type 1


Spread by direct
skin-to-skin contact
Lesions/sores appear
within 8 days after
exposure
Appear as cluster of
blisters
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
o ICE
Treatment
o

See physicianoften necessary for fluid


to be aspirated
o Drained with needle

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

Sanitizers
o Used to reduce germs
from surfaces but not
totally get rid of them
o reduce germs to level
considered safe

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?


Disinfectants effective against staph most
likely also effective vs. MRSA
o Products readily available from
grocery/retail stores
o Check product label
o

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
160F & 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!