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Skin Wounds Classification

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1 Skin Wounds Classification
Chapter 16 (pages )

2 Soft Tissue Injuries Trauma that happens to the skin is visually exposed Categorized as a skin wound Defined as a break in the continuity of the soft parts of body structures caused by a trauma to these tissues Mechanical forces include: Friction, scraping, compression, tearing, cutting, penetrating

3 Abrasion 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

4 Abrasion—Treatment Wash wound to remove all dirt and debris
Soap and water or hydrogen peroxide Scrub wound if particles of dirt, rocks, or tar embedded Leave open to air, unless oozing of fluid or blood Apply antibiotic ointment to inhibit infections Scrapes scab over quickly

5 Abrasion—Treatment Loose skin flaps my form natural dressing; if flap dirty remove with clean nail clippers Check on date of last tetanus immunization Watch for signs of infection Seek medical attention if any of following: Pain increases after several days Redness/red streaks appear beyond edges of wound Swelling Purulent drainage Drainage=yellow, green, or bloody, foul-smelling pus

6 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)

7 Laceration

8 Laceration

9 Laceration—Treatment
Cleaned with soap and water Irrigate with clean water to remove debris Do NOT use alcohol, iodine, or peroxide as it may cause further damage and slow healing process Stop bleeding Cover wound with sterile gauze Apply direct & constant pressure (15min+) For uncontrolled bleeding, seek immediate professional medical attention Lacerations that are superficial (do not involve fat or muscle tissue), are not bleeding heavily, less than 1/2 inch long and do not involve the face can usually be managed at home without stitches. The goals of caring for a wound are to stop the bleeding and reduce the chance of scarring and infection in the wound.

10 Laceration—Treatment
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 Apply ice to site Elevate area above level of heart Contact a physician if: Laceration more than 0.25” (6mm) deep and 0.5” (1.3cm) long The wound is in area where wound by be opened by simple movement of body part Wound on face, eyelids, or lips Deep cuts on palm, finger, elbow or knee Loss of sensation or ROM of body part as result of cut Bruising—caused by blood clotting under skin surface Cut on face—aesthetic outcome may be profoundly affected by scarring

11 Laceration—Treatment
Stitches Steri-Strips® Stitches, also called sutures, are special types of thread that hold wound edges together while they heal. Stitches help to stop bleeding, reduce scarring, and decrease the chance of infection in the wound. Steri-Strips® are special adhesive bandages that can sometimes be used on shallow wounds instead of stitches. Steri-Strips® perform the same functions as stitches. Lacerations that involve the face, are longer than 1/2 inch, are deep, or are bleeding heavily, may require stitches. (see incision wound care for explanations, including liquid glue)

12 Avulsion Layers of skin torn off completely or only flap of skin remains Same mechanism as laceration, but to extent that tissue is completely ripped from it’s source May be considerable bleeding

13 Avulsion—Treatment Clean wound with soap and water
If flap of skin remains connected replace skin in its original position If deep avulsion, seek medical attention for stitches If large piece of skin torn off place in plastic bag and put on ice Skin should not get frozen or soaked in water Take skin in plastic bag to doctor; may be able to save and replace torn-off piece Many times skin in affected area will survive

14 Puncture Wound Penetration of skin by sharp object
Nails, tacks, ice picks, knives, teeth, needles May be small in diameter and not seem serious Do require treatment by physician Can become infected easily b/c dirt and germs carried deep in the tissue

15 Puncture Wound—Treatment
Find out if part of object that caused wound still in the wound i.e. lead from a pencil Determine if other tissues have been injured by the object Blood vessels, nerves, tendons, ligaments, bones, internal organs Prevent infections Bacterial skin infections, tetanus, infections in deeper structures (bones and joints) Wounds at risk of infection bc they are difficult to clean and provide a warm, moist place for bacteria to grow

16 Puncture Wound—Treatment
Risk of infections increases if: wound was exposed to soil (may contain tetanus or other bacteria) went through sole of shoe (↑ risk of bacterial infection that is difficult to treat) injected into skin under high pressure i.e. nail from nail gun, paint from high-pressure paint sprayer Physician should be consulted if object penetrated deeply Seek physician on advice for need of tetanus shot; or if signs of infection appear

17 Contusion A blow compresses or crushes the skin surface and produces bleeding under the skin Does not break skin Bruising due to injury to blood vessels Most mild and respond well to RICE

18 Contusion—Signs & Symptoms
Swelling Pain to touch Redness Ecchymosis accumulation of blood in skin & subcutaneous tissue more than one cm in diameter General term=bruising Result of bleeding; clotting or bleeding disorders Bluish lesion at earliest stages of onset Bluegreenpurplebrownish/yellowish

19 Contusion—Treatment Careful monitoring
Anti-inflammatory oral medications Compressive dressing Ice Modalities to ↓ ecchymosis, ↓ swelling, ↑ ROM Myositis ossificans: calcification that forms within muscle Requires surgical intervention Most are mild and respond to RICE; more serious need to be checked by physician Immediately apply ice in stretched position (keeps muscle from tightening up in response to injury) Athlete may return to full participation when he/she has FROM, full strength, able to complete fully; padding to prevent athlete being struck again

20 Blister Continuous rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layer

21 Blister—Treatment Wash area thoroughly
Use sterile blade to cut small hole in blister Squeeze out clear fluid Do not remove skin Prevention: Wear work gloves Break in new shoes Petroleum jelly/skin lube Adhesive bandage If fluid white/yellow need medical attention (infection)

22 Incision Skin has been sharply cut Surgical cut made in skin or flesh

23 Incision—Treatment Remove bandage day after surgery; replace daily or as needed Normal for edges of healing incision to be slightly red Call physician if: redness increases/spreads more than half an inch pus in incision more than mildly tender or painful Incision bleeds, replace bandage; apply pressure as needed

24 Incision— Treatment Keep incision clean & dry for several days after surgery Non-absorbable sutures or staples must be kept dry until doctor removes Steri-strips® should be kept dry 4-5 days On face, hands, arms: take showers or tub baths along as affected area stays dry usually about seven to 10 days after surgery; If the incision gets wet accidentally, it must be dried at once; Patients with incisions in other parts of the body can usually take sponge baths Read more: Incision Care - procedure, recovery, blood, removal, pain, complications, adults, time, infection, operation, medication, types, risk, children, rate, Definition, Purpose, Description

25 Wound Care Irrigate with clean, cool water to wash away foreign particles Gentle wash with mild soap (superficial cuts only) Minor cuts/abrasions should be washed, dried with sterile gauze sponge, and treated with first aid cream Apply dry, sterile bandage, large enough to cover entire injury

26 Wound Care Clean bandage should be applied daily
Athlete should be instructed on how to clean & manage wound Athlete should check for signs of infection: Redness Swelling Increased pain Oozing of pus Increase body temperature

27 Care of Open Wounds Chart in Arnheim—p 928

28 Skin Infections Skin always has some amount of bacteria, fungus, and viruses living on it Skin infections occur when there are breaks in the skin and the organisms have uncontrolled growth It is more important to understand the potential for infection rather than placing a name on the skin problem Priority is the health of the athlete When in doubt, err on the side of safety and well-being

29 Skin Infections Bacteria—can be cured Fungal—can be cured
Staphlococcus Including MRSA & Impetigo Streptococcus Fungal—can be cured Ringworm Viral—cannot be cured, but can be treated Herpes Warts Molluscum contagiosum

30 When to Worry 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 Lesions that are warmer compared to other skin Inflammation & irritation around skin lesion Prior history of infectious skin lesion Skin abrasions Deeper or more traumatic break in skin, higher risk for subsequent infection

31 Skin Infections The right antibiotic is required to cure a specific bacterial skin infection Antibiotics for bacteria will not improve fungal or viral infections Bacterial infections can be the fastest growing infections Thus the most easily spread among athletes The faster the bacteria grows, the more likely the correct antibiotic will cure infection; other virus infections are relatively resistant to current medications

32 Staph 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 antibiotic-resistant infections to flesh-eating infections Difference is: the strength of the infection How deep it goes How fast it spreads How treatable it is with antibiotics The antibiotic-resistant infections are more common in North America, because of our overuse of antibiotics.

33 MRSA Methicillin resistant Staphylococcus aureus
Resistant to certain antibiotics most are skin infections Methicillin, oxacillin, penicillin, amoxicillin More severe or potentially life-threatening occur most frequently among patients in healthcare settings Type of staph bacteria

34 Symptoms of MRSA Skin Infections Severe Infections
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 Potentially life-threatening Blood stream infections Surgical site infections Pneumonia Signs & symptoms vary by type and stage of infections Type of staph bacteria Bumps that are red, swollen, painful Visable skin trauma=cuts and abrasions, and areas of body covered by hair

35 Causes of MRSA Spread by having contact with someone’s skin infection or personal items they’ve used Spread in places where people are in close contact Close skin-to-skin contact Openings in the skin (cuts or abrasions) Contaminated items & surfaces Crowded living conditions Poor hygiene Personal items include: towels, bandages, razors Close contact i.e.: schools, locker rooms (sports specifically (wrestling)) Higher risk=athletic facilities, dormitories, military barracks, households, correctional facilities, daycare centers

36 Personal Prevention of MRSA
Good hygiene Keep hands clean—wash with soap and water thoroughly Keep cuts and scrapes clean & covered with a bandage Avoid contact with other’s wounds/bandages Avoid sharing personal items i.e. towels, razors Cover your wounds Clean your hands Do not share personal items Maintain clean environment Talk to your doctor (tell anyone treating you that you have had Staph/MRSA)

37 Prevention of MRSA in Athletics
Practice good personal hygiene Keep hands clean Shower after exercise Do not share soap or towels Wash uniform & clothing Take care of your skin Cover abrasions/cuts Change bandages regularly Do not share items that come in contact with your skin Towels & razors Ointments Take precautions with common surfaces & equipment Use barrier between skin & surface (towel, clothing) Common in athletics b/c: Have repeated skin-to-skin contact Get breaks in skin left uncovered, allow MRSA to enter and cause infection Share items & surfaces that come into direct skin contact Have inadequate access to hygiene measures

38 Diagnosis & Testing of MRSA
Culture must be obtained Small biopsy of skin Drainage from infected site Blood Urine Sent to microbiology laboratroy Tested for S. aureus infection Determine which antibiotics will be effective

39 Treatment of MRSA Antibiotic to drain infection
DO NOT attempt to treat yourself! Includes popping, draining, using disinfectants on area If you think you have an infection: Cover affected skin Wash hands Contact physician Take all antibiotic (no sharing) If infection not getting better w/in a few days, contact physician Possible to get repeat infections; if cured of an infection, not immune to future infections

40 MRSA Statistics 2005: estimated 94,360 people develop serious MRSA infection Approx 18,650 person died during hospital stay related to these serious MRSA infections About 85% of all invasive MRSA infections were associated with healthcare (2/3 outside of hospital) About 14% of all infections occurred in persons without obvious exposures to healthcare Journal of American Medical Association 2007 Overall rates consistently highest among older person (age>65), blacks, and males




44 MRSA MRSA Video:

45 Impetigo Mild itching & soreness
Eruption of small vesicles and/or pustules that rupture to form honey-colored crusts Combo of 2 bacteria that spread rapidly when athletes in close contact with one another Responds rapidly to proper treatment Thorough cleansing of crusted area Application of topical antibacterial agent

46 Impetigo—Causes Caused by streptococcus (strep) or staphylococcus (staph) bacteria MRSA becoming common cause May occur on skin where there is no visible break Most common in children, particularly unhealthy living conditions Infection carried in fluid that oozes from blisters

47 Impetigo—Symptoms Single or many blisters filled with pus
Easy to pop When broken leave a reddish raw-looking base Itching blister Filled with yellow or honey-colored fluid Oozing and crusting over Rash Skin lesions on face, lips, arms, or legs Swollen lymph nodes near infection

48 Impetigo Treatment: The goal is to cure the infection and relieve the symptoms. A mild infection may be treated with a prescription antibacterial cream. More severe cases may require antibiotics, taken by mouth. Wash the skin several times a day, preferably with an antibacterial soap, to remove crusts and drainage. Prognosis: The sores of impetigo heal slowly and seldom scar. The cure rate is extremely high, but the condition often comes back in young children.

49 Folliculitis Inflammation of a hair follicle
Starts when hair particles damaged by friction Clothing, blockage of follicle, shaving Frequently become infected Bacteria Staphylococcus (staph) Painless or tender pustule (pimple) May crust over Rash or itching

50 Folliculitis Hot, moist compresses may promote drainage of the affected follicles. Treatment may include antibiotics applied to the skin (mupirocin) or taken by mouth (dicloxacillin), or antifungal medications to control the infection. Folliculitis usually responds well to treatment, but may come back.

51 Ringworm Skin infection caused by fungus (not a worm )
Fungi thrive in warm, moist areas Often several patches at once Contagious Symptoms: Itchy, red, raised scaly patches that may blister and ooze Patches often have sharply-defined edges Redder around outside; normal skin tone in center Skin appear unusually dark or light Ringworm occurs when a particular type of fungus grows and multiplies anywhere on your skin, scalp, or nails. Ringworm is more likely when you have frequent wetness (such as from sweating) and minor injuries to your skin, scalp, or nails. Ringworm is contagious. It can be passed from one person to the next by direct skin-to-skin contact or by contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces. You can also catch ringworm from pets that carry the fungus. Cats are common carriers.

52 Ringworm Types Body—tinea corporis Scalp—tinea capitis
Groin—tinea cruris (jock itch) Feet—tinea pedis (athlete’s foot)

53 Ringworm

54 Herpes Gladitorium (Viral)
Caused by herpes 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 While it does not occur anywhere near as frequently as ringworm or impetigo, it does occur in high school and college wrestling. Responds best to antiviral medication Among athletes called “mat herpes” Before skin lesions appear, some people have a sore throat, swollen lymph nodes, fever or tingling on skin

55 Cauliflower Ear Deformity of outer ear
Caused by accumulation of blood beneath the external surface of ear & underlying cartilage Blunt trauma to ear to cause hematoma or bruising of tissue to develop into this deformity Seen in wrestlers, rugby players, boxers

56 Cauliflower Ear Painful & physically deforming
Fluid accumulates beneath skin surface of ear Underlying cartilage is deprived of blood supply & nutrients necessary for normal functioning If fluid not removed hardening of tissues & keloid formation results Gives ear shriveled & deformed appearance Prevented by appropriate headgear

57 Cauliflower Ear Treatment
ICE See physician—often necessary for fluid to be aspirated Drained with needle Placement of custom-made, form fitting compression dressing made of hardened casting material Worn 3-5 days continuously Athlete return to activity wearing both device and appropriate headgear

58 Cauliflower Ear


60 Cleaning & Disinfecting
Cleaners Products used to remove soil, dirt, dust, organic matter, & germs (bacteria, viruses, fungi) Work by washing surface to lift dirt & germs off surfaces so thy can be rinsed away with water Sanitizers Used to reduce germs from surfaces but not totally get rid of them reduce germs to level considered safe Disinfectants Chemical products that destroy or inactivate germs & prevent them from growing No effect on dirt, soil, or dust Disinfectants regulated by the US Environmental Protection Agency (EPA); use disinfectants for surfaces that have visible blood or drainage from infected skin

61 Which one to use? Disinfectants effective against staph most likely also effective vs. MRSA Products readily available from grocery/retail stores Check product label List of germs that product destroys Use disinfectants that are registered by the EPA Check for EPA registration number on product label for confirmation

62 How should cleaners & disinfectans be used?
Read the label first. Each cleaner and disinfectant has instructions on the label that tell you important facts: How to apply the product to a surface How long you need to leave it on the surface to be effective If the surface needs to be cleaned first and rinsed after using If the disinfectant is safe for the surface Whether the product requires dilution with water before using Precautions you should take when applying the product (wearing gloves or apron)

63 Disinfection Guidelines
All floor and wall padding in athletic areas should be washed daily (if athletic area is used) Separate mop head/buckets should be used for each activity area, locker room, and restroom. Mop heads & buckets should be cleaned regularly Towels/linens laundered on premises should be washed with detergent at a minimum of 160٥F & dried in hot dryer

64 Disinfection Guidelines
CAUTION! If clean athletic gear is dumped into a dirty laundry bag or gym bag, the gear immediately becomes a source of infection Liquid (not bar) soap should be readily available and provided by wall dispenser close to sinks & next to showers Sports equipment should be cleaned regularly Balls, racket grips, bats, gloves

65 Disinfection Guidelines—Wrestling Room & Mats
Mat surfaces with small holes or tears should be repaired with mat tape. Mat surfaces should be replaced promptly when there are large holes or surfaces are excessively worn Both sides of the mats should be cleaned thoroughly before and after each use for practices and meets

66 Maximize Athletic Success! Minimize Risk of Infection!

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