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Skin Wounds Classification Chapter 16 (pages 328-332)

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Presentation on theme: "Skin Wounds Classification Chapter 16 (pages 328-332)"— Presentation transcript:

1 Skin Wounds Classification Chapter 16 (pages )

2 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

3 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

4 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

5 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

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


9 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+)

10 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

11 Laceration—Treatment StitchesSteri-Strips ®

12 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

13 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

14 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

15 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)

16 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

17 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

18 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

19 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

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

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

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

23 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

24 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

25 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

26 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

27 Care of Open Wounds Chart in Arnheim—p 928

28 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

29 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

30 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

31 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

32 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 antibiotic- resistant 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

33 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

34 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

35 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

36 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

37 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)

38 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

39 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

40 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





45 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

46 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

47 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

48 Impetigo

49 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

50 Folliculitis

51 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

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

53 Ringworm

54 Herpes Gladitorium (Viral) o Caused by herpes simplex virus Type 1 o Spread by direct skin- to-skin contact o Lesions/sores appear within 8 days after exposure o Appear as cluster of blisters o Diagnosis upon appearance

55 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

56 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

57 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

58 Cauliflower Ear


60 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

61 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

62 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)

63 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 160 ٥ F & dried in hot dryer

64 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

65 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

66 Maximize Athletic Success! Minimize Risk of Infection!

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