Skin Wounds Classification

Unit 3ROP SPORTS MEDICINE- S. CAMOU

Soft Tissue Injurieso Trauma that happens to the skin is

visually exposedo Categorized as a skin woundo 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

Abrasiono Skin scraped against

a rough surfaceo 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 peroxideo 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—Treatmento Loose skin flaps my form natural dressing; if

flap dirty remove with clean nail clipperso Check on date of last tetanus immunizationo Watch for signs of infectiono Seek medical attention if any of following:

o Pain increases after several dayso Redness/red streaks appear beyond edges of

woundo Swellingo 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—Treatmento Cleaned with soap and watero Irrigate with clean water to remove

debriso Do NOT use alcohol, iodine, or peroxide

as it may cause further damage and slow healing process

o Stop bleedingoCover wound with sterile gauzeo Apply direct & constant pressure (15min+)

Laceration—Treatmento 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 normalo Apply ice to siteo 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®

Avulsiono Layers of skin torn off completely or

only flap of skin remainso 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 watero If flap of skin remains connected

replace skin in its original positiono If deep avulsion, seek medical attention

for stitcheso If large piece of skin torn off place in

plastic bag and put on iceo Skin should not get frozen or soaked in watero 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 objectoNails, tacks, ice picks, knives, teeth,

needles

o May be small in diameter and not seem serious

o Do require treatment by physiciano 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 woundo i.e. lead from a pencil

o Determine if other tissues have been injured by the objecto Blood vessels, nerves, tendons, ligaments,

bones, internal organso 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 sprayero Physician should be consulted if object

penetrated deeply

Contusiono A blow compresses or crushes

the skin surface and produces bleeding under the skin

o Does not break skino Bruising due to injury to blood

vesselso Most mild and respond well to RICE

Contusion—Signs & Symptoms

o Swellingo Pain to toucho Redness

o Ecchymosiso accumulation of blood

in skin & subcutaneous tissue more than one cm in diameter

o General term=bruisingo Result of bleeding;

clotting or bleeding disorders

o Bluish lesion at earliest stages of onset

Contusion—Treatmento Careful monitoringo Anti-inflammatory oral medicationso Compressive dressingo Iceo Modalities to ↓ ecchymosis, ↓ swelling, ↑

ROMo Myositis ossificans: calcification that

forms within muscleoRequires surgical intervention

Blistero Continuous rubbing over

the surface of the skin causes a collection of fluid below or within the epidermal layer

Blister—Treatmento Wash area

thoroughlyo Use sterile blade to

cut small hole in blister

o Squeeze out clear fluid

o Do not remove skin

o Prevention:o Wear work gloveso Break in new shoeso Petroleum jelly/skin

lubeo Adhesive bandage

Incisiono Skin has been sharply cuto Surgical cut made in skin or flesh

Incision—Treatment o Remove bandage day after surgery;

replace daily or as neededo Normal for edges of healing incision

to be slightly redoCall physician if:

o redness increases/spreads more than half an inch

opus in incisionomore than mildly tender or painful

Incision—Treatment o Keep incision clean & dry for several

days after surgeryo Non-absorbable sutures or staples

must be kept dry until doctor removeso Steri-strips® should be kept dry 4-5

dayso On face, hands, arms: take showers or

tub baths along as affected area stays dry

Types of Bleeding

B.L.E.E.D. • Barrier • Put on GLOVES

• Locate/Examine • Look for foreign objects• External Direct Pressure• on wound and pressure

point (main artery)• Elevation• Elevate above the heart.• Dressing• Apply gauze (sterile).Wrap

to keep in place. Should blood seep through repeat the process. Do not remove initial dressing.

Care of Open Wounds

External Bleeding: (Bleeding from open skin wounds such as abrasions, incisions, lacerations, punctures, or avulsions) Direct Pressure Elevation Pressure Points

Internal Hemorrhage: (Invisible to the eye unless manifested through some body opening or identified through other diagnostic testing)

Wound Careo Irrigate with clean, cool water to wash

away foreign particleso 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 Careo Clean bandage should be applied dailyo Athlete should be instructed on how to

clean & manage woundo Athlete should check for signs of infection:

oRednesso Swellingo Increased painoOozing of puso Increase body temperature

SKIN INFECTIONS

Skin Infectionso 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 Infectionso Bacteria—can be cured

o Staphlococcus o Including MRSA & Impetigo

o Streptococcus

o Fungal—can be curedoRingworm

o Viral—cannot be cured, but can be treatedoHerpesoWartsoMolluscum contagiosum

When to Worryo Lesions with an

irregular bordero Raised skin lesionso “wet” or “moist”

lesionso 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 abrasionso Deeper or more traumatic

break in skin, higher risk for subsequent infection

Skin Infectionso The right antibiotic is required to

cure a specific bacterial skin infectiono Antibiotics for bacteria will not

improve fungal or viral infectionso Bacterial infections can be the

fastest growing infectionso Thus the most easily spread among

athletes

Stapho 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

infectiono How deep it goeso How fast it spreadso How treatable it is

with antibiotics

MRSAo Methicillin resistant Staphylococcus

aureuso Resistant to certain antibiotics most are

skin infectionsoMethicillin, oxacillin, penicillin, amoxicillin

o More severe or potentially life-threatening occur most frequently among patients in healthcare settings

Symptoms of MRSASkin Infectionso Appear as pustules or

boilso Redo Swolleno Painfulo Pus or other drainageo First look like spider

bites or bumps o Occur at sites of

visible skin trauma

Severe Infectionso Potentially life-

threateningo Blood stream infectionso Surgical site infectionso Pneumonia

o Signs & symptoms vary by type and stage of infections

Causes of MRSAo 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 hygieneo Keep hands clean—wash with soap

and water thoroughlyo Keep cuts and scrapes clean &

covered with a bandageo Avoid contact with other’s

wounds/bandageso Avoid sharing personal items i.e.

towels, razors

Prevention of MRSA in Athletics

o Practice good personal hygieneo Keep hands cleano Shower after exerciseo Do not share soap or

towelso Wash uniform & clothing

o Take care of your skino Cover abrasions/cutso Change bandages

regularly

o Do not share items that come in contact with your skino Towels & razorso Ointments

o Take precautions with common surfaces & equipmento Use barrier between

skin & surface (towel, clothing)

Diagnosis & Testing of MRSA

o Culture must be obtained o Small biopsy of skinoDrainage from infected siteoBlood oUrine

o Sent to microbiology laboratroyo Tested for S. aureus infectiono Determine which antibiotics will be

effective

Treatment of MRSAo Antibiotic to drain infectiono DO NOT attempt to treat yourself!

o Includes popping, draining, using disinfectants on area

o If you think you have an infection:oCover affected skinoWash handsoContact physician

MRSA Statisticso 2005: estimated 94,360 people develop

serious MRSA infectiono Approx 18,650 person died during hospital

stay related to these serious MRSA infectionso 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

Impetigoo Mild itching & sorenesso Eruption of small vesicles and/or pustules

that rupture to form honey-colored crustso Combo of 2 bacteria that spread rapidly

when athletes in close contact with one another

o Responds rapidly to proper treatmento Thorough cleansing of crusted areao Application of topical antibacterial agent

Impetigo—Causes o Caused by streptococcus (strep) or

staphylococcus (staph) bacteriao MRSA becoming common causeo May occur on skin where there is no

visible breako Most common in children, particularly

unhealthy living conditionso Infection carried in fluid that oozes

from blisters

Impetigo—Symptomso Single or many blisters filled with pus

o Easy to popoWhen broken leave a reddish raw-looking

baseo Itching blister

o Filled with yellow or honey-colored fluidoOozing and crusting over

o Rasho Skin lesions on face, lips, arms, or legso Swollen lymph nodes near infection

Impetigo

Folliculitiso Inflammation of a hair follicleo Starts when hair particles damaged by

frictionoClothing, blockage of follicle, shaving

o Frequently become infected o Bacteria Staphylococcus (staph)

o Painless or tender pustule (pimple)oMay crust over

o Rash or itching

Folliculitis

Ringwormo 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 Typeso Body—tinea corporiso Scalp—tinea capitiso 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-to-skin contact

o Lesions/sores appear within 8 days after exposure

o Appear as cluster of blisters

o Diagnosis upon appearance

Cauliflower Earo Deformity of outer earo 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 Earo Painful & physically deformingo Fluid accumulates beneath skin surface

of earo Underlying cartilage is deprived of blood

supply & nutrients necessary for normal functioning

o If fluid not removed hardening of tissues & keloid formation resultsoGives ear shriveled & deformed appearance

Cauliflower Ear Treatment

o ICEo See physician—often necessary for fluid

to be aspiratedoDrained with needle

o Placement of custom-made, form fitting compression dressing made of hardened casting materialoWorn 3-5 days continuouslyoAthlete return to activity wearing both device

and appropriate headgear

Cauliflower Ear

Cleaning & Disinfectingo 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 Sanitizerso 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. MRSAo Products readily available from

grocery/retail storeso Check product label

o List of germs that product destroys

o Use disinfectants that are registered by the EPAoCheck 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 surfaceo How long you need to leave it on the

surface to be effectiveo If the surface needs to be cleaned first and

rinsed after usingo If the disinfectant is safe for the surfaceo Whether the product requires dilution with

water before usingo Precautions you should take when applying

the product (wearing gloves or apron)

Disinfection Guidelineso 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. oMop heads & buckets should be cleaned

regularlyo Towels/linens laundered on premises

should be washed with detergent at a minimum of 160٥F & dried in hot dryer

Disinfection Guidelineso 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 regularlyoBalls, 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!