Skin Wounds Classification

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Skin Wounds Classification

• Chapter 16 (pages 328-332)

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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

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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

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AbrasionTreatment

• 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

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AbrasionTreatment

• 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

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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)

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Laceration
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Laceration
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LacerationTreatment

• 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)

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LacerationTreatment

• 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

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LacerationTreatment

• Stitches

• Steri-Strips

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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 its source
• May be considerable bleeding

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AvulsionTreatment

• 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

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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

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Puncture WoundTreatment

• 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)

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Puncture WoundTreatment

• 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

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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

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ContusionSigns Symptoms

• Swelling
• Pain to touch
• Redness

• Ecchymosis
• accumulation of blood in skin subcutaneous
  tissue more than one cm in diameter
• General termbruising
• Result of bleeding clotting or bleeding
  disorders
• Bluish lesion at earliest stages of onset

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ContusionTreatment

• Careful monitoring
• Anti-inflammatory oral medications
• Compressive dressing
• Ice
• Modalities to ? ecchymosis, ? swelling, ? ROM
• Myositis ossificans calcification that forms
  within muscle
• Requires surgical intervention

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Blister

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

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BlisterTreatment

• 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

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Incision

• Skin has been sharply cut
• Surgical cut made in skin or flesh

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IncisionTreatment

• 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

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IncisionTreatment

• 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

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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

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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

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Care of Open Wounds

• Chart in Arnheimp 928

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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

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Skin Infections

• Bacteriacan be cured
• Staphlococcus
• Including MRSA Impetigo
• Streptococcus
• Fungalcan be cured
• Ringworm
• Viralcannot be cured, but can be treated
• Herpes
• Warts
• Molluscum contagiosum

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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

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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

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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

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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

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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

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Causes of MRSA

• Spread by having contact with someones skin
  infection or personal items theyve 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

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Personal Prevention of MRSA

• Good hygiene
• Keep hands cleanwash with soap and water
  thoroughly
• Keep cuts and scrapes clean covered with a
  bandage
• Avoid contact with others wounds/bandages
• Avoid sharing personal items i.e. towels, razors

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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)

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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

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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

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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

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MRSA
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MRSA
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MRSA
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MRSA
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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

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ImpetigoCauses

• 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

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ImpetigoSymptoms

• 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

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Impetigo
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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

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Folliculitis
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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

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Ringworm Types

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

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Ringworm
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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

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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

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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

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Cauliflower Ear Treatment

• ICE
• See physicianoften 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

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Cauliflower Ear
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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

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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

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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)

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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 160?F
  dried in hot dryer

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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

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Disinfection GuidelinesWrestling 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

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Maximize Athletic Success!Minimize Risk of
Infection!