Skin Wounds ClassificationChapter 16 (pages 328-332)

Soft Tissue InjuriesTrauma that happens to the skin is visually exposedCategorized as a skin woundDefined as a break in the continuity of the soft parts of body structures caused by a trauma to these tissuesMechanical forces include: Friction, scraping, compression, tearing, cutting, penetrating

AbrasionSkin scraped against a rough surfaceSeveral layers of skin are torn loose or totally removedUsually more painful than a deeper cut b/c scraping of skin exposes millions of nerve endings

AbrasionTreatment Wash wound to remove all dirt and debrisSoap and water or hydrogen peroxideScrub wound if particles of dirt, rocks, or tar embeddedLeave open to air, unless oozing of fluid or bloodApply antibiotic ointment to inhibit infectionsScrapes scab over quickly

AbrasionTreatmentLoose skin flaps my form natural dressing; if flap dirty remove with clean nail clippersCheck on date of last tetanus immunizationWatch for signs of infectionSeek medical attention if any of following:Pain increases after several daysRedness/red streaks appear beyond edges of woundSwellingPurulent drainage

LacerationFlesh irregularly torn; cut or tear in the skin Minimal bleeding, minimal pain, & no numbness or tinglingCuts 0.25 (6mm) deep and 0.5 (1.3cm) long & have smooth, edges can be treated at homeDeeper lacerations should be treated by physician (stitches)

Laceration

Laceration

LacerationTreatmentCleaned with soap and waterIrrigate with clean water to remove debrisDo NOT use alcohol, iodine, or peroxide as it may cause further damage and slow healing processStop bleedingCover wound with sterile gauzeApply direct & constant pressure (15min+)

LacerationTreatmentOnce wound cleaned, antibiotic ointment may be applied to reduce risk of infection & aid healingChange sterile dressing daily as neededBruising and swelling are normalApply ice to siteElevate area above level of heartContact a physician if:Laceration more than 0.25 (6mm) deep and 0.5 (1.3cm) longThe wound is in area where wound by be opened by simple movement of body partWound on face, eyelids, or lipsDeep cuts on palm, finger, elbow or kneeLoss of sensation or ROM of body part as result of cut

LacerationTreatmentStitchesSteri-Strips

AvulsionLayers of skin torn off completely or only flap of skin remainsSame mechanism as laceration, but to extent that tissue is completely ripped from its sourceMay be considerable bleeding

AvulsionTreatment Clean wound with soap and waterIf flap of skin remains connected replace skin in its original positionIf deep avulsion, seek medical attention for stitchesIf large piece of skin torn off place in plastic bag and put on iceSkin should not get frozen or soaked in waterTake skin in plastic bag to doctor; may be able to save and replace torn-off piece

Puncture WoundPenetration of skin by sharp objectNails, tacks, ice picks, knives, teeth, needlesMay be small in diameter and not seem seriousDo require treatment by physicianCan become infected easily b/c dirt and germs carried deep in the tissue

Puncture WoundTreatmentFind out if part of object that caused wound still in the woundi.e. lead from a pencilDetermine if other tissues have been injured by the objectBlood vessels, nerves, tendons, ligaments, bones, internal organsPrevent infectionsBacterial skin infections, tetanus, infections in deeper structures (bones and joints)

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 sprayerPhysician should be consulted if object penetrated deeply

ContusionA blow compresses or crushes the skin surface and produces bleeding under the skinDoes not break skinBruising due to injury to blood vesselsMost mild and respond well to RICE

ContusionSigns & SymptomsSwellingPain to touchRednessEcchymosisaccumulation of blood in skin & subcutaneous tissue more than one cm in diameterGeneral term=bruisingResult of bleeding; clotting or bleeding disordersBluish lesion at earliest stages of onset

ContusionTreatmentCareful monitoringAnti-inflammatory oral medicationsCompressive dressingIceModalities to ecchymosis, swelling, ROMMyositis ossificans: calcification that forms within muscleRequires surgical intervention

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

BlisterTreatmentWash area thoroughlyUse sterile blade to cut small hole in blisterSqueeze out clear fluidDo not remove skinPrevention:Wear work glovesBreak in new shoesPetroleum jelly/skin lubeAdhesive bandage

IncisionSkin has been sharply cutSurgical cut made in skin or flesh

IncisionTreatment Remove bandage day after surgery; replace daily or as neededNormal for edges of healing incision to be slightly redCall physician if:redness increases/spreads more than half an inchpus in incisionmore than mildly tender or painful

IncisionTreatment Keep incision clean & dry for several days after surgeryNon-absorbable sutures or staples must be kept dry until doctor removesSteri-strips should be kept dry 4-5 daysOn face, hands, arms: take showers or tub baths along as affected area stays dry

Wound CareIrrigate with clean, cool water to wash away foreign particlesGentle wash with mild soap (superficial cuts only)Minor cuts/abrasions should be washed, dried with sterile gauze sponge, and treated with first aid creamApply dry, sterile bandage, large enough to cover entire injury

Wound CareClean bandage should be applied dailyAthlete should be instructed on how to clean & manage woundAthlete should check for signs of infection:RednessSwellingIncreased painOozing of pusIncrease body temperature

Care of Open WoundsChart in Arnheimp 928

Skin InfectionsSkin always has some amount of bacteria, fungus, and viruses living on itSkin infections occur when there are breaks in the skin and the organisms have uncontrolled growthIt is more important to understand the potential for infection rather than placing a name on the skin problem

Skin InfectionsBacteriacan be curedStaphlococcus Including MRSA & ImpetigoStreptococcus Fungalcan be curedRingworm Viralcannot be cured, but can be treatedHerpesWartsMolluscum contagiosum

When to WorryLesions with an irregular borderRaised skin lesionswet or moist lesionsLesions that have different colors within the lesionBright red colored lesions are more of a problem compared to faded lesionsLesions that are warmer compared to other skinInflammation & irritation around skin lesionPrior history of infectious skin lesionSkin abrasionsDeeper or more traumatic break in skin, higher risk for subsequent infection

Skin InfectionsThe right antibiotic is required to cure a specific bacterial skin infectionAntibiotics for bacteria will not improve fungal or viral infectionsBacterial infections can be the fastest growing infectionsThus the most easily spread among athletes

StaphInfection caused by Staphylococcus bacteriaAbout 25% of people normally carry staph in the nose, mouth, genitals, and anal areasInfection begins with a little cut gets infected with bacteriaRange from a simple boil to antibiotic-resistant infections to flesh-eating infectionsDifference is: the strength of the infectionHow deep it goesHow fast it spreadsHow treatable it is with antibiotics

MRSAMethicillin resistant Staphylococcus aureusResistant to certain antibiotics most are skin infectionsMethicillin, oxacillin, penicillin, amoxicillinMore severe or potentially life-threatening occur most frequently among patients in healthcare settings

Symptoms of MRSASkin InfectionsAppear as pustules or boilsRedSwollenPainfulPus or other drainageFirst look like spider bites or bumps Occur at sites of visible skin traumaSevere InfectionsPotentially life-threateningBlood stream infectionsSurgical site infectionsPneumonia Signs & symptoms vary by type and stage of infections

Causes of MRSASpread by having contact with someones skin infection or personal items theyve usedSpread in places where people are in close contactClose skin-to-skin contactOpenings in the skin (cuts or abrasions)Contaminated items & surfacesCrowded living conditionsPoor hygiene

Personal Prevention of MRSAGood hygieneKeep hands cleanwash with soap and water thoroughlyKeep cuts and scrapes clean & covered with a bandageAvoid contact with others wounds/bandagesAvoid sharing personal items i.e. towels, razors

Prevention of MRSA in AthleticsPractice good personal hygieneKeep hands cleanShower after exerciseDo not share soap or towelsWash uniform & clothingTake care of your skinCover abrasions/cutsChange bandages regularlyDo not share items that come in contact with your skinTowels & razorsOintments Take precautions with common surfaces & equipmentUse barrier between skin & surface (towel, clothing)

Diagnosis & Testing of MRSACulture must be obtained Small biopsy of skinDrainage from infected siteBlood Urine Sent to microbiology laboratroyTested for S. aureus infectionDetermine which antibiotics will be effective

Treatment of MRSAAntibiotic to drain infectionDO NOT attempt to treat yourself!Includes popping, draining, using disinfectants on areaIf you think you have an infection:Cover affected skinWash handsContact physician

MRSA Statistics2005: estimated 94,360 people develop serious MRSA infectionApprox 18,650 person died during hospital stay related to these serious MRSA infectionsAbout 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

MRSA

MRSA

MRSA

MRSA

ImpetigoMild itching & sorenessEruption of small vesicles and/or pustules that rupture to form honey-colored crustsCombo of 2 bacteria that spread rapidly when athletes in close contact with one anotherResponds rapidly to proper treatmentThorough cleansing of crusted areaApplication of topical antibacterial agent

ImpetigoCauses Caused by streptococcus (strep) or staphylococcus (staph) bacteriaMRSA becoming common causeMay occur on skin where there is no visible breakMost common in children, particularly unhealthy living conditionsInfection carried in fluid that oozes from blisters

ImpetigoSymptomsSingle or many blisters filled with pusEasy to popWhen broken leave a reddish raw-looking baseItching blisterFilled with yellow or honey-colored fluidOozing and crusting overRashSkin lesions on face, lips, arms, or legsSwollen lymph nodes near infection

Impetigo

FolliculitisInflammation of a hair follicleStarts when hair particles damaged by frictionClothing, blockage of follicle, shavingFrequently become infected Bacteria Staphylococcus (staph)Painless or tender pustule (pimple)May crust over Rash or itching

Folliculitis

RingwormSkin infection caused by fungus (not a worm )Fungi thrive in warm, moist areasOften several patches at onceContagious Symptoms:Itchy, red, raised scaly patches that may blister and oozePatches often have sharply-defined edgesRedder around outside; normal skin tone in centerSkin appear unusually dark or light

Ringworm TypesBodytinea corporisScalptinea capitisGrointinea cruris (jock itch)Feettinea pedis (athletes foot)

Ringworm

Herpes Gladitorium (Viral)Caused by herpes simplex virus Type 1Spread by direct skin-to-skin contactLesions/sores appear within 8 days after exposureAppear as cluster of blistersDiagnosis upon appearance

Cauliflower EarDeformity of outer earCaused by accumulation of blood beneath the external surface of ear & underlying cartilageBlunt trauma to ear to cause hematoma or bruising of tissue to develop into this deformitySeen in wrestlers, rugby players, boxers

Cauliflower EarPainful & physically deformingFluid accumulates beneath skin surface of earUnderlying cartilage is deprived of blood supply & nutrients necessary for normal functioningIf fluid not removed hardening of tissues & keloid formation resultsGives ear shriveled & deformed appearance

Cauliflower Ear TreatmentICESee physicianoften necessary for fluid to be aspiratedDrained with needlePlacement of custom-made, form fitting compression dressing made of hardened casting materialWorn 3-5 days continuouslyAthlete return to activity wearing both device and appropriate headgear

Cauliflower Ear

Cleaning & DisinfectingCleanersProducts 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 waterSanitizersUsed to reduce germs from surfaces but not totally get rid of themreduce germs to level considered safeDisinfectants Chemical products that destroy or inactivate germs & prevent them from growingNo effect on dirt, soil, or dust

Which one to use?Disinfectants effective against staph most likely also effective vs. MRSAProducts readily available from grocery/retail storesCheck product labelList of germs that product destroysUse disinfectants that are registered by the EPACheck for EPA registration number on product label for confirmation

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 surfaceHow long you need to leave it on the surface to be effectiveIf the surface needs to be cleaned first and rinsed after usingIf the disinfectant is safe for the surfaceWhether the product requires dilution with water before usingPrecautions you should take when applying the product (wearing gloves or apron)

Disinfection GuidelinesAll 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 regularlyTowels/linens laundered on premises should be washed with detergent at a minimum of 160F & dried in hot dryer

Disinfection GuidelinesCAUTION! If clean athletic gear is dumped into a dirty laundry bag or gym bag, the gear immediately becomes a source of infectionLiquid (not bar) soap should be readily available and provided by wall dispenser close to sinks & next to showersSports equipment should be cleaned regularlyBalls, racket grips, bats, gloves

Disinfection GuidelinesWrestling Room & MatsMat 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 wornBoth sides of the mats should be cleaned thoroughly before and after each use for practices and meets

Maximize Athletic Success!Minimize Risk of Infection!

*Drainage=yellow, green, or bloody, foul-smelling pus*For uncontrolled bleeding, seek immediate professional medical attentionLacerations 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.

*Bruisingcaused by blood clotting under skin surface Cut on faceaesthetic outcome may be profoundly affected by scarring*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)*Many times skin in affected area will survive*Wounds at risk of infection bc they are difficult to clean and provide a warm, moist place for bacteria to grow*Seek physician on advice for need of tetanus shot; or if signs of infection appear*Bluegreenpurplebrownish/yellowish *Most are mild and respond to RICE; more serious need to be checked by physicianImmediately 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*If fluid white/yellow need medical attention (infection)*Incision bleeds, replace bandage; apply pressure as needed*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 http://www.surgeryencyclopedia.com/Fi-La/Incision-Care.html#ixzz168BH6eC1*Priority is the health of the athleteWhen in doubt, err on the side of safety and well-being*The faster the bacteria grows, the more likely the correct antibiotic will cure infection; other virus infections are relatively resistant to current medications*The antibiotic-resistant infections are more common in North America, because of our overuse of antibiotics.

*Type of staph bacteria*Type of staph bacteriaBumps that are red, swollen, painfulVisable skin trauma=cuts and abrasions, and areas of body covered by hair*Personal items include: towels, bandages, razorsClose contact i.e.: schools, locker rooms (sports specifically (wrestling))Higher risk=athletic facilities, dormitories, military barracks, households, correctional facilities, daycare centers*Cover your woundsClean your handsDo not share personal itemsMaintain clean environmentTalk to your doctor (tell anyone treating you that you have had Staph/MRSA)*Common in athletics b/c:Have repeated skin-to-skin contactGet breaks in skin left uncovered, allow MRSA to enter and cause infectionShare items & surfaces that come into direct skin contactHave inadequate access to hygiene measures

**Take all antibiotic (no sharing)If infection not getting better w/in a few days, contact physicianPossible to get repeat infections; if cured of an infection, not immune to future infections*Journal of American Medical Association 2007Overall rates consistently highest among older person (age>65), blacks, and males*MRSA Video: http://www.youtube.com/watch?v=58NtlBuO1jg **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.**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.

*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.

*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 medicationAmong athletes called mat herpesBefore skin lesions appear, some people have a sore throat, swollen lymph nodes, fever or tingling on skin**Prevented by appropriate headgear**Disinfectants regulated by the US Environmental Protection Agency (EPA); use disinfectants for surfaces that have visible blood or drainage from infected skin*