skin wounds classification unit 3 rop sports medicine- s. camou
TRANSCRIPT
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Skin Wounds Classification
Unit 3ROP SPORTS MEDICINE- S. CAMOU
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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
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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
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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
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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
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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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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+)
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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
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Laceration—Treatment
Stitches Steri-Strips®
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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
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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
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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
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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)
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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
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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
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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
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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
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Blistero Continuous rubbing over
the surface of the skin causes a collection of fluid below or within the epidermal layer
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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
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Incisiono Skin has been sharply cuto Surgical cut made in skin or flesh
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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
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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
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Types of Bleeding
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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.
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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)
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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
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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
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SKIN INFECTIONS
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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MRSA
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MRSA
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MRSA
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MRSA
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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
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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
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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
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Impetigo
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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
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Folliculitis
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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
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Ringworm Typeso Body—tinea corporiso Scalp—tinea capitiso Groin—tinea cruris (jock itch)o Feet—tinea pedis (athlete’s foot)
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Ringworm
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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
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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
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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
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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
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Cauliflower Ear
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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
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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
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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)
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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
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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
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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
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Maximize Athletic Success!Minimize Risk of Infection!