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Skin Wounds Classification
Unit 3
ROP SPORTS MEDICINE- S. CAMOU
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
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
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
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
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—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+)
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
Laceration—Treatment
Stitches
Steri-Strips®
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
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
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
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)
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 highpressure paint sprayer
o Physician should be consulted if object
penetrated deeply
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
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
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
Blister
o Continuous rubbing over the
surface of the skin causes a
collection of fluid below or
within the epidermal layer
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
o
o
o
Wear work gloves
Break in new shoes
Petroleum jelly/skin lube
Adhesive bandage
Incision
o Skin has been sharply cut
o Surgical cut made in skin or flesh
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
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
Types of Bleeding
• 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.
B.L.E.E.D.
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 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
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
SKIN INFECTIONS
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
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
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
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
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 antibioticresistant 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
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
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
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
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
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)
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
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
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
MRSA
MRSA
MRSA
MRSA
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
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
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
Impetigo
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
Folliculitis
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
Ringworm Types
o Body—tinea corporis
o Scalp—tinea capitis
o 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-toskin contact
o Lesions/sores appear
within 8 days after
exposure
o Appear as cluster of
blisters
o Diagnosis upon
appearance
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
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
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
Cauliflower Ear
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
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
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)
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
160٥F & dried in hot dryer
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
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!