| Date post: | 03-Apr-2018 |
| Category: |
Documents |
| Upload: | dimas-gunawan |
| View: | 217 times |
| Download: | 0 times |
of 66
7/28/2019 Skin Wounds Classifications Full
1/66
Skin Wounds Classification
Chapter 16 (pages 328-332)
7/28/2019 Skin Wounds Classifications Full
2/66
Soft Tissue Injuries
o Trauma that happens to the skin is visuallyexposed
o Categorized as a skin wound
o Defined as a break in the continuity of the softparts of body structures caused by a trauma tothese tissues
o Mechanical forces include:
o Friction, scraping, compression, tearing, cutting,penetrating
7/28/2019 Skin Wounds Classifications Full
3/66
Abrasion
o Skin scraped against arough surface
o Several layers of skin
are torn loose or totallyremoved
o Usually more painfulthan a deeper cut b/cscraping of skinexposes millions ofnerve endings
7/28/2019 Skin Wounds Classifications Full
4/66
AbrasionTreatment
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 tarembedded
o Leave open to air, unless oozing of fluid orblood
o Apply antibiotic ointment to inhibit infections
o Scrapes scab over quickly
7/28/2019 Skin Wounds Classifications Full
5/66
AbrasionTreatment
o Loose skin flaps my form natural dressing; ifflap 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 ofwound
o Swelling
o Purulent drainage
7/28/2019 Skin Wounds Classifications Full
6/66
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)
7/28/2019 Skin Wounds Classifications Full
7/66
Laceration
7/28/2019 Skin Wounds Classifications Full
8/66
Laceration
7/28/2019 Skin Wounds Classifications Full
9/66
LacerationTreatment
o Cleaned with soap and water
o Irrigate with clean water to remove debris
o
Do NOT use alcohol, iodine, or peroxide as itmay cause further damage and slow healingprocess
o
Stop bleedingo Cover wound with sterile gauze
o Apply direct & constant pressure (15min+)
7/28/2019 Skin Wounds Classifications Full
10/66
LacerationTreatmento Once wound cleaned,
antibiotic ointment maybe applied to reduce riskof infection & aid healing
o
Change sterile dressingdaily as neededo 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 areawhere wound by beopened by simplemovement of body part
o Wound on face, eyelids, orlips
o Deep cuts on palm, finger,elbow or kneeo Loss of sensation or ROM
of body part as result ofcut
7/28/2019 Skin Wounds Classifications Full
11/66
LacerationTreatment
Stitches Steri-Strips
7/28/2019 Skin Wounds Classifications Full
12/66
Avulsion
o Layers of skin torn off completely or only flapof skin remains
o Same mechanism as laceration, but to extentthat tissue is completely ripped from itssource
o May be considerable bleeding
7/28/2019 Skin Wounds Classifications Full
13/66
AvulsionTreatment
o Clean wound with soap and water
o If flap of skin remains connected replace skinin its original position
o If deep avulsion, seek medical attention forstitches
o If large piece of skin torn off place in plasticbag and put on iceo Skin should not get frozen or soaked in water
o Take skin in plastic bag to doctor; may be able to saveand replace torn-off piece
7/28/2019 Skin Wounds Classifications Full
14/66
Puncture Wound
o Penetration of skin by sharp object
oNails, tacks, ice picks, knives, teeth, needles
o May be small in diameter and not seemserious
o Do require treatment by physician
o Can become infected easily b/c dirt and germscarried deep in the tissue
7/28/2019 Skin Wounds Classifications Full
15/66
Puncture WoundTreatment
o Find out if part of object that caused wound stillin the woundo i.e. lead from a pencil
o Determine if other tissues have been injured bythe objecto Blood vessels, nerves, tendons, ligaments, bones,
internal organs
o Prevent infectionso Bacterial skin infections, tetanus, infections in deeper
structures (bones and joints)
7/28/2019 Skin Wounds Classifications Full
16/66
Puncture WoundTreatment
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 bacterialinfection that is difficult to treat)o injected into skin under high pressureo i.e. nail from nail gun, paint from high-
pressure paint sprayero Physician should be consulted if object
penetrated deeply
7/28/2019 Skin Wounds Classifications Full
17/66
Contusiono A blow compresses or crushes
the skin surface and producesbleeding under the skin
o Does not break skino Bruising due to injury to blood vessels
o Most mild and respond well to RICE
7/28/2019 Skin Wounds Classifications Full
18/66
ContusionSigns & Symptoms
o Swelling
o Pain to touch
o Redness
o Ecchymosiso accumulation of blood
in skin & subcutaneoustissue more than one cmin diameter
o General term=bruising
o Result of bleeding;clotting or bleedingdisorders
o Bluish lesion at earlieststages of onset
7/28/2019 Skin Wounds Classifications Full
19/66
ContusionTreatment
o Careful monitoring
o Anti-inflammatory oral medications
o
Compressive dressingo Ice
o Modalities to ecchymosis, swelling, ROM
o Myositis ossificans: calcification that formswithin muscle
o Requires surgical intervention
7/28/2019 Skin Wounds Classifications Full
20/66
Blister
o Continuous rubbing over thesurface of the skin causes acollection of fluid below or
within the epidermal layer
7/28/2019 Skin Wounds Classifications Full
21/66
BlisterTreatment
o Wash area thoroughly
o Use sterile blade to cutsmall hole in blister
o Squeeze out clear fluido Do not remove skin
o Prevention:o Wear work gloves
o Break in new shoes
o Petroleum jelly/skin lubeo Adhesive bandage
7/28/2019 Skin Wounds Classifications Full
22/66
Incision
o Skin has been sharply cut
o Surgical cut made in skin or flesh
7/28/2019 Skin Wounds Classifications Full
23/66
IncisionTreatment
o Remove bandage day after surgery; replacedaily or as needed
o Normal for edges of healing incision to beslightly red
o Call physician if:o redness increases/spreads more than half an inch
opus in incisionomore than mildly tender or painful
I i i
7/28/2019 Skin Wounds Classifications Full
24/66
Incision
Treatment
o Keep incision clean & dry for several daysafter surgery
o Non-absorbable sutures or staples must bekept dry until doctor removes
o Steri-strips should be kept dry 4-5 days
o On face, hands, arms: take showers or tubbaths along as affected area stays dry
7/28/2019 Skin Wounds Classifications Full
25/66
Wound Care
o Irrigate with clean, cool water to wash awayforeign particles
o Gentle wash with mild soap (superficial cutsonly)
o Minor cuts/abrasions should be washed, driedwith sterile gauze sponge, and treated with
first aid cream
o Apply dry, sterile bandage, large enough tocover entire injury
7/28/2019 Skin Wounds Classifications Full
26/66
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
oOozing of pus
o Increase body temperature
7/28/2019 Skin Wounds Classifications Full
27/66
Care of Open Wounds
Chart in Arnheimp 928
7/28/2019 Skin Wounds Classifications Full
28/66
Skin Infections
o Skin always has some amount of bacteria,fungus, and viruses living on it
o Skin infections occur when there are breaksin the skin and the organisms haveuncontrolled growth
o It is more important to understand the
potential for infection rather than placing aname on the skin problem
7/28/2019 Skin Wounds Classifications Full
29/66
Skin Infections
o Bacteriacan be curedo Staphlococcus
o Including MRSA & Impetigo
o Streptococcuso Fungalcan be cured
o Ringworm
o Viralcannot be cured, but can be treatedoHerpes
oWarts
oMolluscum contagiosum
7/28/2019 Skin Wounds Classifications Full
30/66
When to Worry
o Lesions with an irregularborder
o Raised skin lesions
o wet or moist lesionso Lesions that have
different colors withinthe lesion
o Bright red colored lesionsare more of a problemcompared to faded lesions
o Lesions that are warmercompared to other skin
o Inflammation & irritation
around skin lesiono Prior history of infectious
skin lesion
o Skin abrasions
o Deeper or more traumaticbreak in skin, higher riskfor subsequent infection
7/28/2019 Skin Wounds Classifications Full
31/66
Skin Infections
o The right antibiotic is required to cure aspecific bacterial skin infection
o Antibiotics for bacteria will not improvefungal or viral infections
o Bacterial infections can be the fastest growinginfections
o Thus the most easily spread among athletes
7/28/2019 Skin Wounds Classifications Full
32/66
Staph
o Infection caused byStaphylococcusbacteria
o About 25% of peoplenormally carry staph inthe nose, mouth,
genitals, and anal areas
o Infection begins with a
little cut
gets infectedwith bacteria
o Range from a simpleboil to antibiotic-resistant infections toflesh-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 withantibiotics
7/28/2019 Skin Wounds Classifications Full
33/66
MRSA
o Methicillin resistant Staphylococcus aureus
o Resistant to certain antibiotics most are skininfections
oMethicillin, oxacillin, penicillin, amoxicillin
o More severe or potentially life-threateningoccur most frequently among patients in
healthcare settings
7/28/2019 Skin Wounds Classifications Full
34/66
Symptoms of MRSA
Skin Infectionso Appear as pustules or boils
o Red
o Swolleno Painful
o Pus or other drainage
o First look like spider bites or
bumpso Occur at sites of visible skin
trauma
Severe Infectionso Potentially life-threatening
o Blood stream infections
o
Surgical site infectionso Pneumonia
o Signs & symptoms vary bytype and stage of infections
7/28/2019 Skin Wounds Classifications Full
35/66
Causes of MRSA
o Spread by havingcontact with someonesskin infection or
personal items theyveused
o Spread in places wherepeople are in close
contact
o Close skin-to-skincontact
o Openings in the skin
(cuts or abrasions)o Contaminated items &
surfaces
o Crowded livingconditions
o Poor hygiene
7/28/2019 Skin Wounds Classifications Full
36/66
Personal Prevention of MRSA
o Good hygiene
o Keep hands cleanwash with soap and waterthoroughly
o Keep cuts and scrapes clean & covered with abandage
o Avoid contact with others wounds/bandages
o Avoid sharing personal items i.e. towels, razors
Prevention of MRSA in
7/28/2019 Skin Wounds Classifications Full
37/66
Prevention of MRSA in
Athleticso Practice good personal
hygieneo Keep hands clean
o Shower after exerciseo Do not share soap or
towels
o Wash uniform & clothing
o Take care of your skino Cover abrasions/cuts
o Change bandages regularly
o Do not share items thatcome in contact with
your skino Towels & razorso Ointments
o Take precautions withcommon surfaces &equipmento Use barrier between skin
& surface (towel,clothing)
7/28/2019 Skin Wounds Classifications Full
38/66
Diagnosis & Testing of MRSA
o Culture must be obtained
o Small biopsy of skin
oDrainage from infected site
o Blood
oUrine
o Sent to microbiology laboratroy
o Tested for S. aureusinfection
o Determine which antibiotics will be effective
7/28/2019 Skin Wounds Classifications Full
39/66
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
oWash hands
o Contact physician
7/28/2019 Skin Wounds Classifications Full
40/66
MRSA Statistics
o 2005: estimated 94,360 people develop seriousMRSA infection
o Approx 18,650 person died during hospital stayrelated to these serious MRSA infections
o About 85% of all invasive MRSA infections wereassociated with healthcare (2/3 outside of
hospital)o About 14% of all infections occurred in persons
without obvious exposures to healthcare
7/28/2019 Skin Wounds Classifications Full
41/66
MRSA
7/28/2019 Skin Wounds Classifications Full
42/66
MRSA
7/28/2019 Skin Wounds Classifications Full
43/66
MRSA
7/28/2019 Skin Wounds Classifications Full
44/66
MRSA
7/28/2019 Skin Wounds Classifications Full
45/66
Impetigo
o Mild itching & soreness
o Eruption of small vesicles and/or pustules thatrupture to form honey-colored crusts
o Combo of 2 bacteria that spread rapidly whenathletes in close contact with one another
o Responds rapidly to proper treatment
o Thorough cleansing of crusted area
o Application of topical antibacterial agent
7/28/2019 Skin Wounds Classifications Full
46/66
ImpetigoCauseso Caused by streptococcus (strep) or
staphylococcus (staph) bacteria
o MRSA becoming common cause
o May occur on skin where there is no visiblebreak
o Most common in children, particularly
unhealthy living conditionso Infection carried in fluid that oozes from
blisters
7/28/2019 Skin Wounds Classifications Full
47/66
ImpetigoSymptomso Single or many blisters filled with pus
o Easy to pop
oWhen broken leave a reddish raw-looking base
o Itching blistero Filled with yellow or honey-colored fluid
oOozing and crusting over
o
Rasho Skin lesions on face, lips, arms, or legs
o Swollen lymph nodes near infection
7/28/2019 Skin Wounds Classifications Full
48/66
Impetigo
7/28/2019 Skin Wounds Classifications Full
49/66
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)
oMay crust over
o Rash or itching
7/28/2019 Skin Wounds Classifications Full
50/66
Folliculitis
7/28/2019 Skin Wounds Classifications Full
51/66
Ringworm
o Skin infection causedby fungus (not a worm)
o Fungi thrive in warm,moist areas
o Often several patches atonce
o Contagious
o Symptoms:o Itchy, red, raised scaly
patches that may blisterand ooze
o Patches often havesharply-defined edges
o Redder around outside;normal skin tone incenter
o Skin appear unusuallydark or light
7/28/2019 Skin Wounds Classifications Full
52/66
Ringworm Types
o Bodytinea corporis
o Scalptinea capitis
o Grointinea cruris (jock itch)
o Feettinea pedis (athletes foot)
http://www.dermisil.com/categories/Skin-Care/Ringworm/?a_aid=junk66&a_bid=0ec01adfhttp://www.dermisil.com/categories/Skin-Care/Ringworm/?a_aid=junk66&a_bid=0ec01adf7/28/2019 Skin Wounds Classifications Full
53/66
Ringworm
http://www.dermisil.com/categories/Skin-Care/Ringworm/?a_aid=junk66&a_bid=0ec01adfhttp://www.dermisil.com/categories/Skin-Care/Ringworm/?a_aid=junk66&a_bid=0ec01adfhttp://www.dermisil.com/categories/Skin-Care/Ringworm/?a_aid=junk66&a_bid=0ec01adf7/28/2019 Skin Wounds Classifications Full
54/66
Herpes Gladitorium (Viral)o Caused by herpes simplex
virus Type 1
o Spread by direct skin-to-skin contact
o Lesions/sores appearwithin 8 days afterexposure
o Appear as cluster of
blisterso Diagnosis upon
appearance
7/28/2019 Skin Wounds Classifications Full
55/66
Cauliflower Ear
o Deformity of outer ear
o Caused by accumulation of blood beneath theexternal surface of ear & underlying cartilage
o Blunt trauma to ear to cause hematoma orbruising of tissue to develop into thisdeformity
o Seen in wrestlers, rugby players, boxers
7/28/2019 Skin Wounds Classifications Full
56/66
Cauliflower Ear
o Painful & physically deforming
o Fluid accumulates beneath skin surface of ear
o Underlying cartilage is deprived of bloodsupply & nutrients necessary for normalfunctioning
o If fluid not removed hardening of tissues &keloid formation resultso Gives ear shriveled & deformed appearance
7/28/2019 Skin Wounds Classifications Full
57/66
Cauliflower Ear Treatmento ICEo See physicianoften necessary for fluid to be
aspirated
oDrained with needleo Placement of custom-made, form fitting
compression dressing made of hardened
casting materialoWorn 3-5 days continuously
o Athlete return to activity wearing both device and
appropriate headgear
7/28/2019 Skin Wounds Classifications Full
58/66
Cauliflower Ear
7/28/2019 Skin Wounds Classifications Full
59/66
7/28/2019 Skin Wounds Classifications Full
60/66
Cleaning & Disinfecting
o Cleanerso Products used to remove
soil, dirt, dust, organicmatter, & germs
(bacteria, viruses, fungi)o Work by washing
surface to lift dirt &germs off surfaces so thy
can be rinsed away withwater
o Sanitizerso Used to reduce germs from
surfaces but not totally getrid of them
o
reduce germs to levelconsidered safe
o Disinfectantso Chemical products that
destroy or inactivate germs
& prevent them fromgrowing
o No effect on dirt, soil, ordust
7/28/2019 Skin Wounds Classifications Full
61/66
Which one to use?
o Disinfectants effective against staph mostlikely also effective vs. MRSA
o Products readily available from grocery/retail
storeso Check product label
o List of germs that product destroys
o Use disinfectants that are registered by theEPA
o Check for EPA registration number on product
label for confirmation
How should cleaners &
7/28/2019 Skin Wounds Classifications Full
62/66
How should cleaners &disinfectans be used?
o Read the label first. Each cleaner and disinfectanthas instructions on the label that tell youimportant 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)
7/28/2019 Skin Wounds Classifications Full
63/66
Disinfection Guidelines
o All floor and wall padding in athletic areasshould be washed daily (if athletic area isused)
o Separate mop head/buckets should be used foreach activity area, locker room, and restroom.oMop heads & buckets should be cleaned regularly
o Towels/linens laundered on premises shouldbe washed with detergent at a minimum of160 F & dried in hot dryer
7/28/2019 Skin Wounds Classifications Full
64/66
Disinfection Guidelines
o CAUTION! If clean athletic gear is dumpedinto a dirty laundry bag or gym bag, the gearimmediately becomes a source of infection
o Liquid (not bar) soap should be readilyavailable and provided by wall dispenser closeto sinks & next to showers
o Sports equipment should be cleaned regularlyo Balls, racket grips, bats, gloves
Disinfection Guidelines
7/28/2019 Skin Wounds Classifications Full
65/66
Disinfection GuidelinesWrestling Room & Mats
o Mat surfaces with small holes or tears shouldbe repaired with mat tape.
o Mat surfaces should be replaced promptly
when there are large holes or surfaces areexcessively worn
o Both sides of the mats should be cleaned
thoroughly before and after each use forpractices and meets
7/28/2019 Skin Wounds Classifications Full
66/66
Maximize Athletic Success!
Minimize Risk of Infection!
