Wound Care Jennifer L. Doherty, MS, LAT, ATC, CIE Florida International University Dept. of Health, Physical Education, and Recreation

Caring for Skin Wounds Skin wounds are extremely common in sports Skin wounds are extremely common in sports Soft pliable nature of skin makes it susceptible to injury Soft pliable nature of skin makes it susceptible to injury Numerous mechanical forces can result in trauma Numerous mechanical forces can result in trauma –Friction, scrapping, pressure, tearing, cutting and penetration

Abrasions Skin scraped against rough surface Skin scraped against rough surface Top layer of skin wears away exposing numerous capillaries Top layer of skin wears away exposing numerous capillaries Often involves exposure to dirt and foreign materials Often involves exposure to dirt and foreign materials –Increased risk for infection Types of wounds

Laceration Sharp or pointed object tears tissues – results in wound with jagged edges Sharp or pointed object tears tissues – results in wound with jagged edges May also result in tissue avulsion May also result in tissue avulsion

Types of wounds Puncture wounds Can easily occur during activity and can be fatal Can easily occur during activity and can be fatal Penetration of tissue can result in introduction of tetanus bacillus to bloodstream Penetration of tissue can result in introduction of tetanus bacillus to bloodstream All severe lacerations and puncture wounds should be referred to a physician All severe lacerations and puncture wounds should be referred to a physician

Types of wounds Incision Wounds with smooth edges Wounds with smooth edges

Types of wounds Avulsion wounds Skin is torn from body Skin is torn from body –Major bleeding Place avulsed tissue in moist gauze (saline), plastic bag, and immerse in cold water Place avulsed tissue in moist gauze (saline), plastic bag, and immerse in cold water Take to hospital for reattachment Take to hospital for reattachment

Immediate Care Should be cared for immediately Should be cared for immediately All wounds should be treated as though they have been contaminated with microorganisms All wounds should be treated as though they have been contaminated with microorganisms

Immediate Care: Step 1 To minimize infection, clean wound with copious amounts of soap, water, and sterile solution To minimize infection, clean wound with copious amounts of soap, water, and sterile solution –Avoid hydrogen peroxide and bacterial solutions initially

Immediate Care: Step 2 Control bleeding Control bleeding Universal precautions must be taken to reduce exposure risk of bloodborne pathogens Universal precautions must be taken to reduce exposure risk of bloodborne pathogens

Controlling Bleeding Abnormal discharge of blood Abnormal discharge of blood Arterial, venous, or capillary bleeding Arterial, venous, or capillary bleeding –Venous - dark red with continuous flow –Capillary - exudes from tissue and is reddish –Arterial - flows in spurts and is bright red Internal or External hemorrhaging Internal or External hemorrhaging

Internal Hemorrhage Invisible Invisible –May be detected through body opening, X- ray, or other diagnostic techniques May occur… May occur… –Beneath skin –Intramuscularly –Within a joint

Internal Hemorrhage Bleeding within body cavity could result in life and death situation Bleeding within body cavity could result in life and death situation Difficult to detect and must be hospitalized for treatment Difficult to detect and must be hospitalized for treatment Could lead to shock if not treated accordingly Could lead to shock if not treated accordingly

External Hemorrhage Stems from skin wounds, abrasions, incisions, lacerations, punctures or avulsions Stems from skin wounds, abrasions, incisions, lacerations, punctures or avulsions

External Hemorrhage Direct pressure Direct pressure –Firm pressure (hand and sterile gauze) placed directly over site of injury against the bone Elevation Elevation –Reduces hydrostatic pressure and facilitates venous and lymphatic drainage - slows bleeding Pressure Points Pressure Points –Eleven points on either side of body where direct pressure is applied to slow bleeding

Immediate Care: Step 3 Antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing Antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing

Immediate Care: Step 4 Sterile dressing should be applied to keep wound clean Sterile dressing should be applied to keep wound clean Occlusive dressings are extremely effective in minimizing scarring Occlusive dressings are extremely effective in minimizing scarring

Deep lacerations, incisions, and occasionally punctures will require some form of manual closure Deep lacerations, incisions, and occasionally punctures will require some form of manual closure Decision should be made by a physician Decision should be made by a physician Sutures should be used within 12 hours Sutures should be used within 12 hours Area of injury and limitations of blood supply for healing will determine materials used for closure Area of injury and limitations of blood supply for healing will determine materials used for closure Physician may decide wound does not require sutures Physician may decide wound does not require sutures –Utilize steri-strips or butterfly bandages Are Sutures Necessary?

Wound Infection Signs and symptoms are the same as those for inflammation Signs and symptoms are the same as those for inflammation  Pain  Heat  Redness  Swelling  Disordered function Pus may form due to the accumulation of WBC’s Pus may form due to the accumulation of WBC’s Fever may develop as the immune system fights bacterial infection Fever may develop as the immune system fights bacterial infection

Bacterial infection that may cause… Bacterial infection that may cause… –Fever –Convulsions –Possibly tonic skeletal muscle spasm Tetanus bacillus enters wound as spore and acts on motor end plate of CNS Tetanus bacillus enters wound as spore and acts on motor end plate of CNS Tetanus

Tetanus Following childhood vaccination, boosters should be supplied once ever 10 years Following childhood vaccination, boosters should be supplied once ever 10 years If not immunized, athlete should receive tetanus immune globulin (Heper-Tet) immediately following skin wound If not immunized, athlete should receive tetanus immune globulin (Heper-Tet) immediately following skin wound