Wound Care & injury Recognition

OSHA 1991

blood-borne pathogen focus

CDC: 2007

focus on body isolation through the use of PPE

When bleeding occurs

• Removal of athlete from the field of play.

• Assess the source of the bleed.

• Control the bleed.

• Clean the area. Including the jersey.

• Provide appropriate treatment to protect the wound, the injured athlete and the other participants.

Handwashing

• Hands and other skin surfaces that come in contact with blood or other body fluids should be washed immediately with soap and water.

• Anti-germicidal agents can also be used but handwashing should be done when available to do so.

• Hands should be washed between each treatment to decrease the chance of infection or transmission.

Effective hand washing steps

1. Wet hands with water

2. Apply plenty of soap

3. Rub your hands together, palm to palm

4. Rub the back of each hand with the palm of the other hand, with fingers interlaced

5. Rub palm to palm with fingers interlaced

6. Rub with the backs of fingers to opposing palms, with fingers interlaced

7. Rub each thumb clasped in the opposite hand using a rotational movement

8. Rub the tips of the fingers in the opposite palm using a circular motion

9. Rinse your hands well with water

10. Dry your hands thoroughly with a single-use towel

11. Keep the towel in your hand and use it to turn off the tap

Effective hand-washing

Personal Protective Equipment (PPE)

Disposable gloves, non-absorbent gowns, facemask/shield, goggles, disposable face shields for CPR.

Gloves:

• Must be used when handling any potentially infectious materials.

• Recommended use of non-latex, latex free vinyl or nitrile rubber gloves.

• Gloves should always be removed carefully after use and disposed of properly.

Steps to remove gloves

1. On removal of the first glove, be careful not to touch your skin with any part of the contaminated glove. To do this, using the external surface as a shield, hook the gloved fingers of one hand at the wrist of the other glove ...

2. ... and pull the glove down towards the fingers.

3. Once the first glove is removed, hold it in the gloved hand

4. To remove the second glove and avoid contact with the contaminated glove, place fingers into the inside surface of the glove (close to wrist) and pull down over the fingers

5. When both gloves are removed, touch only the surface close to the wrist.

6. Dispose of the gloves in the clinical waste bin - if gloves are heavily soiled removed and place gloves into the clinical waste bin separately.

7. Decontaminate your hands. This is imperative in order to reduce cross-contamination.

MSK Assessment and Management

• Ax decisions

• Immediate Tx

• Detailed Hx:

• Observation:

• “Palpation”

• SHARP

Immediate Tx

• POLICE (PRICE, PIER, RICE, RICES)

• Cryokinetics

Police

Protection, Optimal Loading, Ice, Compression, and Elevation.

Protect (P)

• discontinuing activity

• Taping, wraping, splinting, slinging

Optimal loading (O)

• After 24-48 hours

• Start loading the joint

  • Weight bearing, movements

Icing (I)

• 20 minutes (crushed ice)

• Chemical pack = need wet barrier between skin

Compress (c)

• Compress the injury

• towards the heart (lower body)

Elevate

• as much as you can

How long before you can do optimal loading

24-48 hours after injury

Why do we use crushed ice

you can put it directly onto the skin

• the water barrier prevents frostbite

How we wrap ice to the skin

Compression

• flexy wrap

• Tensor bandage

How long ice stay on (first part)

20 minutes

The four ice sensations

3-5 minutes

1. Cold

2. Burn

3. Ache

4. Numb

Elevate how much and long

• 6-8 inches

Horseshoe pad (Foam)

reduce swelling around the area

• Wrap over w/ tensor wrap (overlap by half) - compression

• 24-48 hours

• No weight on ankle (crutches)

MSK Assessment “Remember to!!”

Document everything related to the injury

Detailed Hx:

• MOI (events leading up to the injury)

• Was anything heard at the time of injury(snaps, cracks, pop?)

• Pain (severity ?/10; type; location)

Observation:

• Compare to the other side (checking for asymmetry)

• Obvious deformity, swelling, discoloration

“Palpation“

can be done very lightly to feel for temperature changes

SHARP

is an acronym used to evaluate inflammation:

SHARP

S – swelling (evaluate symetrically)

H – heat (must touch and compare sides)

A – altered function (reported/asked)

R – rubor (redness, discoloration)

P – pain (severity, type, location)

S (sharp)

swelling (evaluate symetrically)

H (sharp)

heat (must touch and compare sides)

A (sharp)

altered function (reported/asked)

R (sharp)

rubor (redness, discoloration)

P (sharp)

pain (severity, type, location)

What is important to consider sharp

Always evaluating bilaterally to identify asymmetry.

Goals and treatment in acute care

• Protect the injury from further damage.

• Reduce secondary injury (from acute inflammatory response)

• Control pain

• Control swelling

Cryokinetics

Cryokinetics (steps)

Crushed ice application	15-20 minutes
Movement " mini squat"	3 minutes
Crushed ice application	5 minutes
Movement "walk"	3 minutes
Crushed ice application	5 minutes
Movement "side lunge"	3 minutes
Crushed ice application	5 minutes

When treating what do you want to do (important)

a functional test

• wiggle toes

• What toe touching

• Cap refill

Skin trauma

• Blisters (open/closed)

• Wounds

• Cleaning, debridement, dressing

• Are sutures needed

• Bleeding nose

Wounds

• Abrasions

• Lacerations

Supplies (Abrasions)

• Zinc Oxide

• Non-Stick Pad

• Pre-Wrap

• Elastic Tape

• Athletic tape (keep elastic tape down)

Abrasions (treatment)

• clean area

• Put zinc oxide over the wound

• Put non stick pad overtop

• Wrap pre-wrap over non-stick pad

• Secure with elastic tape

• Athletic tape end (keep elastic tape down)

Lacerations

Deeper lacerations or incisions may require manual closure using sutures, if underlying tissues such as fat, tendons, bone or vessels are exposed.

Supplies (Lacerations)

• skin tuffner

• Q-tip

• Sutures

• Bandage/pad

• Hyperflex

Lacerations (treatment)

• clean area

• Apply skin tuffner around area w/ q-tip

• Suture the wound

• Put bandage over (must cover)

• Hyperflex each side

• elastic tape (optional)

Blisters (open/closed)

• Formed by friction and shearing forces on the superficial skin

• As friction delaminates tissues the space between layers is filled with fluid.

  • Open

  • Closed

Supplies (Open Blister)

• Second Skin

• Hyperflex

• Elastic Tape

• Athletic tape (keep elastic tape down)

Open blister (treatment)

• Second skin on top of blister (remove plastic film one side only)

• Hyperflex over second skin

• Wrap overtop with elastic tape

• Athletic tape end (keep elastic tape down)

Supplies (Closed Blister)

• Zinc Oxide

• Pad (cut it to size, hole in middle)

• Elastic tape

• Athletic tape (keep elastic tape down)

Closed blister (Treatment)

• zinc oxide on the blister

• Cut & Put a pad overtop (w/ hole to go around)

• Wrap overtop with elastic tape

• Athletic tape end (keep elastic tape down)

Bleeding nose

• Typically occur from trauma.

• Must evaluate other issues from the trauma:

Must evaluate other issues from the trauma: (bleeding nose)

• R/O concussion

• Evaluate nose and surrounding area for fracture

Supplies (Bleeding Nose)

• Gause

• Rhino Rocket

Bleeding nose (Treatment)

• lean forward

• Gause and squeeze nose (5 minutes)

• Rhino rocket (if continues)

• Go to hospital (if continues for longer 15 minutes)

Skin Trauma – cleaning techniques

• Irrigation:

• Scrubbing & Swabbing:

• Soaking:

• Debridement:

Irrigation:

controlled flow of a solution across the wound bed is the preferred cleansing technique for open traumatic wounds.

Scrubbing & Swabbing:

involves direct contact of a soft brush or sterile gauze, with tissues, to remove debris and bacteria.

Soaking

immersion of the body, part in wound into a tub or container of a cleansing solution to hydrate and loosen contaminants.

Debridem

removal of necrotic tissue, foreign bodies/debris, and bacteria from the wound bed by way of scrubbing.

Puncture (Definition)

A type of wound caused by a sharp object penetrating the skin, which can lead to serious infection risks.

• referred immediately to physician

Lacerations (Definition)

A type of wound resulting from the tearing of skin or soft tissues, often characterized by jagged edges and a high risk of infection.

• sharp or pointed object

Incisions (definition)

A type of wound caused by a clean, smooth cut through the skin or soft tissue, usually created by a sharp instrument such as a knife, resulting in well-defined edges.

Avulsions (definition)

A type of wound where tissue is forcibly detached from the body, often causing heavy bleeding and requiring immediate medical attention for potential reattachment.

Bruise (definition) {ecchymosis}

injury to the soft tissue characterized by localized bleeding under the skin due to ruptured blood vessels. This results in a discoloration that typically appears black and blue, accompanied by swelling and tenderness

• POLICE method

• Compressive blunt force