Wound Care

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Wound Care

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

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Caring for Skin Wounds

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

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Types of wounds

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

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Types of wounds

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

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Types of wounds

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

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Types of wounds

• Incision
• Wounds with smooth edges

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Types of wounds

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

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Immediate Care

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

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Immediate Care Step 1

• To minimize infection, clean wound with copious
  amounts of soap, water, and sterile solution
• Avoid hydrogen peroxide and bacterial solutions
  initially

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Immediate Care Step 2

• Control bleeding
• Universal precautions must be taken to reduce
  exposure risk of bloodborne pathogens

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Controlling Bleeding

• Abnormal discharge of blood
• 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

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Internal Hemorrhage

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

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Internal Hemorrhage

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

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External Hemorrhage

• Stems from skin wounds, abrasions, incisions,
  lacerations, punctures or avulsions

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External Hemorrhage

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

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Immediate Care Step 3

• Antibacterial ointments are effective in limiting
  bacterial growth and preventing wound from
  sticking to dressing

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Immediate Care Step 4

• Sterile dressing should be applied to keep wound
  clean
• Occlusive dressings are extremely effective in
  minimizing scarring

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Are Sutures Necessary?

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

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Wound Infection

• Signs and symptoms are the same as those for
  inflammation
• Pain
• Heat
• Redness
• Swelling
• Disordered function

• Pus may form due to the accumulation of WBCs
• Fever may develop as the immune system fights
  bacterial infection

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Tetanus

• 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

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Tetanus

• 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