Wound Care on the Field. Objectives

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1 Wound Care on the Field Brittany Witte, PT, DPT Cook Children s Medical Center Objectives Name 3 different types of wounds commonly seen in sports and how to emergently provide care for them. Name all signs and symptoms of infection. State 2 ways to decrease chance of infection. State the importance of moist wound healing. 1

2 Wounds on the field 30 million adolescents participate in sports/year 2 million high school athletes injured 4.1% of athletic trainers contact athletes with potentially infectious bodily fluids 12.9%: incidence of exposure to these fluids Universal Precautions Always have gloves readily available Sterile 4x4s as well as basic bandages should be available 2

3 Common types of wounds Abrasions Blisters Carpet burn Avulsion Puncture from spike Friction wounds Pressure ulcers Lacerations from equipment Open fracture Dehisced surgical sites 5 Common Categories of Wounds Arterial Venous Capillary Blisters Burns 3

4 Arterial Wounds Laceration and/or puncture Result of major trauma Blood spurting rhythmically Bright, red blood Medical emergency Management of Arterial Wounds Goal: hemostasis Direct pressure over site Wrap a bandage to keep dressing in place Elevate the wound Add pressure to pressure points 4

5 Management of Arterial Wounds Brachial artery: between bicep and tricep Femoral artery: femoral triangle Venous Wounds Laceration or puncture Blood: dark red and flows at steady rate When large veins are injured it can be serious 5

6 Management of Venous Wounds Apply direct pressure Elevate extremity if necessary Wrap bandage to hold dressing in place Capillary Wounds Abrasions Occur due to friction or scrape Blood: Slow or persistent weeping Most painful 6

7 Management of Capillary Wounds Wash with soap and water or sterile water Apply direct pressure Cover with dressing and wrap as needed If laceration, decide if sutures are needed Blisters Result of sustained pressure or friction Common after using new equipment 7

8 Leave intact Management of blisters Provides moist wound environment Protect with bandage If blister opens, remove excess tissue Burns 1 st, 2 nd and 3 rd degree burns May be result of carpet burn or friction to a site 8

9 1 st degree Management of burns Thin bandage to protect skin Lotion to prevent skin from drying out Management of burns 2 nd & 3 rd degree burns Blisters: leave intact Cover with dressing that promotes moist wound healing Refer for further care Takes a few days for burns to show their true colors 9

10 Burns continued Cleaning wounds Normal saline or tap water are best Discourage whirlpool Hydrogen peroxide and alcohol are cytotoxic 10

11 Management of wounds Keep bandages in place! Use kling, coban, ACE wraps, tape Keep bandages dry Moist wound healing Moist environment: cell migration and granulation tissue formation Scabs delay wound healing 11

12 Signs and symptoms of infection Redness Swelling Heat around the wound Extreme pain or tenderness Discharge Fever Odor MRSA: Staphylococcus aureus Nostrils of 30% of population Once in the body, it can cause infection CA MRSA more aggressive Resistant to antibiotics commonly used Transmitted: direct physical contact or indirectly through contaminated objects 12

13 MRSA continued Lesions that are red, painful, swollen Pimples or boils Can progress to abscesses or cellulitis Mistaken as spider bite Preventing spread of MRSA Wound care Hygiene Routine cleaning schedules Train athletes and coaches in first aid Encourage athletes to report skin lesions 13

14 Hidradenitis Suppurativa (HS) Recurrent, chronic inflammation of apocrine sweat glands Obstruction and rupture of duct Lesions drain spontaneously Axilla, neck, groin, around breasts, buttocks Hidradenitis Suppurativa (HS) Diagnosis: Typical lesions deep seated nodules and/or fibrosis Typical localziations genitoanal and axillary region, usually symmetrical Typical course relapses and chronicity Family history 14

15 Hidradenitis Suppurativa (HS) Associated with Obesity Depression Pain Usually not before puberty 1: 600 Caucasions Higher in African Americans Hidradenitis Suppurativa (HS) Stage 1 Stage 2 Stage 3 15

16 Bibliography MRSA in contact sports. Alabama Department of Public Health. January Smith, D. Management of bleeding and open wounds in athletes. June 2012; Int J of Sports Physical Therapy; 7(3): Scheinfield, N. Diseases associated with hidradenitis suppurativa: part 2 of a series on hidradenitis. June 2013; Dermatol Online J; 19(6). Wollina, U, Koch, A, Heinig, B, Kittner, T, Nowak, A. Acne Inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment. Indian Dermatol Online J. March 2013; 4(1): Questions? 16

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