Week 2: Tissue Response to Injury Flashcards
Pain
-Complex phenomenon, very individualized (not everyone has same experience)
-Common to measure by rating on scale 1-10 (different for each person relative to their experience with pain)
-Can cause shock and fear/catastrophizing
-Essential role along with pain management is reassurance (making a plan)
Types of Skin Wounds (5)
- Lacerations
- Abrasions
- Punctures
- Contusions
- Blisters
Management of Lacerations (3 Steps)
Step 1- Control bleeding
Step 2- Clean the wound
Step 3- Steri-strips
Step 1: Controlling Bleeding
-Apply pressure (“all gauze sponges”, i.e. non-sterile loose gauze; add extra layers as needed *do not remove previous layer). Pressure on major artery for large lacerations
-Elevation (raise above heart to decrease blood flow)
-Wear personal protective equipment (e.g. gloves) to protect yourself and keep it clean
Step 2: Clean the Wound
-Use soap and water
-Cinder suds (foam soap) can be applied directly to wound, lifts dirt and debris
-Hydrogen peroxide not as good for tissues, can damage them
Step 3: Steri-Strips
-Dry area around laceration, adhesive spray via Q-tip (not directly on skin) which you rub on either side of laceration where strip will be applied
When do we Send for Stitches?
-Deep wounds affecting more than just skin
-Unable to stop the bleeding
-Wound is to the face or across a joint
*can only be done effectively within 24 hrs of injury (faster the better)
Minor Cuts and Abrasions Treatment
For RTP use non-stick gauze and cover roll to dry skin
Punctures
-Common in feet/hands
-Can penetrate multiple levels (skin, then fat, then muscle)
-With deep/large punctures, if the object is still in you should: leave it in (prevent further bleeding), pad around it with gauze rolls, send for medical attention
Contusions
-Definition: bleeding under the skin from blunt trauma
-Deep contusions need proper management (need to avoid myositis ossificans (bone growths);
-No deep tissue manage/do not massage (except effleurage)
-Use effleurage or lymph drainage to drain blood from area
-Ice
-Use protective padding (donut pad to prevent pressure right on contusion)
-Supervised in clinic (ultrasound- pulsed setting not continuous, interferential current- IFC)
Blisters
-Definition: fluid-filled bubble caused by friction
-Prevention- skin lube over areas of friction
-Treatment- if broken clean well, second-skin, cover roll
OVERALL: When do we seek medical attention? (6)
- Unable to control bleeding
- Wound is dirty and unable to be thoroughly cleaned
- Deep wound or puncture
- Object is still impaled (leave it in)
- Changes in sensation
- Wound is from a human or animal bite, or rusty object
Soft Tissue Healing
-Cartilage and Meniscus- limited capacity to heal (little or no direct blood supply), longer healing time
-Ligament- during repair phase, collagen or CT fibers lay down randomly, gradually a scar is formed, over following months collagen fibres align in response to joint stress/strain
-Skeletal muscle healing- regeneration of new myofibers is minimal, healing and repair follows same process of random collagen alignment and develops tensile strength in response to stress/strain
-Nerves- regeneration can take place very slowly (3-4mm/day), peripheral nerves regenerate better than CNS
Wound Healing Stages (4)
Stage 1: Hemostasis- process leading to cessation of bleeding (blood clotting)
Stage 2: Inflammation- essential vascular and cellular response for proper tissue healing (macrophages come in)
Stage 3: Repair and regeneration/proliferation- formation of granulation tissues (a type of new CT; fibroblasts come in and start healing)
Stage 4: Remodelling- strengthening of tissues along lines of tension
Phases of Wound Healing (Time-Frame)
- Inflammation (4-6 days)
-Aim to minimize, reduce pain, protect and educate - Proliferation (4-24 days)
-Reduce residual swelling/pain, increase ROM, strength, proprioception, fitness, prevent 2nd degree complications, educate - Remodelling (21 days-2 years)
-Increase circulation, ROM, strength, fitness (more sport specific), proprioception
*people can get impatient, important to have at-home programs for them to follow
