FIRST AID GRAZE MANAGEMENT By Heidi Collishaw, RMN

This article is the first in a regular series covering topics on first aid in sport and covers the assessment and management of grazes, particularly but not exclusively caused by cycling.

Because both recreational and competi- tive cyclists rarely wear protective cloth- ing for a variety of reasons the grazes are very often contaminated by dirt, soil, gravel and in the case of competitive cyclists small balls of fibres from the lycra clothing typically worn. Competitive cyclists also rarely allow themselves to be sidelined by superficial wounds such as grazes which means the injuries are noto- riously difficult to manage.

The following factors are important con- siderations in the assessment stage and will help carers to decide how to progress with treatment: ● infection - cyclists are often unable to get medical help until several hours after the incident has occurred so infection may already be present or the injury might be an old one which is failing to heal ● site - if the fall is significant there may be several sites of injury ● contamination - road dirt is one of the most common culprits in most cyclists however soil (as with mountain bikers) or wood splinters from race tracks are also common contaminates along with lycra in the case of competitive cyclists ● amount of bleeding ● capacity for casualty to carry out after care ● need for referral - if scarring is likely ie. if the wound is on the face or in severe cases on the hands or the injury is over a

QUICK MANAGEMENT GUIDE 1. Rinse the wound with lots of tepid water under mild pressure to flush out contamination 2. Ensure that the wound is completely clean before applying a dressing 3. The main aim is to create an environment that is moist, prevents fur- ther infection and protects the wound from further trauma 4. This is best achieved by applying a semi-permeable film dressing such as Opsite which is transparent, flexible, waterproof, bacteria proof and self-adhesive. It allows moisture to evaporate, requires no secondary dressing and is particularly good over joints and for sports people 5. If there is any exude from the wound a small piece of non-adherent absorbent dressing such as Melolin can be placed beneath the semi-per- meable film dressing 6. Replace the film dressing with a just a non-adherent absorbent dressing at night to deal more effectively with the exude 7. A paraffin jelly dressing can be used beneath the absorbent pad to prevent the wound sticking to the pad, if stuck to the wound soak off with a saline solution 8. Absorbent dressings should be changed daily but a film dressing if intact can be left for 5-7 days 9. Granulation may take several days depending on each individual - if you are unsure of the severity of the wound or suspect infection seek further advice from a GP or nurse

joint with insufficient viable tissue for the wound to heal then referral for skin graft- ing might be considered (this is

rare in

recreational activity) ● dressing to be used

Wound cleansing As there are often several sites of injury, cleansing is often done most effectively using copious amounts of tepid water under mild pressure to flush out contamination and allow a more accurate assessment of the wound. Flushing also removes the need for swabbing of the wound which might introduce further contamination. Cold water may play a role in reducing swelling and slowing bleeding by causing constric- tion of the blood vessels in the area.

Research has shown that the advantages and effectiveness of antiseptic products, in comparison to water, are debatable for cleaning a wound and are not usually rec- ommended. However it is very important to remove any gravel present in the graze as this can cause ‘tattooing’ of the skin.

Once the wound is clean it is sometimes (but not always) possible to see any remaining contamination which in serious cases may need to be removed by medical staff, possibly with anaesthesia.

Any wound left without the protection of skin is susceptible to infection until new skin has formed. It is therefore a good idea to cover a wound even if it means simply using a plaster on a small graze. Apply the dressing as soon as possible after the wound has been cleaned.

Healing Research indicates that optimal wound healing conditions include: ● moisture ● even temperature ● minimised risk of infection ● protection from further trauma

Photograph 1: Track injury showing extent of damage (multiple sites on whole leg length) 24 SportEX