Managed Tissue Injury Case Study

Damaged tissue (inflammation)

Inflammation is the body’s response to injury. Inflammation is a protective attempt by the body to attempt to remove harm and to initiate the healing process. Inflammation occurs with a few minutes of the incident up to a few hours after depending on the severity of the injury.

There are 5 key characteristics of inflammation these are:

• Pain

• Redness

• Swelling

• Heat

• Immobility (loss of use)

Injury causes Tissue damage.

Damaged tissue causes release of chemicals.

Blood vessels dilate

(This means more blood is able to be moved around the body as there is more room for blood to travel. We want to get blood to the injury.)

Going through

each stage of the flow chart things become clear how each lead to another and one thing triggers another. Tissue damaged is caused by the connection with the skin of the object and this causes the soft tissues within the body to become damaged. Then the damaged of the soft tissue causes the chemicals to be released. This happens because for the inflammation to occur the waste chemicals must go, once these are gone it then allows the body to begin to inflame and get the swelling out because then this means that the process of recovery is able to begin. This then triggers the blood vessels to dilate this means that we can then get more blood to the area that has suffered the injury. They do this because it allows for the quick repair of the broken blood vessel or in the soft tissue case get more blood to support the area, this also leads to making the cell permeable, the more serious the soft tissue damage the longer the cells are permeable for. (Sport BTEC level 3 book 2) This leads to the 5 responses to the soft tissue injury. The first one that we will feel is pain at the moment of the injury this is where we have to watch out for signs such as screaming and discomfort, this is signs that the injury could be bad on first thoughts. Then it will be heat, the place where the injury has occurred will become very warm, this will not always happen it depends on the severity of the injury. When the heat does become to come up this means that it is a sign of swelling. Swelling is the next stage; this is when the blood flow begins to surround the injury. The means the injured area begins to swell up. This could also mean bleeding if the area begins to leak, this could cause the body to lose blood. This next one is something that doesn’t always happen but sometimes you get a loss of function. This means that it can be pins and needles or even it is too saw to play with, this means that the soft tissue damage could be quiet deep and takes a long while to recover.

The clotting mechanism
Clotting, also known as “coagulation”, occurs almost immediately after injury to a blood vessel. It is the process of blood changing from its usual liquid state to a solid form.
A clotting mechanism is the series of chemical processes that occur in the body and that lead to the formation of a clot. A clot is a collection of cells that seals and protects damaged areas of blood vessels while the body heals itself. Although a clot can form because there has been an injury, it also can form because of certain diseases or blood disorders. A clot is intended to stop bleeding and prevent infection as well as provide a safe area for healing to occur. After the area has been repaired, the clot dissolves back into the body.
When a blood vessel is damaged, the clotting mechanism begins when the walls of the vessel release certain unique proteins. These proteins send signals to a type of cell in the blood called a platelet. Platelets are created in the bone marrow and are the first cells to encounter the damaged area. They immediately converge on the injury and form a temporary barrier to seal the wound and stop the bleeding.
The next event to occur is the activation of the thrombin system. This is also called a clotting cascade. After this part of the blood clotting process begins, a series of chemical reactions occurs. Each reaction forms a new set of chemicals and proteins, which then react again. This cascade results in the formation of long strands of a substance called fibrin. http://www.wisegeekhealth.com/what-is-a-clotting-mechanism.htm
Clotting is also known as coagulation occurs almost immediately after injury to a blood vessel. It is the process of blood changing from its liquid state to a solid.
There are 3 stages:
Formation of Prothrombinase: When liquid blood comes into contact with certain molecules it stimulates the formation of an enzyme called prothrombinase.
Prothrombin is then converted to thrombin: The enzyme prothrombinase converts prothrombinase into thrombin.
Fibrinogen is converted into fibrin: Thrombin convert fibrinogen into fibrin which forms tread like scaffolding structures that form a clot and eventually a scab.
Signs of the clotting mechanism in sport can be put down to these different symptoms:
•Reddish or bluish skin.
•Sudden shortness of breath
•Rapid heart rate
•Chest pain-sharp, stabbing; may get worse with deep breath
•Fainting or passing out
•Unexplained cough, sometimes with bloody mucus
The blood clotting mechanism can be caused by excess weight on the body, this could be caused by a fatty body, the could mean that the fat is restricting the blood flow within the body causing a clot. Smoking is a big cause because this can blood up veins and arteries and affect the lungs and this will affect your breathing. Making sure you are always hydrated is key as well this helps with the blood flow and prevention of blood clots.

Scar Tissue/RE modelling process.
A scar is an example of the bodies remodelling process. Scar tissue replaces normal tissue after it is damaged. Scar tissue is the formation and the laying down of a protein called collagen. It is not as elastic or pliable as skin or muscular tissue which makes the tissue less effective and efficient than normal tissue. This can lead to a disfunction of feeling in this part of the body, it is very tough to restore scar tissue to its original state. Scars form every time the skin is damaged beyond its first layer, whether that damage comes from a cut, burn, or a skin condition like acne or a fungal infection. It is possible to minimize the amount of visibility of scar tissue but it is impossible to get rid of it completely. Though both scar tissue and normal skin are made with these collagen proteins, they look different because of the way the collagen is arranged. In regular skin, the collagen proteins overlap in many random directions, but in scar tissue, they generally align in one direction.
There are different types of scar tissue and there are several factor that can affect this, it can be the circumstances of the injury and also the skin tone and then you also have the toughness of the skin and the surface that the cut occurs on. Also different wounds cause difference scars, like a puncture wound causes a different scar to a burn wound. If the wound becomes infected then this also has an effect of the type of scar and how the skin re-models.
The re modelling is not always something that will happen immediately it is something that could take months or years, this depends on the severity of the injury and the demands that have been placed on the body tissues. The healing process has no set time onto what time it will take, the main factor is the type of tissue that has been damaged and how badly the tissue has been damaged. When treating a scar it is key to make sure that you keep check on the scar to see if it has moved from one stage to the next.
If the correct treatments are not applied it is very likely that we will not get the full function into the body part again so this is why the correct treatments must be put in place to regain full use of the body part. If the correct recovery is not put in place then it means that it will be harder to restore it to its closest possible chance of original state.
Sprain and strain:
Sprains and strains are some of the most common types of injuries, these are picked up in sports all of the time, but there is a difference between a sprain and a strain.
A sprain is a stretch or tear of a ligament, the tissue that joins the end of one bone with another.

Ligaments stabilize and support the body's joints. They act almost as a shock absorber to stop the two ends of the bones grinding together. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run.

A strain is an injury of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone.

A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and ruptures ligaments. This injury can occur when an individual lands on an outstretched arm; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface.

Strains are the result of overuse of muscles and tendons. Poor timed rest breaks during intensive training leads to a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.

Sprains and strains are classed in three different categories, these are first, second and third, this depends on how many fibres have been torn. Grade 1 would be a few fibres torn and when moving up to grade three this would be a total rupture. Symptoms are different for each

grade.

We also have something called haematomas, these are is a localized collection of blood outside the blood vessels, usually caused by trauma (in this case a muscle). It is different from a bruise, which is the spread of blood under the skin in a thin layer. We have two types of these they are Intramuscular and Intramuscular.
Intramuscular is where it only affects the muscle fibre tissue and this means that the blood us contained within the sheath that is around the muscle. This can become very painful because the pressure within the muscle builds up, the jobs of the sheath is to prevent the fluid leaving the muscle so it acts like a balloon, the healing will take as long as it takes for the bleeding to go, with and Intramuscular haematoma you are less likely to see the bruising.
Intramuscular is including the muscle and also the muscle sheath, in this the bleeding is not contained so this means that the bleeding is able to spread. The initial bleeding can last longer, but the recovery is usually quicker than intramuscular as the blood is able to flow away from the surface of the injury quicker. With an intramuscular haematoma you are more likely to see bruising.