Physical Injuries in Workplace

Introduction & Classification - Workplace Skin Woes

Occupational physical injuries: Skin damage or alterations resulting from direct exposure to physical agents or forces within the workplace environment. Classified by causative agent:

Mechanical Trauma - Friction & Force Fiesta

• Direct Force Injuries:
  • Abrasions: Superficial epidermal damage; e.g., construction falls.
  • Lacerations: Irregular skin tears; e.g., butcher's knife cuts.
  • Punctures: Deep, narrow wounds; e.g., healthcare needlesticks.

    ⭐ Puncture wounds from contaminated objects (e.g., agricultural tools, waste disposal) pose significant tetanus and deep infection risk.

• Friction & Pressure Injuries:
  • Friction Blisters: Epidermal fluid separation from rubbing; common in manual labor.
  • Calluses (Tyloma): Diffuse protective hyperkeratosis from chronic friction/pressure. E.g., carpenter hands.
  • Corns (Clavus): Painful, localized hyperkeratotic cones on bony points. E.g., workers' ill-fitting shoes.
  • Pressure Ulcers: Ischemic necrosis from sustained pressure. 📌 Stages (RBCD):
    • Stage 1: Redness (non-blanchable erythema).
    • Stage 2: Blister/Break (partial-thickness).
    • Stage 3: Crater (full-thickness skin loss, fat visible).
    • Stage 4: Deep damage (full-thickness tissue loss, muscle/bone exposed).

Thermal Trauma - Sizzle & Shiver Saga

Heat Burns:

• Types: Thermal, Chemical, Electrical.
• Depth Classification:
  • 1st Degree (Superficial): Epidermis. Red, painful. Heals 3-6 days.
  • 2nd Degree (Partial Thickness): Dermis. Blisters.
    • Superficial: Painful. Heals 7-21 days.
    • Deep: ↓Pain, mottled. Scarring. Heals >21 days.
  • 3rd Degree (Full Thickness): Subcutaneous. Leathery, insensate. Grafting.
  • 📌 Rule of Nines (BSA estimation).

Cold Injuries:

• Frostnip: Superficial, reversible numbness, pallor. No tissue loss.
• Frostbite: Tissue freezing. Degrees vary: depth, blistering (clear→hemorrhagic), necrosis.
• Raynaud's Phenomenon: Episodic vasospasm (digits). Triggers: cold, vibration tools.

Initial Workplace Burn Management: Stop burn (cool water 10-20 min for thermal, not ice; irrigate chemical), ABCs, remove constrictions, clean dry dressing, medical aid.

⭐ Electrical burns: "Iceberg effect" - deep damage exceeds surface injury. Current prefers nerves/vessels.

Radiation & Other Agents - Invisible Impactors

• Non-Ionizing Radiation:
  • UV Radiation (UVR):
    • Sources: Solar exposure, welding arcs, lasers.
    • Skin Effects: Sunburn (erythema), photoaging (wrinkles, lentigines), photocarcinogenesis (BCC, SCC, melanoma).

    ⭐ Welder's flash (arc eye/photokeratitis) is a common UV radiation injury to eyes; skin burns also occur.

  • Infrared Radiation (IR):
    • Sources: Furnaces, molten glass/metal, heat lamps.
    • Skin Effects: Erythema ab igne (reticulated hyperpigmentation), thermal burns, accelerates photoaging.
• Ionizing Radiation (X-rays, Gamma rays):
  • Acute Radiodermatitis: Dose-dependent. Erythema (threshold ~2-5 Gy), epilation (~3 Gy), dry/moist desquamation (>10-12 Gy), necrosis (>20 Gy).
  • Chronic Radiodermatitis: Develops months/years later. Atrophy, telangiectasias, hyper/hypopigmentation, fibrosis, chronic ulceration, ↑ risk of SCC.
• Vibration:
  • Hand-Arm Vibration Syndrome (HAVS): From vibrating tools. Skin signs: Vibration white finger (Raynaud's phenomenon), numbness, tingling.

High-Yield Points - ⚡ Biggest Takeaways

• Friction & Pressure: Cause callosities, blisters, and pressure ulcers (decubitus).
• Vibration (HAVS): Leads to Raynaud's phenomenon, digital blanching, and neuropathy.
• Thermal Injuries: Include burns (heat, chemical, electrical) and heat rash (miliaria).
• Cold Exposure: Results in frostbite (tissue freezing) and chilblains (pernio).
• UV Radiation (Solar): Key risk for sunburn, actinic keratosis, and skin malignancies.
• Ionizing Radiation: Can cause acute, chronic, or recall radiation dermatitis.
• Physical Trauma: Cuts/abrasions may lead to keloids, hypertrophic scars, and infections.