9/18/2012 chapter 21 - jones & bartlett...

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Chapter 21

Soft Tissue Injuries

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Learning Objectives

State major functions of skin

List layers of skin

List types of open & closed soft tissue injuries

Establish relationship between BSI & soft tissue injuries

Describe emergency medical care of patient with open & closed soft tissue injury

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Learning Objectives

Establish the relationship between airway management and a patient with chest injury, burn, blunt injury, or penetrating injury

Describe emergency care of a patient with an amputation

Describe emergency medical care of a patient with an impaled object

List functions of dressing & bandaging

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

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Learning Objectives

Describe the purpose of a bandage

Describe steps in applying pressure dressing

Describe effects of improperly applied dressings, splints, tourniquets

List categories of burn injuries

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Learning Objectives

Define a superficial burn and list it characteristics

Define a partial-thickness burn and list it characteristics

Define full-thickness burn and list it characteristics

Describe emergency medical care of a patient with a superficial burn, partial-thickness burn, and a full-thickness burn

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Learning Objectives

Describe emergency care for a chemical burn

Describe emergency care for an electrical burn


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Introduction

Soft tissues include: Skin

Subcutaneous layer of fat

Connective tissue beneath the skin

Skeletal muscles

Tendons

Ligaments

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Introduction

Injuries are classified as: Open – skin is broken

Closed – Skin remains intact

Must look at skin in conjunction with the mechanism of injury for clues to the type of trauma sustained

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Anatomy & Physiology

Skin Largest organ

Provides protective covering & insulation

Separates internal environment from external environment

Barrier to infection and loss of body fluids

2 major layers• Epidermis

• Dermis


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Epidermis Surface, outermost layer

Avascular

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Epidermis 4 separate sublayers

• When intact, is impermeable and cannot be penetrated by microorganisms

• Prevents water loss from cells underneath

• Most superficial layer is dead tissue

• Filled with protein called keratin as new cells move toward skin surface

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Epidermis Responsible for color of skin

• Contains pigment called melanin

• Influenced by blood flow in the skin capillaries contained within the dermis


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Dermis Dense connective tissue that contains:

• Nerves

• Blood vessels

• Sweat glands• Sebaceous glands• Hair follicles

Skin grafting

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Subcutaneous tissue Layer of fat and connective tissue

Serves as body insulator

Fascia

Mucous Membranes Lines internal surface of the body

Rich in mucus glands

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Wounds

DCAP-BTLS Deformities

Contusions

Abrasions

Punctures

Burns

Tenderness

Lacerations

Swelling

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Wounds

Closed wounds Result of blunt force

Do not break integrity of skin

Bruise/contusion• Blood vessels leak or rupture from blunt or compression

force

• May be accompanied by swelling from leakage or plasma into injured area

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Wounds

Closed wounds Ecchymosis

• Blood leakage from injured vessels

• Visible just under skin Black-blue area

Hematoma• Blood collects in pocket beneath skin

• Tumor or swelling containing blood


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Wounds

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Wounds

Open wounds Skin surface broken

Abrasion• Scraping of surface of skin or mucous membrane

• May damage superficial capillaries

• No significant blood loss

• Subject to infection

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Wounds


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Wounds

Open wounds Laceration

• Tearing of skin or other soft tissues

• Result from blunt tearing force or sharp object

• Extent of tissue damage dependent on mechanism of injury

• Severe bleeding possible

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Wounds

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Wounds

Open wounds Avulsion

• Tearing away of the skin’s surface

• Complete avulsion

• Incomplete avulsion


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Wounds

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Wounds

Open wounds Puncture, penetrations

• Occurs when sharp instrument is driven through the skin’s outer layer

• Punctures can be deceiving

• Little external bleeding, but may have severe internal bleeding

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Wounds


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Wounds

Open wounds Amputations

• Cutting away from the body of a limb or protruding structure

• Can be caused by sharp or crushing forces

• Amputated part has no blood supply

• Bleeding massive/limited

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Wounds

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Wounds

Open wounds Crush injury

• May result in both open and closed wounds

• Result of severe compressing force that damages/tears the soft tissues and underlying structures

• Can cause significant damage to underlying structures with minimal/no external bleeding


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Wounds

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Wounds

Severity and complications Severity depends on:

• Mechanism

• Site

• Extent

• Introduction of foreign bodies/contamination into the wound

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Wounds

Severity and complications Must consider damage to underlying structures

Common complications• Bleeding

• Infection

• Damage to underlying structures


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Wounds

Severity and complications Possible loss of function from:

• Nerve damage

• Fractures

• Injury to muscles, tendons, and ligaments

Wounds over the major body cavities carry the risk of damage to internal organs

• Head

• Chest

• Abdomen

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Wounds

Wound management Use appropriate PPE

• Gloves

• Eyewear

• Mask

• Gown

Routine hand-washing – precedes and follows every call

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Wounds

Wound management Obtain history

Life-threatening conditions to ABCs take priority

For projectile injuries, look for exit wound

If loss of function, consider damage to bones and muscles or nerves and vessels

Check for neurovascular function distal to injury

Record findings


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Wounds

Wound management Procedures

• Control bleeding

• Prevent further contamination

• Immobilize affected part

• Preserve avulsed/amputated parts

• Stabilize impaled objects

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Wounds

Wound management Bleeding control

• 1st expose wound

• Control bleeding through: Direct pressure

Elevation

Use of pressure points

Tourniquet application

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Wounds

Wound management Bleeding control

• Extent of blood loss should be assessed

• Blood loss in infants and children

• Large contusions with swelling or hematomas

• Cover open wounds with sterile dressing

• Patient is at greatest risk from associated injuries


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Wounds

Infection All open wounds are subject to infection

Sterile dressings applied when possible

Superficial abrasions can be washed gently with sterile saline solution before dressing is applied

Abrasions washed gently with sterile saline solution/sterile water before dressing

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Wounds

Special considerations Chest and abdominal injuries

• Require special attention because of the major organs that lie within

• Wounds through chest wall Require airtight, occlusive dressing

• Abdominal wounds with exposed organs (evisceration) Can dry out and be damaged when exposed to air for an

extended period

Cover with moist, sterile dressing

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Wounds

Special considerations Amputations, avulsions

• Avulsed portion of skin may be reattached to cover an open wound

• Parts detached from body remain viable for a few hours when left at room temperature If cooled, can be viable for up to 18 hours


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Wounds

Special considerations Parts detached from

body• May be reattached

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Wounds

Special considerations Impalement injury

• Stabilize object with bulky dressings

• Remove object if it interferes with CPR

• Identify available resources when special rescue techniques needed

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Wounds


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Wounds

Special considerations Neck wounds

• May lead to air embolism when large veins are torn

• Cover with occlusive, airtight dressing

• Transport in supine or head-down position to reduce chance of air embolism

• When torn/lacerated, bleeding is usually severe because the neck is highly vascular

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Wounds

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Dressings & Bandages

Dressings Any material that

covers wounds

Prevent further contamination

Bleeding control

Basic dressing is sterile gauze


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Dressings Multitrauma/universal dressing

• For large surface area

• Thick, absorbent material that is 9x36 inches

• Can be used as a pressure dressing over long, open wounds or as a padding for splints

Occlusive airtight dressing• Sterile plastic wrap/sterile aluminum foil may be used

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Bandages Material used to secure dressing in place

Provides pressure to help in bleeding control

Must be tight enough to control bleeding but must not cut off circulation to the limb

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Bandages Types

• Self-sticking

• Self-adherent

• Gauze roller

• Triangular bandages


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Bandages Self-adherent bandages

• Rolls of slightly elastic, gauzelike material

Elastic/ace bandages support joints• If not properly applied, result is uneven pressure to limb

May cause obstruction of distal blood flow and pressure on local nerves

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Bandages Gauze roller bandages

• Used for extremity, head-dressing application

Triangular bandages• Most versatile

• Fold as necessary for multiple uses

• Used for direct pressure or to support any portion of the body

• Slings

• Cravat-type bandage

• Used in application of tourniquets

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Related materials Adhesive tape

Pneumatic antishock garment

BP cuffs


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Bandage application May be attached to various parts of body

• Extremities

• Head

• Trunk

Roller bandage• Self-adherent/gauze material

• Pressure dressing

• Head bandage

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Skill 21-1: Applying Pressure Dressing with Roller Bandage

Cover wound with sterile dressing

Apply firm pressure until bleeding stops

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If bleeding continues, reinforce dressing with more absorbent material

Apply more pressure


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Once controlled, continue pressure Attach self-

adherent/roller bandage around part

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After encircling body part, anchor bandage

Overlap halfway over previous layer

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Once in place, tape/tie off end


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Skill 21-2:Applying Head Bandage

Apply gentle pressure to wound with flat hand

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Begin head bandage by anchoring bandage below occipital protuberance

Circle head completely

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Skill 21-2: Applying Head Bandage

Transverse bandage back/forth across top of head until completely covered


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Circle head twice

Tape

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Bandage application Figure-eight bandage

• Secures dressing over joint

• Allows mobility

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Skill 21-3:Applying Bandage to Knee/Elbow

Start roller bandage below joint, anchor in place

Transverse diagonally across joint over dressing


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Skill 21-3:Applying Bandage to Knee/Elbow

Circle bandage above joint

Transverse downward to form “X” over dressing on joint

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Bandage application Object impaled

• Stabilized to limit movement

• Never remove impaled object unless penetrating cheek or interfering with CPR

• If significant bleeding occurs in cheek after removal

• Apply dressing from within the mouth, with finger pressure applied to control bleeding

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Skill 21-4: Stabilizing Impaled Object

Place surgical pads on both sides of object

Tape on all 4 sides


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Skill 21-5:Managing Impaled Object in Cheek

As object is withdrawn, control bleeding from inside

Manually control bleeding outside of cheek

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Skill 21-5:Managing Impaled Object in Cheek

Keep suction ready to remove blood & secretions from airway

Position patient to permit blood drainage from mouth, to prevent aspiration

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Bandage application Chest and back dressings

• Most dressing applications can be done with tape across skin’s surface

• Sweaty/wet skin surface Use triangular bandage

• Chest dressings When securing bandage around circumference, do not

exert excessive pressure that may restrict movement


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Facial Injuries

Face, neck 1st concern is airway

Facial bones give structural support to the airway• Loss of their integrity can compromise airway patency

• Possible airway obstructions Bleeding

Foreign bodies

Broken teeth and dentures

Vomitus

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Facial Injuries

Clear airway techniques Manual extraction of foreign bodies

Control bleeding

Suctioning

Position patient to permit drainage

Can cause excessive bleeding

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Facial Injuries

Facial bones are part of the skull and offer protection to the brain Must search for signs of injury to brain and the

cervical spine

Special handling techniques

Remove blood, blood clots or loose teeth from airway with finger sweep/suction

• Unconscious patients


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Facial Injuries

Bleeding from face or within oral cavity should be controlled with direct pressure

Impaled objects in cheek should be removed Do not use excessive force

Stabilize object

Position patient to allow for drainage

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Facial Injuries

Eye injuries Anatomy and physiology

• Proper handling can preserve eye function

• Globular structure filled with vitreous humor

• Rotates within the bony orbit through action of the orbital muscles

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Facial Injuries


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Facial Injuries


• Sclera Outer layer of eye

Composed of tough, fibrous, opaque protective membrane

• Cornea Outer layer

Transparent to light

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Facial Injuries


• Cornea Outer layer

Transparent to light

• Iris Pigmented/colored portion of the eye

Circular muscular structure

Controls amount of light that enters eye through the pupil

Made of constricting and dilating muscles

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Facial Injuries


• Pupillary size Constricts in response to light

Dilates in dim light, permits more light to enter

Changes in size when focusing on close objects

Used to evaluate brain function


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Facial Injuries


• Retina Posterior wall of the eye

Ciliary muscles are attached to the lens to change its shape so light can be focused

Composed of millions of sensory receptors

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Facial Injuries

Eye injuries Anterior chamber

• Filled with aqueous humor Circulating watery fluid

Specialized capillaries

Is drained and reabsorbed back into other capillaries

When drainage is obstructed, pressure builds is and causes glaucoma

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Facial Injuries

Eye injuries Posterior chamber

• Filled with vitreous humor Firmer, gel-like fluid

Not formed or drained continuously

Cannot be lost without permanent damage

Direct pressure must never be applied to the eyeball


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Facial Injuries

Eye injuries Protection

• Eye is set deep within orbits/sockets formed by many bones

• Eye is protected in front by eyelids

• Blinks quickly to protect from oncoming object

• Eyelashes act as filters to help small particles from entering

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Facial Injuries

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Facial Injuries


• Conjunctiva Mucous membrane

Lines of interior surface of the eyelids

Covers the anterior surface of the eye

Changes its composition as it extends over the sclera and cornea

When irritated by a foreign body or inflamed, the capillary vessels become prominent


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Facial Injuries

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Facial Injuries


• Lacrimal glands Located at superior lateral surface of eyeball

Secrete tears

• Layer of fat behind the eye serves as cushion between eyeball and the bony orbit

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Facial Injuries

Eye injuries Management

• Principles of care Avoid pressure

Cover both eyes to limit movement

Patient’s cooperation needed


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Facial Injuries

Eye injuries Management of eye injuries

• Foreign body removal

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Skill 21-6:Removing Foreign Bodies from Eye

Use sterile water, saline, eye-irrigating solution

Explain your actions

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Allow stream of water to pass from medial portion of sclera

Do not use high-pressure stream

Rinse eyelid if needed


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If irrigation unsuccessful, gently whisk foreign body off eye with clean, moistened, cotton-tipped applicator

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Facial Injuries


• Corneal abrasions Will notice a small defect on normally smooth corneal

surface

Possible accompanying inflammation of conjunctiva over the sclera

Patching the eye may offer some relief

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Facial Injuries


• Impaled objects Never remove protruding object

Stabilize object with 4x4 gauze squares built up around object

Cover dressing with paper cup or cardboard folded into cone shape

Cover other eye

Transport in supine position


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Facial Injuries


• Lacerations Can cause brisk bleeding because of rich blood supply

Check to see if there is accompanying damage

Use gentle and direct pressure to control bleeding

Avoid transmitting pressure to eye itself. Cover eye with plastic eye shield or cup to protect from external pressure

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Facial Injuries

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Facial Injuries


• Extruded eyeball Do not attempt to replace

Place several layers of 4x4 gauze squares, hole cut in center, and moistened with sterile saline solution around eyeball

Attach cup/cone-shape cardboard over dressing with bandages

Cover opposite eye

Transport to hospital


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Facial Injuries

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Facial Injuries

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Facial Injuries


• Orbit fracture Blows can result in fractures

Possible signs of soft tissue trauma at orbital ridge

May be complicated by impaired eye movement and visual disturbance

Muscles that move eye become entrapped in the fracture

Patient may not be able to move both eyes symmetrically


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Facial Injuries

Ear injuries Anatomy, physiology

• Ear functions Hearing

Establishing potential sense

Provides balance

• Blood extruding from the ear after trauma is sign of possible skull fracture

• Ear infections are potential cause of meningitis

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Facial Injuries


• External ear Composed of auricle/pinna

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Facial Injuries


• Middle ear Air-filled cavity transmits sound waves from external to

inner ear

Begins at tympanic membrane (eardrum)

Ends at oval window of the inner ear

Auditory ossicles act as levers to transmit sound waves collected at eardrum to the inner ear

Communicates with nasopharynx by Eustachian tube


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Facial Injuries


• Inner ear Encased within skull

Contains coiled, looped tubes filled with fluid, lined with sensory cells

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Facial Injuries

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Facial Injuries

Ear injuries Management of ear injuries

• Blood extruding from ear Sign of possible skull fracture

Apply loose sterile dressing


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Facial Injuries


• Auricle Remove gross contamination

Apply sterile dressing

Apply bulky dressing around auricle before bandaging

Treat incomplete avulsed parts of the auricle by approximating their anatomic position

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Facial Injuries


• Completely avulsed/amputated part Remove gross contamination

Wrap amputated part in gauze moistened with sterile saline solution

Place part in plastic bag

Keep part cool

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Facial Injuries


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Facial Injuries


• Foreign bodies Removed in emergency department unless directed

otherwise by local protocol

Do not obstruct blood flow from ear canal

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Facial Injuries


• Barotrauma During exposure to changing environmental pressures,

middle ear maintains equal pressure on each side of the tympanic membrane

Moves air through Eustachian tubes

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Facial Injuries


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Facial Injuries

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Burns

Injury cause Thermal

Chemical

Electrical

Skin most often injured by burns – 15% of body weight in an adult

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Burns

Skin serves as: Protective barrier against infection

Barrier to water loss

Major thermoregulatory organ

Sensory organ for touch, pain, temperature, pressure perception


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Burns

Outer dermis – impermeable to water and bacteria

Dermis – contains blood vessels, nerves and other structures

Subcutaneous tissue – protects and insulates

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Burns

Burns result in: Loss of temperature control

Loss of body fluids and water

Susceptibility to infection

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Burns

Thermal burns Most occur in the home from flames or scalding

water

Ages 3 to 4 years: burning clothing most common source


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Burns

Thermal burns Smoke produced by burning materials contains

toxins• Most common is CO

Colorless

Tasteless

Odorless gas

Impairs O2 transport

Smoke inhalation

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Burns

Thermal burns Assessment of burn injuries

• Wide criteria used to assess severity Depth

Extent

Location

Age

Respiratory involvement

Associated medical/traumatic conditions

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Burns


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Burns

Thermal burns Assessment of burn injuries

• Depth of burns Based on skin anatomy

Referred to in terms of degree

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Burns

Assessment of burn injuries Depth of burns

• Superficial/1st -degree burns Involve epidermis only

Skin appears reddened and is dry and warm

1st degree burns are generally painful because the nerves in the deeper layers are left intact

Possible slight edema from congestion and dilation of the intradermal vessels

Heal spontaneously

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Burns


• Partial-thickness/second-degree burns Involve epidermis, extend into dermis but not through

entire dermis

Flash injuries or hot-liquid scalds

Appearance depends on extent of dermal injury

Common characteristics caused by tissue damage and accumulation of plasma from injured capillaries


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Burns


• Partial-thickness/second-degree burns Color varies depending on depth

Vary in sensitivity

Skin functions lost

Heal spontaneously

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Burns


• Partial-thickness/2nd -degree burns Common characteristic edema, blister

Blisters left intact

Color may vary, depending on depth

Extremely painful, sensitive

Deeper burns, normal/decreased sensation

Very deep, no sensation

Skin functions lost

Heal spontaneously

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Burns


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Burns


• Full-thickness/3rd -degree burns Involve entire thickness of epidermis, dermis

Skin charred, yellow-brown, dark red, white, translucent

No pain, nerves destroyed

Texture of skin is leathery

Skin has restricted skin movement

Heal only from margins of the wound

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Burns

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Burns


• Other burns 4th -degree burn


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Burns


• Extent of burns Amount of skin burned indicates severity of the burn

Calculations made according to the “rule of nines”

Always describe depth of burns in reports and communications:

Do not delay transport to calculate burn severity

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Burns

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Burns


• Location of burns Perineum & genital prone to infection

Facial burns can involve special structures, with respiratory tract involvement

Circumferential burns involve extremities, neck, torso


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Burns

Assessment of burn injuries Complicating factors

• Age

• Inhalation injuries cause direct damage to respiratory tract Hot air

Smoke particles

Toxic gases

Cause airway compromise

Damage to lungs

Smoke interferes with O2 delivery and use

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Burns


• Physical signs of inhalation injury Singed nasal hairs

Sputum with black particles

Burns around mouth, nose

Hoarseness of voice

Respiratory distress

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Burns


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Burns

Assessment of burn injuries Associated conditions

• Take precedence over burn injury Medical conditions

Lung, heart disease

Diabetes

Other severe injury/illness

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Burns

Assessment of burn injuries Burn severity

• Local protocols often use burn severity as criterion for determining which facility selected

• Nationally accepted criteria used to reflect local resources

• Depth & extent are major determinants in classifying severity

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Burns

Management of burns Management steps

• Stop burning process

• Remove patient from smoky environment

• Provide high-concentration supplemental O2

• Treat for shock

• Prevent infection

• Transport to appropriate facility


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Burns

Management of burns Stop burning

• Remove patient from burning/smoky environment

• Extinguish flames with blankets or water

• Remove smoldering clothing and jewelry

• Pour cool, sterile water over articles of clothing that adhered to skin to stop the burning process

• Use caution in applying cool, wet compresses

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Burns

Management of burns Treat life-threatening conditions first

• Assess for airway compromise, respiratory distress signs Stridor

Hoarseness

Use of accessory muscles

Cyanosis

Other signs of respiratory distress

Signs of inhalation injury

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Burns

Management of burns Treat life-threatening conditions 1st

• If evidence of inhalation injury, shock or extensive burns: Administer high-concentration supplemental O2

• Assume patient inhaled CO Administer high-concentration O2

• Assess for associated trauma and shock caused by other injuries

• Obtain history


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Burns

Management of burns Cover the wound

• Sterile clean dressings/sheets

• Remove rings/bracelets that may constrict

• Never apply ointments

• Leave blisters intact

• Covering the wound often gives some pain relief

• In cool environments, use blankets to insulate and maintain body temperature

Transport per local protocols

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Burns

Chemical burns Type, concentration, duration determines severity

Chemicals continue to burn until removed

Initiate immediate thorough irrigation

Position patient, self to avoid runoff, splashes

Wear gloves, eye protection, gown, mask

Powders/dried chemicals

Yellow/white phosphorus

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Burns

Chemical burns Sodium, potassium

• Extinguish with fire extinguisher

• Smother with sand

• Cover with petroleum jelly

Hydrofluoric acid• Water used for irrigation

• Soak dressing Calcium chloride

Calcium gluconate

Magnesium oxide paste


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Burns

Chemical burns Burns to eyes

• Chemical damage depends on nature of chemical, duration of contact

• Flush eye immediately with clean water/irrigating solution

• Irrigate at least 20 minutes

• Longer contact with eye, greater risk of injury

• Exposure to infrared light, ultraviolet light

• Burns to eyelids

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Burns

Electrical burns When electricity traverses the body, it is converted

to heat that burns tissues in its path

High-voltage arcs generate intense amount of heat and can burn nearby person

Death can occur from passage of current through vital organs

EMTs must take precautions to protect self and patient

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Burns

Electrical burns Electrical basics

• Amperage

• Voltage

• Resistance

• Conductors

• Insulator

• Electricity seeks to flow along path of least resistance from higher to lower potential


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Burns

Electrical burns Electrical effects on body

• Electrical current passes through body as part of circuit

• Follows internal path of least resistance

• Burns to soft tissues extend from superficial to full thickness burns

• Longer duration of contact - greater severity of burn

• Immediate life-threatening effects Respiratory

Cardiac arrest

• Lightning injuries burn skin, soft tissue

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Burns

Assessment, management 1st priority

• Assess whether hazards continue to exist

Fallen wires• If patients trapped in vehicle in contact with downed wire

Have them remain in vehicle

Do not touch vehicle/patient until authorities confirm power is off

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Burns

Assessment, management Ensure rescuer safety

• After, assess & manage life-threatening conditions

• Look for cervical spine injury if falls or violent contractions have occurred

• Look for fractures and splint

When assessing the skin, look for entrance and exit wounds

Cover wounds with sterile dressings

Transport


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Burns

Chemicals continue to burn until removed

Initiate immediate thorough irrigation

Position patient, self to avoid runoff, splashes

Wear gloves, eye protection, gown, mask

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Burns

Powders/dried chemicals Brushed off

Contaminated clothing & shoes removed before irrigation

Yellow/white phosphorus Affected part kept submerged in water or covered

with soaked dressings

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Burns

Sodium, potassium Extinguished with fire extinguisher

Smothered with sand

Covered with petroleum jelly

Hydrofluoric acid Water used for irrigation

Soak dressing


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Burns

Burns to eyes Chemical damage depends on nature of chemical,

duration of contact

Flush eye immediately with clean water/irrigating solution

Irrigate at least 20 minutes

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Burns

Burns to eyes Longer contact with eye, greater risk of injury

Exposure to infrared light, ultraviolet light• Cover eyes with moist patches

Burns to eyelids• Cover eyelids with moist, sterile dressing

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Burns

Electrical basics Amperage

• Number/volume of electrons flowing

Voltage• Force which movement occurs

Resistance• Degree of hindrance to electron flow

Current can be direct/unidirectional in flow, alternate/switch direction of electron flow


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Burns

Electrical basics Low voltage less serious than high voltage

Symptoms range• Tingling

• Sustained muscular contraction

• Fatal organ damage

Resistance• Measure of hindrance to electron flow through given

material

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Burns

Electrical basics Conductors

• Low resistance

• Conduct electricity readily

Insulator• Very high resistance to electrical flow

Electricity seeks to flow along path of least resistance from higher to lower potential

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Burns

Electrical effects on body Electrical current passes through body as part of

circuit

Follows internal path of least resistance

Burns to soft tissues extend from superficial to full thickness burns

Longer duration of contact, greater severity of burn.

Lightning injuries burn skin, soft tissue


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Burns

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Burns

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Burns

Assessment, management 1st priority

• Assess whether hazards continue to exist

Patients trapped in vehicle in contact with downed wire

Ensure rescuer safety

Assess, manage life-threatening conditions


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Summary

Skin has 2 major layers; epidermis, dermis

Subcutaneous tissue lies beneath skin, consists of fat, connective tissue

Closed wounds caused by blunt trauma

Open wounds caused by blunt/penetrating trauma

Crush injuries may result in closed open wounds

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Summary

Severity/complications of wounds are determined by MOI, site of injury, extent of injury, introduction of foreign bodies/contaminants into wound

Common complications of wounds include bleeding, infection, damage to underlying structures

Wound management may include control bleeding, immobilization of affected part, prevention of contamination, preservation of avulsed/amputated parts, stabilization of impaled objects

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Summary

Partially avulsed body parts rinsed of gross debris, dressed, bandaged in original anatomic position

Amputated parts rinsed of gross debris, wrapped in sterile gauze, placed in plastic bag placed on ice

Dressing, material used to cover wound; bandage, material used to secure dressing in place/provide pressure over wound

Foreign bodies in eye irrigated out of eye/removed with cotton swab


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Summary

Impaled objects should never be removed from body, except from cheek

Cover extruded eyeballs with moistened dressing, cup, bandage; cover good eye

Burns may be caused by thermal, electrical, chemical mechanisms

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Summary

General burn management includes Stopping burning process

Removing patient from burning environment

Providing supplemental O2

Treating for shock

Preventing shock

Transporting to appropriate facility

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Summary

3 major categories of burn injuries: superficial, partial-thickness, full-thickness

Superficial burns, painful, cause reddened, dry, warm skin

Partial-thickness burns - very painful, characterized by pink, red, blotchy appearance, wet, weepy surface, edema, blisters

Full-thickness burns - not painful, characterized by deep-red, black, brown appearance; edema, disrupted skin, may have no sensation to touch


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Summary

Extent of burns evaluated with “rule of nines”

Factors that complicate/affect severity of burns include inhalation injuries, age, associated conditions, location of burn

Irrigate chemical burns at least 20 to 30 minutes before/during transport to hospital

Brush dry chemicals from skin before irrigation

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Summary

Electrical burns have entrance, exit wounds, may be more extensive than they appear on surface

Electrical injuries may cause fractures/lead to respiratory/cardiac arrest

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Questions?


9/18/2012 chapter 21 - jones & bartlett...

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