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WOUNDS Emergency Procedures in PT
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Types of Wounds
Abrasions – uppermost layer scraped
away, minor capillary bleeding occurs,
nerve endings exposed
Lacerations – skin tear with edges jagged
and uneven
Incisions – made by a knife, edges are
straight
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Types of Wounds
Punctures – an incision made by a sharp,
pointed object
Avulsions – forceful separation of a limb
from the body because of trauma
Amputations – clean removal of a limb
from the body
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
ASSESSMENT •Scene Size-Up •Primary Assessment •Rapid Trauma Assessment
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Scene Size-Up
Assess for the MOI
Standard precautions against blood should
be taken if bleeding is present.
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Primary Assessment
Assess for signs of hypoperfusion e.g.
tachycardia and tachypnea.
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Rapid Trauma Assessment
If no life-threatening injuries are present,
perform a complete head-to-toe rapid trauma
assessment
Focus on DCAP-BTLS ◦ Deformities
◦ Contusions
◦ Abrasions
◦ Penetrations
◦ Burns
◦ Tenderness
◦ Lacerations
◦ Swelling
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
MANAGEMENT •Wound bandaging
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Bandaging
GOAL: protect the wound from further
injury and contamination
Roller bandage, military compress,
triangular bandage
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
TRANSPORTATION
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Ongoing Assessment
Carefully monitor all bandages.
Often it becomes slack and loose or acts
like a tourniquet when swelling is present
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
THERMAL BURNS
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Management
Stop burning
Cool the area with sterile water and wash
away excess debris
Remove any jewerly
Never apply ointments or antiseptic
lotions
Apply appropriate dressings
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Management
Less than 10% TBSA
◦ Use a wet dressing, excess water squeeze out
◦ Secure with dry sterile bandage
More than 10% TBSA
◦ Use a dry dressing
◦ Consider risk for hypothermia - cover the
patient
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
CHEMICAL BURNS
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Management
Dry Chemicals
◦ Brush off the patient
◦ Remove clothing
◦ Wait for MSD authority decision
◦ Flush the chemicals with water*
* Some chemicals can react violently upon
contact with water
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Management
Wet Chemicals
◦ Wash off the patient
◦ Remove clothing
◦ Wait for MSD authority decision
◦ 20-30 minutes of flushing, continuous
irrigation (gentle rather than forceful)
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Management
Eye Injury
◦ Irrigation of the eyes continuously for 20-30
minutes
◦ Water is running away from the unaffected
eye
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
ELECTRICAL BURNS
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Management
Should be treated like any trauma, spinal
precautions
Check ABC, start CPR immediately
Use AED, as indicated
Assist breathing
Rapid transport
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
WOUND CARE
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Initial Wound Care
Isolation or universal precautions
Clean wounds; blisters debrided
Shave hair for prevention of infection
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Daily Wound Care
Pain medications, as needed
Dressings soaked off
Remove old topical and gently wash
wounds. Debride loose tissue.
Reapply topicals and dressings as ordered
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Debridement
Remove dead tissue to get between dead
and viable tissue
Not so aggressive as to cause bleeding
Some removed with coarse mesh gauze
Debrided with sedation / analgesic /
conscious sedation or general anesthesia
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Debridement
Sharp debridement
Scalpel or scissors to remove devitalized
tissue
Indications
Removing adherent eschar
Devitalized tissue in extensive ulcer
Urgent debridement in advanced Cellulitis
or Sepsis
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Debridement
Sharp debridement
Follow-up sharp debridement
Apply clean, dry dressings for 8-24 hours
Restart wet-to-moist (or wet-to-dry) dressings
Debridement under Anesthesia Indications
Indicated for extensive stage 4 Decubitus Ulcers
Consider bone biopsy to assess for Osteomyelitis
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Debridement
Mechanical debridement
• Wet-to-Dry Dressing
• Hydrotherapy (Occlusive Wound
Dressing)
•Transparent Film Dressing
• Wound irrigation
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Debridement
Enzymatic debridement (chemical)
• Indicated where surgical debridement is not possible and wound infected or dead tissue
• Enzymatic debridement is more specific in targeting dead tissue
• Enzymatic debridement ointments were previously FDA approved: Santyl, Panafil, and Accuzyme.
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
Debridement
Autolytic debridement
• In vivo enzymes self-digest devitalized tissue
• Contraindicated for infected wounds
• Synthetic dressing applied to cover wound
• Mildly draining wounds: Hydrogel
Dressing, Hydrocolloid Dressing
• Moderately to strongly draining
wounds: Alginate Dressing
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Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT
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