1 soft tissue injuries treatment procedures. 2 skin anatomy and physiology body’s largest organ...
TRANSCRIPT
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Soft Tissue Injuries
Treatment Procedures
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Skin Anatomy and Physiology
• Body’s largest organ
• Three layers– Epidermis
–Dermis
– Subcutaneous tissue
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Skin Anatomy and Physiology
• Complex system, variety of functions– Sensation
–Control of water loss
– Protection against microbes
– Temperature control
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Soft Tissue Injuries
• Closed
• Open
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Closed Injury
• Associated with blunt trauma
• Skin remains intact
• Damage occurs below surface
• Types–Contusions
–Hematomas
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Contusion
• Produced when blunt force damages dermal structures
• Blood, fluid leak into damage area causing swelling, pain
• Presence of blood causes skin discoloration called ecchymosis (bruise)
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Hematoma
• “Blood lump”
• Larger blood vessel damaged
• Causes mass of blood to collect in the injured area
• Fist-sized hematoma = 10% volume loss
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With Closed Soft Tissue Injury
• How much blood is tied up in that injury rather than circulating in the vessels?
• What could the force the caused the soft tissue trauma have done to underlying organs?
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Closed Injury Management
• Rest
• Ice
• Compression
• Elevate
• Splint
When in doubt assume underlying fractures are
present
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Open Injury
• Skin broken
• Protective function lost
• External bleeding, infection become problems
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Open Injury Types
• Abrasions
• Lacerations
• Punctures
• Avulsions
• Amputations
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Abrasion
• Loss of portions of epidermis, upper dermis by rubbing or scraping force.
• Usually associated with capillary oozing, leaking of fluid
• “Road rash”
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Laceration
• Cut by sharp object
• Typically longer than it is deep
• May be associated with severe blood loss, damage to underlying tissues
• Types– Linear
– Stellate
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Punctures
• Result from stabbing force
• Wound is deeper than it is long
• Difficult to assess injury extent
• Object producing puncture may remain impaled in wound
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Avulsions
• Piece of skin torn loose as a flap or completely torn from body
• Result from accidents with machinery and motor vehicles
• Replace flap into normal position before bandaging
• Treat completely avulsed tissue like amputated part
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Amputations
• Disruption of continuity of extremity or other body part
• Part should be wrapped in sterile gauze, placed in plastic bag, transported on top of cold pack
• Do NOT pack part directly in ice
• Do NOT let part freeze
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Open Wound Management
• Manage ABCs first
• Control bleeding
• Prevent further contamination, but do not worry about trying to clean wound
• Immobilize injured part
• Mange hypoperfusion if present
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Special Considerations
• Impaled objects
• Eviscerations
• Open chest wounds
• Neck wounds
• Gunshot wounds
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Impaled Objects
• Do NOT remove
• Stabilize in place
• Exception–Object in cheek
–Remove, dress inside and outside mouth
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Eviscerations
• Internal organs exposed through wound
• Cover organs with large moistened dressing, then with aluminum foil or dry multi-trauma dressing
• Do NOT use individual 4 x 4’s
• Do NOT attempt to replace organs
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Open Chest Wound
• May prevent adequate ventilation
• Cover with occlusive dressing
• Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax)
• If tension pneumo develops lift dressing corner to relieve pressure
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Neck Wounds
• Risk of severe bleeding from large vessels
• Risk of air entering vein and moving through heart to lungs
• Cover with occlusive dressing
• Do NOT occlude airway or blood flow to brain
• Suspect presence of spinal injury
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Gunshot Wound
• Special type of puncture wound
• Transmitted energy can cause injury remote from bullet track
• Bullets change direction, tumble
• Impossible to assess severity in field or ER
• Patient must go to OR