chapter 24 soft tissue injuries. © 2005 by thomson delmar learning,a part of the thomson...
TRANSCRIPT
Chapter 24Soft Tissue Injuries
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Overview
Anatomy Review Bleeding Types of Wounds Wound Management Bruising Crush Injury Burns Chemical Burns Electrical Burns
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Anatomy Review
Skin’s cells and tissues constitute the integumentary system
Skin protects the internal organs, regulates the internal environment, and allows us to sense external environment
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Anatomy Review
Injury to the skin– First and immediate sensation is pain– Inflammation helps the body prevent infection and
begin healing
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Bleeding
Loss depends on how much skin is damaged and amount of force behind the bleeding– Arterial bleeding—bright red, tends to spurt– Capillary bleeding—low pressure, tends to ooze– Venous bleeding—darker red, tends to flow
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Bleeding
Assessment– Prepare for large amounts of blood to be present – Wear applicable PPE– Bring bleeding control supplies to scene
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Bleeding
Scene size-up– Assess and render harmless the mechanism of
injury– Establish perimeter to contain onlookers
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Bleeding
Initial assessment– Constantly consider the patient’s ABCs– Focus attention on the important facts– Expose the entire length of the limb
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Bleeding
Management – Once the scene is safe, the EMT’s first concern is
to control the bleeding– Begin with the easiest and safest techniques
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Bleeding
Principles of bleeding control– Ask “Can this bleeding lead to shock and possibly
death?”• If not immediately life threatening, continue with the initial
assessment of the patient• If life threatening, bleeding must be dealt with
immediately
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Bleeding
Principles of bleeding control– Allow coagulation to occur– Apply direct pressure– Elevate the wound above the heart– Apply a dressing– Apply manual pressure at a pressure point
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Bleeding
Principles of bleeding control– Apply an arterial-constricting band called a
tourniquet to the entire limb– May result in loss of the limb– Should not be removed without a physician’s order– Note exact time that tourniquet is applied
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Bleeding
Dressings– Once bleeding is controlled, apply dressing– Dressing protects wound from further injury, while
supporting clotting activity – Apply the cleanest dressing possible
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Bleeding
Types of dressings– Gauze – Trauma– Nonadherent– Self-adherent– Occlusive– Universal
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Bleeding
Pressure dressing– Used when bleeding continues despite direct
pressure, dressing, and elevation– Maintains pressure over the wound edges and
compresses surrounding blood vessels
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Bleeding
Transportation– Priority is dictated by the presence or absence of
hypoperfusion– Complete set of vital signs
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Stop and Review
Identify the different types of bleeding Describe two principles of bleeding control
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Types of Wounds
A break in the skin is called a wound Results from blunt forces like a baseball bat
or sharp edges like a knife
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Types of Wounds
Abrasions– Upper layer of skin is scraped away, exposing
nerve endings– Usually the result of skin being rubbed against a
rough surface
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Types of Wounds
Lacerations– A full-thickness skin tear– Can be linear or stellate in appearance– Can involve veins, arteries, and bones
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Types of Wounds
Incisions– A full-thickness injury of the skin– Usually made by a knife– Wound edges are straight
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Types of Wounds
Punctures– An incision made by a sharp, pointed object– Severity depends upon depth and location– Gunshot wounds are considered puncture wounds
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Types of Wounds
Amputation– The clean removal of a limb from the body
Avulsion– A forceful separation of a limb from the body
because of trauma– Can be either partial or complete
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Wound Management
Assessment– A cut implies that some sort of violence occurred– The source of violence should be identified and
neutralized whenever possible
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Wound Management
Scene size-up– Mechanism of injury can cause the EMT injury– Identify and render harmless the mechanism of
injury– Take standard precautions against blood
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Wound Management
Initial assessment– The external appearance of the wound can be
deceiving– Focus on signs of hypoperfusion such as
tachycardia and tachypnea
Rapid trauma assessment– Proceed with a head-to-toe rapid trauma
assessment
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Wound Management
Bandages– Primary purpose is to hold dressing in place– Roller bandage– Military compress– Elastic bandage– Triangular bandage– Cravat– Binder bandage
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Wound Management
Principles of wound bandaging– Wounds are dressed differently depending on
where they occur– Several fundamental bandaging techniques exist;
use individually or in combination– Practice is the key to success
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Wound Management
Principles of wound bandaging– Recurrent bandage
• Bandage holds dressing down over a large area
– Spiral bandage• Bandage in which successive turns overlap preceding
turns
– Figure-of-eight• Bandage turns across itself like a figure eight
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Wound Management
Principles of wound bandaging– Special bandages
• Neck wound– Occlusive dressing must be applied– A gloved hand is often sufficient temporarily
• Sucking chest wound– Occlusive dressing is applied – Tape only three sides, while fourth is left unattached
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Wound Management
Principles of wound bandaging– Special bandages
• Evisceration– Cover the wound with a large trauma dressing– Follow local protocols
• Straddle injury– Cover the wound with a dressing– Create belt and tie around waist– Secure triangular bandage to belt– Bandage holds dressing in place, helps control bleeding
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Wound Management
Principles of wound bandaging– Special bandages
• Impaled objects– Stabilize object in the position found– Secure with a large, bulky dressing – If an object like a pencil is impaled in the eye, a paper
cup maybe used to stabilize the object
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Wound Management
Principles of wound bandaging– Special bandages
• Avulsions and amputations– Reaffix partial amputations to natural position– Control bleeding by elevation of stump– Wrap stump with triangular bandage– Administer oxygen and monitor for signs of shock– When the amputated part is found, wrap in moistened
gauze and place in a plastic bag
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Wound Management
Principles of wound bandaging– Special bandages
• Degloving avulsion– Treat the same as any large wound– Take great care in handling the extremity, since bone
fractures often accompany these wounds
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Wound Management
Transportation– Focus on caring for and comforting the patient,
including driving carefully to the hospital– Ongoing assessment
• Monitor bandages• Check PMS
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Stop and Review
When should a tourniquet be used? Describe the field care for an amputation.
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Bruising
Contusions can signify damage to deeper tissues and organs
Bleeding that forms a swelling under the skin is called a hematoma
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Crush Injury
Sustained pressure results in a crush injury Toxic chemicals are released into circulation Acidosis can irritate the heart, causing
sudden cardiac death
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Crush Injury
Compartment syndrome– Increasing pressure in muscle compartments
(fascia) compresses nerves and blood vessels– Results in
• Paresthesia—loss of feeling• Paralysis—loss of motion• Pulselessness—loss of circulation
– Field treatment is splinting and transport
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Crush Injury
Assessment– Other signs of injury predict contusion
• Abrasion marks• Swelling• Tissue that is firm to the touch
– An ecchymosis will turn blue and then black
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Crush Injury
Scene size-up– Confined space rescue is potentially lethal to
an EMT– Technical rescue requires specialized equipment
and training– Set up stage nearby, observe the rescue, and
maintain the perimeter
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Crush Injury
Initial assessment– Priorities are the same as in other trauma cases
• Spinal immobilization• Rapid initial assessment• Observe for hyperthermia• Assess for life threatening injuries
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Crush Injury
Rapid trauma assessment– Complete assessment of patient– Assess entire skin surface– Note every minor defect
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Crush Injury
Management– ABCs– Provide ALS backup– Promptly package for transport– Splint patient on a backboard
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Crush Injury
Transport– Transport to a trauma center
Ongoing assessment– Prepare for the possibility of the patient going into
shock– Assess vital signs at least every 5–10 minutes– Assess for hypoperfusion
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Burns
Two million Americans suffer burn injuries annually, with 100,000 hospitalizations and 8,000 deaths
Four sources of burns– Flame– Electrical burns– Chemical burns– Radiation burns
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Burns
Classification of burn injury– Skin has three layers
• Epidermis (top layer)• Dermis (middle layer)• Subcutaneous (bottom layer)
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Burns
Classification of burn injury– Superficial– Partial thickness– Full-thickness
Superficial Partial thickness Full- thickness
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Burns
Burn severity– Rule of nines calculates the percentage of the
burn area• Each arm—9%• Each leg—18%• Upper back and lower back—18%• Chest and abdomen—18%• Genitals—1%
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Burns
Burn severity– Palmar method calculates small burns or
widespread burns– Palm of hand used to estimate total percent
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Burns
Critical burns– Those with critical burns should be transferred to a
burn center– Critical burn—a full-thickness or partial thickness
burn that is 10% or greater– Burns to the face, airway, hands or feet, and
genitals are all considered critical
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Burns
Assessment– Identical to that of any other trauma patient
– CO2 poisoning makes providing oxygen a problem
Scene size-up– The fire scene is inherently dangerous– The EMT must carefully assess the scene
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Burns
Initial assessment– Assess facial burns for airway involvement– Examine inside of mouth for swelling– Listen for stridor– Auscultate apices of lungs
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Burns
Rapid trauma assessment– Conduct head-to-toe assessment– Be aware that burn injury is a distracting injury
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Burns
Management– Burn field dressing
• Universal dressings for large areas; roller gauze for extremities
• No ointments or antiseptic lotions• Less than 10% of BSA: can apply wet dressing• More than 10% of BSA: apply only dry dressings• Minimize heat loss and hypothermia
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Burns
Transportation– Transport critically burned patients to the closest
specialized burn center– Consider air medical transport
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Chemical Burns
Result from direct contact or exposure to fumes
Frequent causes—mishandling of chemicals and failure to wear protective apparel
Depth of burn depends on the amount of chemical spilled and the length of contact with the skin
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Chemical Burns
Scene size-up– Chemical spill is a hazmat incident– Special team must respond to spill– Allow the hazmat team to deliver the patient– Wear eye protection and gloves
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Chemical Burns
Initial assessment– Focus on airway and breathing
Management– Identify the chemical– Refer to MSDS for guidance on treatment– Consult the Emergency Response Guidebook
or CHEMTREC
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Chemical Burns
Dry chemicals – Wear a dust/mist mask to prevent inhalation– Flush chemicals off the patient with water only if
this is the correct procedure– Assess for the presence of other injuries– Cover burned areas with a dressing and keep the
patient warm
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Chemical Burns
Wet chemicals – Wear a gown and eye protection – Flush the chemicals off the patient with copious
amounts of water, per instructions in the MSDS or ERG
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Chemical Burns
Eye injury– Begin irrigation of the eyes as soon as possible– Keep eyelids open– Ensure drainage is running away from unaffected
eye– If both eyes need drainage, use a nasal cannula
hooked up to an IV setup
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Electrical Burns
Water is an excellent conductor; skin and bones are excellent insulators
When electricity meets insulator, heat results Electricity enters the body through an
entrance wound and creates an exit wound
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Electrical Burns
Scene size-up– Utility poles are a serious hazard to EMTs– All downed power lines are dangerous
– Never touch a downed power line!
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Electrical Burns
Assessment– Internal damage may be substantial– Degree of electrical burn is determined by duration
of contact– Let go energy threshold
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Electrical Burns
Management– Check ABCs; start CPR and defibrillation– Administer oxygen– Rapid trauma assessment– Cover entrance and exit wounds
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Electrical Burns
Transportation – All patients require rapid transportation– Transport to a regional burn or trauma center per
local protocols
Ongoing assessment– Monitor vitals, particularly pulse– Follow standard cardiac arrest protocols
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Stop and Review
Describe the classification of burn injuries. Explain how to manage a chemical burn
involving a dry chemical. Describe the injuries that can occur from an
electrical shock.