chapter 27: soft tissue

soft tissue

tissue excluding organs + bones

epidermis

watertight protective seal for body (most superficial layer of skin)

dermis

hair follicles, sweat glands, nerve endings

skin functions

barrier against infection, helps maintain fluid balance

contusions

epidermis intact but cells within dermis are damaged + small blood vessels torn

contusions are detectable via _

ecchymosis (bruising)

hematoma

collection of blood within damaged tissue/body cavity; when large blood vessel is damaged + bleeds rapidly

what is hematoma associated w/

extensive tissue damage

crushing injury

damage to tissue due to significant blunt force; larger + longer force compresses → greater damage

crush syndrome

dead muscle cells release toxins → remain trapped as long as circulation is impaired; crushed + object stays there

what happens during crush syndrome when body part is freed

toxins flood body → renal failure + cardiac arrest

compartment syndrome

swelling in a closed soft tissue compartment → circulation impaired → tissue death

compartment syndrome S/S

severe pain (passive mvmt), swelling, paresthesia (pins and needles sensation)

abrasion

wound of superficial layer of skin; caused by friction

abrasion treatment

cover w/ sterile dressing + comfort

laceration

jagged cut caused by sharp object/blunt force that tears the tissue

avulsion

wound that separates various layers of soft tissue

what should you not do during an avulsion

remove skin flap

penetrating wound

deep injury from object piercing into soft tissue

emergency care: superficial injury

irrigate

emergency care: deep injury

brush away debris + direct pressure

emergency care: evisceration (ABD wound)

organs protude through wound; cover w/ moist sterile dressing → secure w/ occlusive dressing

impaled objects should be removed when

object is; in cheek/mouth, obstructs airway, in chest, interferes w/ CPR

neck injuries have risk for

air embolism

neck injury treatment

cover wound w/ occlusive dressing (air tight), apply manual pressure but DON’T compress both carotids at the same time

bites

consider all bites potentially causing infection

small animal bites have risk for

rabies: acute potentially fatal viral infection of CNS that can affect all warm blooded animals

human bites have risk for

wide range of bacteria

burns

occurs when body/body part receives more radiant energy than it can absorb

burn potential sources

heat, toxic chemicals, electricity

severity of thermal injury correlates w/

temp, concentration, amnt of heat energy possessed by object/substance, duration of exposure

burn victims are at high risk for

infection, hypothermia, hypovolemia, shock

burn severity: depth (3)

superficial (first deg), partial thickness (second deg), full thickness (third deg)

superficial/first deg burn

involves only top layer of skin (epidermis); ex = sunburn

superficial burn S/S

skin turns red but NO blistering/burn through top layer, painful burn site

partial thickness/second deg burn

involves epidermis + some of dermis; reaches nerve endings + blood vessels

partial thickness burn S/S

moist, mottled, white/red blisters, severe burn

full thickness/third deg burn

extends through all skin layers + may involve subcutaneous layers, muscle, bone, internal organs

full thickness burns S/S

dry, leathery, white/dark brown/charred skin, no feeling in burn site (if nerve endings destroyed)

burn severity (3)

minor, moderate, severe

extent of burns measured by

rule of palms (pt palm = 1% of patient’s TBSA), rule of 9s

minor burn injuries

full thickness: <2% TBSA

partial thickness: <15% TBSA

superficial: <50% TBSA

moderate burn injuries

full thickness: 2-5% TBSA

partial thickness: 15-20% TBSA

superficial: 50+% TBSA

severe burn injuries

burns w/ respiratory compromise, circumferential burns → compartment burns, burns w/ associated trauma, all moderate burn for 50+ y/o pts

full thickness: >5% TBSA

partial thickness: >20% TBSA

burn classifications: infant/children

minor burn: partial thickness <10% TBSA

moderate: partial thickness 10-20% TBSA

severe: partial thickness 20+% TBSA (any full thickness burn)

thermal burns (5)

flame, scald, contact, steam, flash

flame burn

from fire

scald burn

from water; common in cooking + children/handicapped adults

contact burns

hot surface; rarely deep unless pt prevented from drawing away

steam burn

topical/airway burn

flash burn

explosion/lightning burn

thermal burn treatment

stop burning source, cool area, remove jewelery; maintain high index of suspicion for inhalation injuries (airway burn); dry sterile dressing for large surface burn (hypothermia/hypovolemia)

inhalation burns

burning in enclosed spaces w/o ventilation

inhalation burn causes airway damage through

upper airway: superheated gases (STRIDOR)

lower airway: inhalation of chemicals/particulate matter

inhalation burn treatment

apply cool mist, aerosol therapy, humidified O2 (reduce minor edema)

apply ice pack to throat (reduce swelling; IF NO OPEN BURNS)

HCN (hydrogen cyanide) S/S

faintness, anxiety, abnormal vitals, headaches

chemical burns

from strong acids/alkalis; eyes esp vulnerable

electrical burns

can occur from contact w/ high/low electricity

insulator of electrical circuit

any substance that prevents circuit from being completed

conductor of electrical circuit

any substance that allows for circuit to be completed

burn injuries appear _ (2)

where electricity enters/exits the body

entrance wound vs tissue damage

small compared to amnt of internal damage

dangers associated w/ electrical burns (2)

large amnts of deep tissue injury, cardiac/resp arrest from electric shock

taser injuries

associated w/ dysrhythmia + sudden cardiac arrest

dressing/bandaging

used to control bleeding, protect wound from further damage/contamination/infection

what should you not use to secure dressings

elastic bands (acts like tourniquet when injury swells → compartment syndrome)