Chapter 27 EMT Basic

barotrauma

any drastic changes in pressure in lungs

contusions in soft tissue injuries

- bruising, blood under skin - cells in dermis are damaged ,small blood vessels are torn

epidermis

- outermost layers of skin for considerable protection - thickness varies on location on body

dermis location

- layer below epidermis and germinal layer

sweat main function

helps cools the body

hair follicles

- small organs that produce hair - connected w sebaceous gland and tiny muscle that erects hasir when cold or frightened - grow and shed

mucous membranes

- provide protective barrier against bacterial invasion, moist - watery substances that lubricates openings

skin functions

- protect body from environment - maintain normal body temp - transmit sensory info from enviornment to brain - maintain fluid balance

when to remove object protruding from wound

- in cheeck and blocking the patient's airway - in chest and interferes with chest

treating thermal burns

- eyes will close to protect from heat, and eyelids will burn -> natural reflex to test the eye -> exposed and burned - transport promptly - cover both eyes with sterile dressing and apply eye shields - stop burning source, cool burned area, remove jewelry - dry dressing

soft-tissue trauma is related to

hemorrhage or infection

what happens if skin barrier is breached

pathogens can get into skin and cause infection

strategies that reduce burn injuries and death

building codes for electrical and construction, control temperature for heaters, smoke alarms

what is one of the most frequently performed procedures in EDS in the uS

wound care

types of wound care

wound irrigation, dressing, bandaging, suturing

skin

body's first line of defense against external forces and infectino

places where skin is thin

eyelids, lips, ears

populations where skin is thin

young and old

blood vessels in dermis

- provide skin with nutrients and oxygen - reach up germinal but not up to epidermis

parts of body that are not covered in skin

mouth, nose, anus, vagina

any break in the skin may allow bacteria to enter and increases the posibilities of:

infection, fluid loss, loss of temperature control

what will often not complete wound healing

large wounds or injuries that disrupts the skin

three types of soft tissue injuries

closed injuries, open injuries, burns

examples of closed injury

bruising, hematoma

examples of open injury

paper cut, shot, stab

burns

soft tissue damage occurs as result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation

why is soft tissue often injured

exposed to environment

inflammation

removal of foreign material, damage to cellular prats, invading microorganisms of wound side

cessation of bleeding

- blood loss hinders provision of vital nutrients and oxygen to affected area - impairs tissue's ability to eliminate wastes -> abnormal or absen function and lose balance in body

pathophysiology of closed and open injuries

- cessation of bleeding - inflammation -> white cells fight infection and begin repair - new cells move into damaged area -> multuiply over wound and returns to preinjury state for clean incision - new blood vessels form and capillaries -> allow exchange of production and removal -> can bleed easily as new -> takes a while until fully healed - collagen

collagen

provides stability to damaged tissue and joins wound borders

where is collagen

scar tissues, hair bones, other connective tissue

last stage of wound healing

collagen

histamine

- dilates blood vessels and increases blood flow - makes capillaries more permeable -> swelling as fluid leaks out

when is histamine released

early stage of inflammation

what does hematoma result from

soft-tissue injury, fracture, or any injury to blood vessel

loss of blood from fractuer

greater than 1L

crushing injury

significant amount of force is applied to body -> cuts off circulation and tissue is destroyed

crushing injury severity

depends on how much force was applied

what happens if release of limb from entrapment

release of by-products of metabolism and harmful products of tissue destruction

crush syndrome

• cause cardiac arrest

• muscle cells die and release

when does cardiac arrest happen from crush syndrome

released -> limb is freed and blood flow is returned

what should ALS do for crush syndrome

give IV and tournique before crushing object is lifted off body

compartment syndrome

- swelling that occurs whenever stissues are injured -> pressure increases and interferes with circulation and production/waste exchange - ischemia and anaerobic metabolism - low oxygenation and kills muscle cells

when is compartment syndrome commo

in extremities

when does swelling also occur for compartment syndrome

immobilization devices

longer the situation in compartment syndrome

greater chance for tissue death

difference for treating compartment syndrome

assess skin and temp, hidden injuries, splint, reassess

four types of open injuries

abrasions, lacerations, avulsions, penetrating wounds

abrasions aka

road rash, road burn, strawberry and rug burn

difference between laceration and incision

laceration -> jagged incision -> shasrp, smooth

types of lacerations

linear or stellate

stellate

irregular

avulsion

separates various layers of soft tissue so that they become either completely detached or hang as a flap -> circulation is at risk

trating amputation

direct pressure and pressure dressings, tournique, hypovolemic shock

amputation

injury in which body is completely severed

fascia

- fibrous tissue - divides muscles into numerous compartments

shotgun wounds

multiple paths of missiles and create larger surface area and volume of tissue damage

treating stabbings and shootings

- identify wounds -> exit and entrance - count penetrating injuries - type of weapon - treatment

what can extensive contusions lead to

hypovolemic shock

mnemonic for treating closed soft-tissue injury

RICES

RICES

rest, ice, compression, elevation, splinting

rest RICES

quiet and comfortable

compression RICES

apply pressure over injury to slow bleeding

elevation

raise injured part just above patient's heart to decrease swelling

sterile dressing

reducing further contamination and keeps foreign material out of wound

small open wound treatment

use sterile saline then dressing

splinting

- reduces pain and keeps patient calm and quiet - keeps sterile dressing in place - minimizes damage to injured extremity - easier to move patient

what to not use for treating open injuries

tissue paper and paper towels

difference for treating abdominal wounds

- control bleeding - keep organs moist and warm

treating neck injuries

- apply manual pressure but do not compress both carotids at same time - spinal immobilization - cover wound with occlusive dressing

debridement

removal of damaged tissue

small-animal bites

heavily contamined with bacteria

what might small-animal bites require

- debridement - antibiotics - tetanus prophylaxis - surgical repair

who should evaluate small-animal bites

physician

treating small-animal bites

- sterile dressing - transport - if extremity -> splint

who can have rabies

stray dogs, squirrels, bats, foxes, skunks, raccooons

rabies

- acute, potentially fatal viral infection of CNS - affect all warm-blooded animals

how are rabies transmitted

biting or licking an open wound

how are rabies prevented

series of special vaccine injuections -> painful after bite

human bites

- serious, spreading infection - serious injury

treating human bites

- dressing - banadage or splint - transport to ED

most serious and painful of all soft-tissue injuries

burns

how does burn happen

body receives more radiant energy than it can absorb

severe burn injury life threats

hypovolemic shock, sepsis, hypothermia, respiratory failrue

who is more likely to experience shock from burn injuries

children, older patients, chronic illness patients

thermal burns

skin is exposed to temperatures higher than 111 degrees

the greater the heat energy

deeper the wound

when can people not limit energy and exposure time

unconscious or trapped

burns are at a high risk for

- infection - hypothermia - hypovolemia - shock

circumferential burns to chest

- compromise breathing

circumferential burns of extremity

lead to neruvascular compromise and irreversible damage

circumferential burns

burns that go completely around a body part such as arm, foot or chest

burn severity depends on

depth of burn, extent of burn, critical areas involved, type of chemical, preexisting medication conditions or other injuries, patient <5 and >55 years

if yes to any 3 of burn severity

upgrade classification

superficial burns

only top layer of skin -> turns red but does not blister or burn

example of superficial burn

sunburn -> health without scarring

partial-thickness burns

- blisters, intense pain - does not destroy entire thickness of skin nor subcutaneous layer -> heal without scarring

full-thickness burns

- burned area is white, dark brown, charred, hard to touch, dry, leathery

what happens if nerves are damaged from burn

no feeling and surrounding extremely painful -> prone to scarring, surgery