what are considered soft tissues
skin, fatty tissues, muscles, blood vessels, connective tissues, membranes, glands, and nerves
what are hard tissues
teeth, bones, and cartilage
what is the total surface area for adults
more than twenty square feet
major functions of the skin
protection, water balance, temperature regulation, excretion, shock absorption
skin protection
skin is a barrier that keeps out microorganisms, debris, and unwanted chemicals
water balance for the skin
skin helps prevent water loss and stops environmental water from entering the body
skin temperature regulation
blood vessels in the skin can dilate to carry more blood to the skin, allowing heat to radiate away from the body
excretion of the skin
salts, carbon dioxide, and excess water can be released through the skin
shock absorption for the skin
the skin and it’s layers of fat help protect underlying organs from minor impacts and pressures
what are the major functions of the subcutaneous layer of the skin
shock absorption and insulation
epidermis
the outer layer of the skin
dermis
the inner layer of the skin found beneath the epidermis. rich in blood vessels and nerves and the second layer of the skin)
subcutaneous layer
the layers of fat and soft tissues found below the dermis
which layer of skin is heat loss found
subcutaneous
closed wound
an internal injury with no open pathway from the outside
contusion
a bruise, most frequent encountered type of closed wound
in a contusion, the epidermis remains intact but the cells and blood vessels in the
dermis are damaged
hematoma
a swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel
crush injury
an injury caused when force is transmitted from the body's exterior to its internal structures, bones can be broken; muscles, nerves, and tissues damaged; and internal organs ruptured, causing internal bleeding
what do you always consider when you examine a PT with a closed wound
MOI
open wound
an injury in which the skin is interrupted, exposing the tissue beneath
abrasion
a scratch or a scrape
laceration
a cut
puncture wound
an open wound that tears through the skin and destroys underlying tissues
a penetrating puncture wound can be
shallow or deep
a perforating puncture wound has both
an entrance wound and an exit wound
often there is no severe external bleeding, although internal bleeding may be profuse. common puncture wounds are relatively small and insignificant to look at but, depending on the depth of penetration
may cause devastating injuries
your assessment may find only tiny external wounds on the surface of the skin, but
the damage may prove to be deadly
always consider a puncture wound a
serious injury
the threat of contamination and subsequent infection is
high
avulsion
the tearing away or tearing off of a piece or flap of skin or other soft tissue. (this term may also be used for an eye pulled from it’s socket or a tooth dislodged from its socket)
amputation
the surgical removal or traumatic severing of a body part, usually an extremity
pressure wave/primary injury
air molécules slam into one another, creating a pressure wave moving outward from the blast center, causing pressure injuries
blast wave/secondary injury
instantaneous combustion of the explosive agent creates superheated gas. the resulting pressure blows the bomb casing apart. pieces of the bomb projectiles that cause injuries by impacting the pt
patient displacement/tertiary injury
the blast wind may propel the pt to the ground or against objects, causing further injuries
patient exposed to hazardous material or structural collapse/quaternary injury
the pt may also be exposed to harmful chemicals or toxins or may be injured by structural collapse
an uncommon but important injury can occur when a pt is working with a
machine that injects grease, paint, air, or some other substances under high pressure
be sure to take appropriate standard precautions when working on an
open wound
for an open wound, make sure you
control the bleeding. start with direct pressure or direct pressure and elevation and make sure scene is safe with proper PPE (most important)
do NOT remove an
impaled object from the patient
stabilize an impaled object with a bulky dressing and bandage the
impaled inject and surrounding dressings in place
only remove an impaled object if it
obstructs breathing for the pt
for managing an object impaled in the eye, make sure you
cover the good eye to prevent further injury
if skin or another body part is torn from the body, control bleeding and
dress the wound using a bulky pressure dressing
save the avulsed body part and wrap it in a
sterile dressing kept moist with sterile saline
make sure you label the avulsed part with
what it is, the pt’s name, and the date and time the part was wrapped and bandaged. your records should show the approximate time of the avulsion
be sure to keep the part as cool as possible without freezing it, by placing it in a cooler or any other available container so
it is on top of a cold pack or a sealed bag of ice
wrap or bag the amputated part in a plastic bag and keep it cool by
cold packs
do not immerse the amputated part directly in
water or saline
do not let the part come in direct contact with
ice or it may freezen
never complete
an amputation
blood at the meatus (the external opening for urine flow) which is often an indication of a
disruption of the urethra
in pt’s who have sustained blunt trauma, the cause of the urethral injury may be a
fracture to the pelvis
for burn pt’s, classify and evaluate by
the agent and source, by depth, and by severity
superficial burn
a burn that involves only the epidermis, the outer layer of the skin. it is characterized by reddening of the skin and perhaps some swelling
what is an example of a superficial burn
a sunburn or a first degree burn
partial thickness burn
a burn in which the epidermis is burned through and the dermis is damaged. also called second degree burns
partial thickness burns cause what type of reaction
Redding, blistering, and a mottled appearance.
full thickness burn
burn in which all the layers of the skin are damaged
full thickness burns are burns that are usually
areas that are charred black ir areas that are dry and wet (also called third degree burns)
rule of nines
method for estimating the extent of a burn
rule of nines for an adult
each of the following areas represent 9% of the body surface: the head and neck, each upper extremities, the chest, abdomen, upper back, lower back and buttocks, the front of each lower extremity and the back of each lower extremity. the remaining 1%is assigned to the genital region
rule of nines for an infant or child
the percentages are modified, so 18% is assigned to the head, 14% to each lower extremity
rule of palm
method for examining the extent of a burn. the palm and fingers of the pt’s own hand, which equals about 1%of the body’s surface area, is compared with the pt’s burn to estimate its size
when determining the severity of a burn, you also must consider
other illnesses and injuries a pt may have m
critical burns
all burns complicated by injuries of the respiratory tract, other soft tissue injuries, and injuries of the bones; partial thickness or full thickness burns involving the face, hands, feet, genitalia, or respiratory tract; full thickness burns of more than 10%; partial thickness burns more than 30%; burns complicated by the musculoskeletal injuries; circumferential burns
burns pose a greater risk to
infants and children than to adults. this is because their body surface area is greater in relation to their total body size
the standing orders for burn care are determined by your EMS medical director and the regional EMS system. some EMS systems state that
all partial thickness and full burns are to be wrapped with dry sterile dressing or a burn sheet. where as other burn centers recommend moist dressings for partial thickness burns less than 10% of the body and dry dressing for more severe cases
don’t apply ____ which would trap the heat against the burn site and have to be scraped off by the hospital staff
butter, ointments, sprays
what do you do for a pt that is exposed to a chemical burn
brush away dry powders and flood the area with water for 20 minutes
electrical current, including lightning, can cause
severe damage to the body
the skin Is burned where the energy enters the body and
where it flows into the ground
along the path of this flow, issues are damaged due to
heat and forceful contraction of muscle tissue
significant chemical changes take place in the
nerves, heat, and muscles, and body processes are disrupted or many completely shut down
make certain that you and the pt are in a
safe zone (not in contact with any electrical source or outside the area where downed or broken wires or other sources of electricity can reach you
occlusive dressing
any dressing that forms an airtight seal
what type of dressing is an occlusive dressing used for
open wounds to the abdomen, for external bleeding from large neck veins and for open wounds to the chest
if bleeding continues, reapply pressure, apply additional hemostatic agent and
put new dressings over the blood soaked ones