Chapter 26

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