Ch 28 - Bleeding and Soft Tissue Trauma

When are most soft tissue injuries cared for?

after the primary assesment

what does the severity of bleeding depend on?

• how much blood was lost

• the rate of blood loss

• other injuries/existing conditions

• pt’s existing medical problems

• pt’s age

What is the best way to estimate blood loss?

by assessing the pt’s signs and symptoms

What happens as a pt loses more blood?

• the heart rate increases

• vasoconstriction increase

• ventilatory rate increases

• systolic pressure decreases

• the pulse pressure becomes narrower

• skin becomes more pale, cool, clammy (shock)

types of bleeding

• arterial

• venous

• capillary

arterial bleeding

• bright red

• spurting blood

• pulsating

venous bleeding

• dark red (sometimes even purple)

• steady, slow flow

capillary bleeding

• slow, even flow

methods to control external bleeding

• direct pressure

• tourniquet

• splints

• topical hemostatic agents

steps to control bleeding

1. apply direct pressure

2. apply pressure dressing

3. apply tourniquet

   • if none are available, consider a hemostatic agent

   • if multiple pts are hemorrhaging, skip straight to step 3

when do you not want to apply direct pressure?

when there is an impaled object

What must you always write on the tourniquet?

the time that it was applied, make sure to also always notify the receiving facility that you put one on

splints

• an important way to reduce bleeding from an injured extremity

• don’t delay splinting at scene with an unstable pt

traction splint

helpful for fractured femur

homeostatic agents

• can be used when direct P is ineffective

• promotes blood clotting

• generally reserved for long transport times

• some associated complications

junctional areas

where the extremities and head meet the torso

junctional area bleeding control

cant use traditional tourniquet

When do you perform a rapid secondary assessment

• significant bleeding

• pt has an altered mental status

• multiple injuries

• significant MOI

what does bleeding from the nose ears or mouth indicate

• skull injury and facial trauma

• digital trauma to the nose

• sinusitis

• hypertension

• clotting disorders

• esophageal disease

common source of internal bleeding

injured organs and fracture extermities

hematoma

• involves larger blood vessels and tissues areas than a contusion

• forms pocket of blood beneath the skin (can separate tissues)

• presents a lump with discoloration

What can be a sign of internal bleeding

• bleeding from a bodily orifice

• vomiting, bright red or coffee ground material

What are additional signs of internal bleeding or hemorrhagic shock

• anxiety, restlessness, combativeness, altered mental status

• weakened, faintness, dizziness

• tachycardia, tachypnea

what factors can increase bleeding

• movement

• decrease in body temperature

• medication (blood thinners)

• IV fluids

• removal or dressings and bandages

signs of shock

• mental status changes

• decrease peripheral perfusion

• vital signs changes and narrowed pulse pressure

• dilated pupils, nausea/vomiting, thirst

closed injury

• no break in the skin

• three types

  • contusions

  • hematomas

  • crush injuries

contusions

• bruise

• injury to blood vessels in the dermis

• swelling and discoloration (ecchymosis)

crush injuries

• result from significant blunt trauma/crushing force

• may be open or closed

• serious damage to underlying tissue

• internal bleeding

open injuries

• continuity of the skin is broken

• at risk of external bleeding and contamination

• may be a sign of a deeper underlying issue

• six types

  • abrasions

  • lacerations

  • avulsions (flap of skin)

  • amputations

  • penetrations/punctures

  • crush injuries

why are dog bites complicated

because of the possibility of infection, cellulitis, septicemia, and concerns of rabies and tetanus

what can human bite result in

infection and hepatitis

clamping injuries

• a body part (often finger or hand) is caught or strangled in machinery

• it becomes more difficult with time to extricate the body part(s) because of swelling

special considerations for soft tissue injuries

• penetrating chest wounds (occlusive dressing)

• penetrating/open abdominal injuries

• impaled objects

• amputations

• large neck injuries

How to treat abdominal injuries?

• do not repack protruding organs

• cover injuries with a most and sterile dressing or an occlusive dressing

How to treat injuries with impaled objects?

• don’t remove unless it’s in the check, neck or obstructing the airway

• stabilize in place

How to carry for amputated parts?

• remove gross contamination

• wrap the part in a dry, sterile gauze

• wrap/bay the part in plastic

• keep the amputated part cool

• never complete a partial amputation

What is a danger of open neck wounds?

• bleeding can be severe

• air can be sucker in though the veins can cause an air embolism

dressings

• cover wound to control bleeding and prevent further contamination

• should be sterile

• various types

bandages

• secure dressings

• should be clean and free of debris