Chapter 27 Soft Tissue Injury EMT

compartment syndrome

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.

When an area of the body is trapped for longer than 4 hours and arterial blood flow is compromised, __ can develop.

crush syndrome

Crush syndrome

Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods. This can lead to renal failure and death. Need ALS to do IV lines.

If an avulsion is complete

wrap the separated tissue in sterile gauze and take it with you to the ED.

Your documentation must include:

• A description of the MOI

• The position in which you found the patient when you arrived on scene

• Report of blood loss using terms that you are comfortable with and that will be easily understood by other personnel

• The location and description of any soft-tissue injuries or other wounds you have located and treated

• The size and depth of the injury

• An accurate account of how you treated these injuries

Treat a closed soft-tissue injury by applying the mnemonic RICES:

Rest: Keep the patient as quiet and comfortable as possible.

Ice: Use ice or cold packs to slow bleeding by causing blood vessels to constrict and also to reduce pain.

Compression: Apply pressure over the injury site to slow bleeding by compressing the blood vessels.

Elevation: Raise the injured part just above the level of the patient’s heart to decrease swelling.

Splinting: Immobilize a soft-tissue injury or an injured extremity to decrease bleeding and reduce pain.

Small wound surfaces without significant bleeding can be _________ prior to applying a dressing.

flushed with sterile saline

If the wound is in the _______, cover it with an occlusive dressing.

chest, upper abdomen, or upper back

If the evisceration patient’s legs and knees are uninjured, and spinal injury is not suspected,

flex them to relieve pressure on the abdomen.

Apply manual pressure, but do not compress both carotid vessels at the same time.

This impairs circulation to the brain and can cause a stroke.

Burns to the airway are of significant importance because

the loose mucosa in the hypopharynx can swell and lead to complete airway obstruction.

Circumferential burns of an extremity can lead to compartment syndrome,

resulting in neurovascular compromise and irreversible damage if not appropriately treated.

Superficial burns

Involve only the epidermis

The skin turns red but does not blister or burn through this top layer.

The burn site is often painful.

Partial thickness (second-degree) burns

Involve the epidermis and some portion of the dermis

These burns do not destroy the entire thickness of the skin nor is the subcutaneous tissue injured.

Typically, the skin is moist, mottled, and white to red.

Blisters are present.

Partial-thickness burns cause intense pain.

Full thickness (third-degree) burns

Extend through all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs

The burned area is dry and leathery and may appear white, dark brown, or even charred.

Some full-thickness burns feel hard to the touch.

Clotted blood vessels or subcutaneous tissue may be visible under the burned skin.

If the nerve endings have been destroyed, a severely burned area may not have feeling and the surrounding less severely burned areas may be extremely painful.

A pure full-thickness burn is unusual.

Significant airway burns are serious. They may be associated with:

Singed hair within the nostrils

Soot around the nose and mouth

Hoarseness

Hypoxia

Rule of palm

Compare the size of the burn area to the size of the patient’s palm, which is roughly equal to 1% of the patient’s total body surface area. Don’t include the superficial burns in this estimate.

When you assess the respiratory system of a burn patient, look specifically for:

Soot around the mouth

Soot around the nose

Singed nasal hairs

If any of these findings are present, open the patient’s mouth and examine for burns or swelling of the tongue.

Ask the patient to cough, and assess for black sputum, which indicates smoke inhalation

If the patient sustained an electrical injury,

assess thoroughly for entry or exit burn wounds. This should include the axilla and the area between digits. Record pulse and motor and sensory function.

Apply ________ to help reduce minor edema.

cool mist, aerosol therapy, or humidified oxygen