Chapter 18 - soft tissue injuries + bleeding

blunt trauma

an injury to the body caused by forceful impact with a dull object or surface, without the skin being pierced

care for external bleeding

1. BSI and PPE

2. direct pressure w/ sterile dressing

3. apply pressure bandage (once blood isn’t soaking through dressing)

4. elevate wound (if no fractures)

5. if bleeding doesn’t stop, apply tourniquet

6. care for shock

   • oxygen

   • blanket

   • lay supine

how to apply pressure bandage

1. place a few layers of clean dressing over wound (maintain pressure)

2. use roller bandage or cravat

3. tightly wrap around dressing and wound (above and below wound as well)

4. check distal CSM (re-tie if no pulse)

applying touriquet

1. place pressure bandage over wound

2. put on tourniquet

3. check distal pulse (there SHOULD be NO pulse)

4. write time of application

5. care for shock, dont cover tourniquet

hemostatic dresssing function

helps promote blood to clot

recognizing internal bleeding

• most often caused by blunt trauma (or penetrating wound)

• bruises

• vomiting or coughing up blood

• rigidity or distension (swelling)

• vaginal or rectum bleeding 

• signs of shock

Care for Internal Bleeding

1. BSI

2. primary assessment (ABC’s)

   • likely high concentration oxygen

3. secondary assessment (look for evidence of trauma)

4. care for shock

5. reassure patient - keep them calm

6. rapid transport to trauma center

what does multisystem trauma lead to?

it leads to to quicker because the body can’t compensate as well

what is as soft tissue injury

damage to the skin, muscles, nerves, blood vessels, or any of the connective tissues that hold these structures together

care for open wounds

1. PPE

2. primary assessment (care for breathing and airway first)

3. expose wound

4. wipe wound with sterile gauze pad

5. control bleeding

6. administer oxygen (if needed)

7. keep patient lying still - care for shock

8. transport and comfort patient

penetrating wound care

same as open wounds but DO NOT remove object AND stabilize object w/ bulky dressing

how to preserve amputated body parts

1. wrap in sterile gauze

2. put in plastic bag or plastic wrap

3. if possible, keep it cool (NOT cold)

what is an evisceration?

protruding organ. Place moist, sterile dressings over it and cover dressing with plastic covering

care for any head/face injuries

be careful of neck injuries and skull fractures (apply pressure on edges of wound if fracture).

Care is same as any other open wound

implaled object through cheek care

If there’s an impaled object through the cheek into the mouth, it' may need to be removed

1. place dressing between wound and patient’s teeth. Leave some dressing outside of mouth, so patient doesnt swollow it

2. position patient so blood flows out mouth - not back into throat

3. pack against inside wound

4. dress + bandage outside wound

5. care for shock

care for light burns to eyes

apply dark patches over both eyes

chemical burns eye care

flush eye for 20 minutes (clean water - does not have to be sterile)

after, cover eyes with loose moist dressings

care for ear injuries

• Cuts. Apply dressings and bandage in place.

• Tears. Apply bulky dressings, beginning with several layers behind the torn tissue.

• Avulsions. Use bulky dressings bandaged into place. Save the avulsed part in a plastic bag or plastic wrap. Keep the part dry and cool. If no plastic is available, then wrap in dressing material. Be certain to label the bag, wrap, or dressing with the patient’s name.

recognizing neck injuries

• Difficulty speaking, loss of voice

• Difficulty swallowing

• Obvious swelling or bruising of the neck

• Pain on swallowing or speaking

• Obvious cuts or puncture wounds

care for neck injuries

1. direct pressure to wound (using palm)

2. apply occulsive dressing or plastic cover to wound.

3. tape to seal the dressing down

4. care for shock

minor vs significant SUPERFICIAL (2nd degree) burn

minor burn if: covers less than 9 percent of BSA (body surface area)

significant: more than 9%, OR less than 9% if burns on face, hands, feet, major joints, groin, or involved respiratory system

rule of 9s

care for burns

• Stop the burning process immediately. This may require the patient to stop, drop, and roll to extinguish the flames. You might also have to smother the flames and wet down or remove smoldering clothing.

• Flush superficial burns with water (or saline) for several minutes. For partial- or full-thickness burns, do not flush with water unless they involve an area of less than 15% of the total BSA. Flushing large burn areas may cause the patient to become chilled. Follow local protocols.

• Remove smoldering clothing and jewelry. Do not remove any clothing that is melted onto the skin.

• Continually monitor the airway. Any burns to the face or exposure to smoke may cause airway problems. Administer oxygen per local protocols.

• Prevent further contamination. Keep the burned area clean by covering it with a dressing. Infection is common with burns.

• Cover partial- and full-thickness burns with dry, sterile dressings if available. In some EMS systems, you may be instructed to moisten dressings before placing them on the patient. Otherwise, place dry, sterile dressings onto the burned area. Follow local protocols.

• If the eyes or eyelids have been burned, place clean dressings or pads over them. Moisten these pads with sterile water if possible.

• If a serious burn involves the hands or feet, always place a clean pad between toes or fingers before completing the dressing.

• Provide oxygen and care for shock.

card for electrical burns

• Perform a scene size-up and take appropriate BSI precautions.

• Perform a primary assessment and ensure an open airway and adequate breathing.

• Evaluate the burn. Look for two burn sites: an entrance and an exit wound. The entrance wound (often the hand) is where the electricity entered the body. The exit wound is where the electricity came into contact with a ground (often a foot). The entrance wound may be small, and you may need to look very carefully for it. The exit wound may be large and obvious.

• Apply dry, clean dressings to the burn sites. You may apply moistened dressings if transport is delayed, the burn involves less than 9% of the body surface area, and the patient will not be in a cold environment.

• Provide oxygen and care for shock.