Soft tissue injury

variety of mechanisms

1. blunt injury

2. penetrating trauma

3. barotrauma

4. burns

death is often related to

hemorrhage or injection

leading form of injury

soft tissue trauma

goal

1. controlled bleeding

2. prevent further contamination/decreased risk of infection

_____ first line of defense against _____

epidermis

dermis

skin is thicker on

skin is thinner on

bodily openings are lined with

functions of skin

skin breaking allows bacteria to enter and raises possibilities of

wound healing

types of trauma

1. penetrating

2. blunt force

types of soft tissue injuries

1. closed: damage beneath skin or mucous membranes

2. open: break in surface; exposes deeper tissues to contamination

3. burns: damage from heat, chemicals, electricity, nuclear radiation

characteristics of closed injuries

1. history of blunt trauma

2. pain at site

3. swelling beneath skin

4. discoloration

ecchymosis

bruise, contusion

consider possibility of closed injury when you observe

1. bruising

2. swelling

3. deformity

4. patient reporting pain

hematoma

blood in damaged tissue or body cavity

crushing injury

great amount of force applied to body

crush syndrome from a crush injury can develop when

trapped for longer than 4 hours

compartment syndrome is caused by _____ and ft.

1. Compression of tissue from swelling

2. pain out of proportion to injury

BLUNT TRAUMA

S/S of compartment syndrome

1. extreme pain

2. decreased pain sensation

3. pain on stretching of affected muscles

4. decreased power

splint affected limb and transport of compartment syndrome

reassess neurovascular status frequently

treatment for bruise

check CMS distal to the injury

treat closed soft tissue injury using

RICES: Rice, Ice, Compression, Elevation, Splinting

signs of developing shock

1. anxiety/agitation

2. changes in mental status

3. increased HR

4. increased RR

5. diaphoresis

6. cool/clammy skin

7. decreased blood pressure

signs of hypoxia

1. anxiety/agitation

2. changes in mental status

four types of open injuries

1. abrasions

2. lacerations

3. avulsions

4. penetrating wound

typical signs of open injury include:

1. bleeding

2. break in skin

abrasion

wound of superficial layer of skin; results when body part rubs or scrapes across hard surface or friction

laceration

penetrating cut, usually jagged; caused by sharp object or blunt force that tears through tissue

incision

sharp, smooth cut (surgical cut)

avulsion is and ft.

top skin layer has come off

1. separates various layers of soft tissue

2. detached (degloved)

3. flapping

4. often has significant bleeding

5. never remove an avulsed skin flap

amputation

severing of a body part

What do you do when you find the patient’s amputated body part?

Wrap it with sterile gauze, bag it, cover it, and put it in ice or lukewarm water. NEVER PUT THE BODY PART DIRECTLY ON ICE. Read book*

Puncture wound

penetrating wound from sharp, pointed object; can damage structure deep within body

You want a little wiggle when treating puncture wounds

to make sure the connection is still there

Treating for stabbings and shootings [often results in multiple penetrating injuries]

-asses patients carefully to ID all wounds

-count # of penetrating injuries

-ID type of gun, rounds fired, document care

-may have to testify in court

types of blast injuries

primary: pressure wave from initial explosion

secondary: damage from flying debris

tertiary: thrown in the air, perhaps into an object

treatment for blast injuries

1. BSI/scene survey

2. ABCs

3. Admin oxygen as needed

control life threatening bleeding using

-direct even pressure

-

all open wounds

-assumed to be contaminated

-present risk of infection

splinting controls bleeding by

limiting muscle movement

abdominal wounds

-open wound may expose internal organs

-organs may even protrude through wound

treating an open wound with exposed internal organs

“If it dries, it dies”

keep protruding organ moist and sterile

only remove an impaled object when

-object is in facial cheek and obstructs breathing

-object is in chest and interferes with CPR

neck injuries

-can be life threatening

• open veins may suck air and cause cardiac arrest (pulmonary embolism)

-cover wound with occlusive dressing

• bulk gauze over occlusive dressing; occlusive dressing only prevents air from entering, not bleeding

-apply pressure

• DO NOT compress both carotid arteries at same time

animal mouths heavily contaminated with

virulent bacteria

human bites are worse than animal bites, they contain

-exceptionally wide range of virulent bacteria/viruses

• penetrating bite is very serious

• high infection rate

small animal bites wound may require

1. antibiotics

2. tetanus prophylaxis

3. suturing

4. physician evaluation

major concern of small animal bites

rabies

-acute, potential fatal viral infection of central nervous system

-can affect warm-blooded animals

-transmitted through biting or licking an open wound

-prevented by series of special vaccine injections

treatment for human bites

1. apply dry, sterile dressing

2. immobilize area with splint or bandage

burns occur when

body receives more radiant energy than it can absorb

thermal burns are caused by

heat; scalds or open flame

A patient burns herself after touching a hot object, what type of of burn does she have?

contact burn

flash burn is produced by

explosion

-briefly exposed to intense heat

-lightning strikes

treatment for burns

-stop burning

• cool burn area

• remove all jewelry, clothes/shoes from burn area

-apply dry dressing to:

• maintain body temp (barrier)

• prevent infection

• provide comfort

severity of thermal wounds correlates directly with:

1. temp

2. concentration

3. amount of heat energy possessed by objects or substance

4. duration of exposure

when burned, skin acts as barrier is destroyed, patient is at risk for:

1. hypothermia

2. hypovolumia

3. infection

4. shock

significant complications

-burns to airway

-circumferential burns of chest

-circumferential burns of extremity

burns severity depends on:

1. depth of burn

2. extent of burn

3. critical areas involved

4. preexisiting medical conditions

5. younger than 5, older than 55

extent is measured by

rule of nines or patient’s palm (1%)

care for burns

1. stop burning process

2. keep patient warm and dry

3. prevent additional injury

classifying victim’s burns determining the:

1. source of burn

2. depth of the burn

3. severity

chemical burns caused by

strong acids or strong alkalis

the human body is a good ______ for electricity.

conductor

inhalation burns can occur in

enclosed spaces without ventilation

upper airway damage associated with

breathing superheated gases

lower airway damage associated with

breathing chemicals and particulate matter

carbon monoxide management

1. safety of your own and coworkers

2. ensure high-low oxygen

burning plastic gives off

hydrogen cyanide

radiation burns potential threats, incidents related to:

-use and transportation of radioactive isotopes

-terrorist attacks

three types of ionizing radiation:

treatment of radiation

1. decomp first by HazMat team

2. irrigate open wounds

3. notify ED

4. ID source and length of patient’s exposure

5. Time-Distance-Shielding