EMC - soft tissue injury + burns

mr sprek soft tissue injury test idk ocsa and burns aughhhh Diabetes, Fractures, Soft Tissue injuries, Burns and Seizures.

What are the three layers of skin

Epidermis

Dermis

Subcutaneous layer

What are the three types of burns by depth

Superficial burns

Partial thickness burns

Full thickness burns

Superficial burns

only involves epidermis

pink red dry

no blisters

painful

Partial Thickness burns

involves the epidermis and portions of the dermis

red or blanched white and MOIST

usually blisters

painful

Full thickness

all 3 layers of skin

can smell it , like bacon

dry, hard, tough, leathery

colors range from white to waxy brown, or black and charred

burns themselves are not painful bc neve endings have been destroyed

Minor burns

full thickness burns: 2% BSA

partial thickness: 15% BSA

superficial burns: less than 50% BSA

Moderate Burns

full thickness: 2-10% BSA

partial: 15-25% BSA

superficial: over 50% BSA

critical/severe burns

respiratory systems burn (soot around mouth/face, check throat)

full thickness: over 10% BSA

partial: 25% BSA

full thickness burns of hands, feet, face, genitalia!!!!! no matter BSA

thermal burn tx

1. remove patient from source

2. cool burn w clean water

3. establish airway

4. classify severity of burn

5. REMOVE JEWERLY CLOTHING SEPERATE FINGERS

6. cover burned area with a dry sterile dressing

7. keep pt warm w blanket

8. be careful of dehydration

What are the three types of bleeding

Arterial bleeding

Venous bleeding

Capillary bleeding

arterial bleeding

bright red - rich in oxygen

spurting normal blood pressure

MOST difficult to control bc under MOST PRESSURE

venous bleeding

dark red blood

steady flow of blood

may be profuse but generally easier to control than arterial bleeds

capillary bleeding

slowly oozing blood

dark or intermediate red

easiest to control

can self clot

if large surface area is involved the risk of infection is great

closed wounds (3)

contusions

hematomas

crush injuries

open wound (7)

higher risk of external bleeding and infection

• abrasions

• lacerations

• avulsions

• amputations

• penetrations/punctures

• crush injuries

• clamping injuries

how much average blood is in adult

5 liters of blood circulating through body

15% or more blood lost is considered significant and lead to shock

lacerations

cut

amputations

partial vs complete

1. remove contamination by flushing with sterile water (never submerge)

2. wrap body part in dry sterile gauze dressing

3. put the amputated body part in a plastic bag

4. keep cool (do not put directly on ice)

5. mark name date and body part

6. transport WITH patients

penetrations/punctures (stabs)

check for exit wound for GSW

impaled object shud never be removed in field unlessssss

tx.

1. manually secure the object

2. expose the wound area

3. control bleeding with direct pressure around the impaled object

4. use a bulky dressing to stabilize the object

avulsions (flap)

partial and complete

loose flap of skin that has been torn loose or is completely off

tx.

1. for partial . clean wound of debris

2. replace skin over the wound and bandage in place

abrasion (skidding)

shearing away epidermis

extremely painful with nerve ending exposed

large abrasions huge contamination infection

contusion/hematoma (bruise)

a fist size hematoma can result in 10% blood loss

bleeding control

elevate the injury above heart

use tourniquet as last resort

check distal pulses before and after applying the bandage

greenstick

common in children

comminuted

bone breaks into 3 or more pieces

more common in the elderly with brittle bones

impacted

broke bones are forced into each other

spiral

common sports injury

transverse

perpendicular or shaft of the bone

oblique

bone breaks at an angle to the bone

diabetic mellitus

body can not adequately regulate its blood sugar or BGL

• body cannot make or use insulin

• cant properly regulate glucagon

Normal glucose regulation

1. eat a meal

2. BGL increases 120-140 mg/dl

3. insulin secreted

4. cells uptake glucose/liver created glycogen

5. BGL drops to 70 mg/dl

6. glucagon secreted

7. glycogen broken down into glucose, released from liver

8. BGL increased once maintained

Normal BGL

fasting for 12 hours

bgl is around 80-90 mg/dl

throughout the day it is between 70-120 mg/dl

after meal its usually 120-140 mg/dl

normal is considered 80-120 mg/dl

hypoglycemia (insulin shock) and hyperglycemia

1. hypo

   -low BGL 60 mg/dl or less

   -50mg/dl or less with or without s/s

2. hyper

   -persistent BGL greater than 120 mg/dl

hypo glycemia

rapid onset usually minutes

altered

violent

seizure

BODY RELEASES EPINEPHRINE to deal with this which causes shock signs

• tachycardia

• pale cool clammy

• weakness

• hunger

tx:

• administration of sugar, oral intake, iv for altered

• monitor airway and EKG

• oxygen if nessacary

• rapid transport/eat a meal

hyperglycemia or DKA (diabetic ketoacidosis)

buildup or glucose in blood

• once in BGL is over 350 mg/dl DKA sets in

• this causes theb ody to throw up ketones as a byproduct

tx:

• same as hypolycemia

• IV fluid push 500 tml

s/s the 3 p’s (hyperglycemia s/s)

polydipsia (thirst)

polyuria (frequent urination)

polyphagia (hunger)

kussmaul respiration (hyperglycemia s/s)

type of hyperventalation

status elipeticus

medical emergency

• pt suffers generalized motor seizures that last more than 5 minutes OR consecutive seizures without a period of responsiveness between them

tonic clonic seizure (grandmal)

jerky convulsive motor activity

• aura: warning of oncoming seizure

• smell or taste in mouth or sound

• loss of conciousness

• tonic phase (muscle rigidity)

• clonic phase: muscle spawms followed by the muscular relxation

• 1-3 minutes

• breathing is shallow or absent

• postictal state: recovery alter mental status lasts10-30 minutes, oxygen helps

Febrile seizures

caused by high fever

most common in children under 6 years of age

generally not life threatening

tx:

• monitor airway and suction as needed

• oxygenate if needed , esp if in the postictal state of a tonic clonic seizure

• check oral for bleeding

• if first seizure » transport to hospital highly recommended