Chapter 28 Soft Tissue Injuries PDF

 Chapter 28 Soft Tissue Injuries 8/22/2024 Slide 3 Overview  Skin  Function  Layers  Injuries  Closed Injuries  Open Injuries  Emergency Medical Care for Patients with Soft Tissue Injuries  Bur...

 Chapter 28 Soft Tissue Injuries 8/22/2024 Slide 3 Overview  Skin  Function  Layers  Injuries  Closed Injuries  Open Injuries  Emergency Medical Care for Patients with Soft Tissue Injuries  Burns  Classification of Burns  Severity of Burns  Emergency Medical Care for Burn Victims  Special Considerations in Burn Care 8/22/2024 Slide 4  Skin 8/22/2024 Slide 5 Skin  Largest organ, Protects the body from the environment, bacteria, and other organisms  Helps regulate the temperature of the body  Senses heat, cold, touch, pressure, and pain; transmits this information to the brain and spinal cord 8/22/2024 Slide 6 Skin  Layers  Epidermis  Outermost layer of skin, dead cells, no pain or bleeding.  Dermis  Deeper layer of skin containing sweat and sebaceous glands, hair follicles, blood vessels, and nerve endings  Subcutaneous layer  More bleeding and pain. Slide 7 Injuries to the Skin  Soft tissue injuries often appear worse than they are 8/22/2024 Slide 8 Injuries to the Skin  Same injury after cleaning 8/22/2024 Slide 9  Injuries to the Skin  Closed injuries  Skin remains intact and no external bleeding  Contusion (bruise)  Epidermis remains intact  Cells are damaged and blood vessels torn in the dermis  Swelling and pain are typically present  Blood accumulation causes discoloration 8/22/2024 Slide 10 ALERT A bruise over a vital organ may mean that the organ has been damaged and internal bleeding may be present. 8/22/2024 11 Injuries  Closed injuries  Hematoma  Collection of blood beneath the skin  Larger amount of tissue damage compared with contusion  Larger vessels are damaged  May lose one or more liters of blood 8/22/2024 Slide 12 Injuries  Closed injuries  Crush injuries  Crushing force applied to the body  Can cause internal organ rupture  Internal bleeding may be severe with shock (hypoperfusion) 8/22/2024 Slide 13 Injuries  Open injuries  Abrasion  Outermost layer of skin is damaged by forces  Painful injury, even though superficial  No or very little oozing of blood 8/22/2024 Slide 14 Injuries  Open injuries  Laceration  Break in skin of varying depth  May be linear (regular) or stellate (irregular) and occur in isolation or together with other types of soft tissue injury  Caused by forceful impact with sharp object  Bleeding may be severe 8/22/2024 Slide 15 Injuries  Open injuries  Avulsion  Flaps of skin or tissue are torn loose or pulled completely off 8/22/2024 Slide 16  Injuries  Open injuries  Penetration/puncture  Caused by sharp, pointed object  May be no external bleeding  Internal bleeding may be severe  Exit wound may be present  Examples  Gunshot wound  Stab wound 8/22/2024 Slide 17 Injuries  Open injuries  Amputation  Involves the extremities and other body parts  Massive bleeding may be present or bleeding may be limited 8/22/2024 Slide 18 Injuries  Open injuries  Open crush injuries  Damage to soft tissue and internal organs  May cause painful, swollen, deformed extremities  External bleeding may be minimal or absent  Internal bleeding may be severe 8/22/2024 Slide 19 Emergency Medical Care for Patients with Soft-Tissue Injuries  Body substance isolation  Proper airway/artificial ventilation/oxygenation  Treat for shock (hypoperfusion)  Manage bleeding  Expose the wound  Control the bleeding  Prevent further contamination  Apply dry sterile dressing to the wound and bandage securely in place  Keep the patient calm and quiet  Splint a painful, swollen, deformed extremity 8/22/2024 Slide 20 Emergency Care for Soft-Tissue Injuries  Dressings and bandages  Dressings  Stop bleeding  Protect the wound from further damage  Prevent further contamination and infection 8/22/2024 Slide 21 Emergency Care for Soft-Tissue Injuries  Types of dressings  Universal dressing  4 × 4-inch gauze pads  Adhesive-type  Occlusive 8/22/2024 Slide 22  Emergency Care for Soft-Tissue Injuries  Bandages  Hold dressing in place 8/22/2024 Slide 23 Emergency Care for Soft-Tissue Injuries  Self-adherent bandages  Gauze rolls  Triangular bandages  Adhesive tape  Air splint 8/22/2024 Slide 24 Alert When you encounter a patient with a soft tissue injury. Always check for an exit wound, especially with penetrating injuries. An object may have passed entirely through the body. 8/22/2024 25 Dressing and bandaging  BSI  Expose injured area  Sterile dressing to be kept  Maintain direct pressure  Bandage, assess distal pms.  Lot of bleeding add another dressing, if become a lot of gauzes remove the top gauzes only. 8/22/2024 26 Emergency Care for Soft-Tissue Injuries  Specific areas  Forehead 8/22/2024 Slide 27 Emergency Care for Soft-Tissue Injuries  Specific areas  Shoulder 8/22/2024 Slide 28 Emergency Care for Soft-Tissue Injuries  Specific areas  Hip 8/22/2024 Slide 29 Emergency Care for Soft-Tissue Injuries  Specific areas  Hand 8/22/2024 Slide 30 Emergency Care for Soft-Tissue Injuries  Specific areas  Joint 8/22/2024 Slide 31 Emergency Care for Soft-Tissue Injuries  Injuries requiring special considerations  Chest injuries  Occlusive dressing to open wound  Administer oxygen if not already done  Position of comfort if no spinal injury suspected 8/22/2024 Slide 32 Emergency Care for Soft-Tissue Injuries  Injuries requiring special considerations  Abdominal injuries  Evisceration (organs protruding through the wound)  Do not touch or try to replace the exposed organ  Cover exposed organs and wound with a sterile dressing, moistened with sterile water or saline, and secure in place  Flex the patient’s hips and knees, if uninjured 8/22/2024 Slide 33 Emergency Care for Soft-Tissue Injuries  Injuries requiring special considerations  Impaled objects  Do not remove the impaled object, unless it is through the cheek; removal will interfere with chest compressions or transport  Manually secure the object  Expose the wound area  Control bleeding  Use a bulky dressing to help stabilize the object 8/22/2024 Slide 34 Emergency Care for Soft-Tissue Injuries  Injuries requiring special considerations  Amputations  Concerns for reattachment  Wrap the amputated part in a sterile dressing  Wrap or bag the amputated part in plastic and keep cool  Transport the amputated part with the patient  Do not complete partial amputations  Immobilize to prevent further injury 8/22/2024 Slide 35 Emergency Care for Soft-Tissue Injuries  Injuries requiring special considerations  Large open neck injury  May cause air embolism  Cover with an occlusive dressing  Compress carotid artery only if necessary to control bleeding 8/22/2024 Slide 36 Soft tissue injuries  Face and head: scalp bleeds a lot, put pressure.  Eye injuries: flush the eye.  Chemical injury to the eye: contact medical direction and flush it 20 minutes or more.  Eye or eyelid burnt: cover with moist dressing.  Injury to the mouth: loose teeth or blood that can obstruct the airway.  Teeth came out of the mouth can be replaced if the root has not been damaged.  Treat the tooth gently and do not touch the root. 8/22/2024 37 questions  List at least three functions of skin?  Contusion?  Abrasion?  Avulsion?  A _____ is used to stop the bleeding.  Wounds to the chest may be covered with____ dressing.  How to treat a patient with a chemical splashed in his eyes? 8/22/2024 38 Burns  Painful and can lead to disability and disfigurement.  Severe burn require treatment at specialty burn centre.  Burn may not kill the patient but its effect on ABC actually kill the patient.  Loss of protective barrier can cause fluid loss, hypothermia and infection  Check for the ABC first and then concentrate on burns.  Check for the scene if it is safe then only enter the scene. 8/22/2024 Slide 39 Burns  Classification of burns  According to depth 8/22/2024 Slide 40 Burns  Superficial/ first degree burn:  Involves only the epidermis  Reddened skin  Pain at the site 8/22/2024 Slide 41 Burns  Partial-thickness/ second degree burn:  Involves both the epidermis and the dermis, but does not involve underlying tissue  Intense pain  White to red skin that is moist and mottled  Blisters 8/22/2024 Slide 42 Burns  Full-thickness/ third degree burn:  Burn extends through all the dermal layers and may involve subcutaneous layers, muscle, bone, or organs  Skin becomes dry and leathery and may appear white, dark brown, or charred  Loss of sensation—little or no pain, hard to the touch, pain at periphery 8/22/2024 Slide 43 Burns  Percentage of body area burned  Size of the patient’s hand is equal to 1%  Rule of nines—Adult  Head and neck–9%  Each upper extremity–9%  Anterior trunk–18%  Posterior trunk–18%  Each lower extremity–18%  Genitalia–1% 8/22/2024 Slide 44 Burns  Rule of nines—infant  Head and neck–18%  Each upper extremity–9%  Anterior trunk–18%  Posterior trunk–18%  Each lower extremity–14% 8/22/2024 Slide 45 Burns  Rule of nines 8/22/2024 Slide 46 Burns  Severity  Location  Percentage of body surface area (BSA)  Depth of burn  Preexisting medical condition  Age 8/22/2024 Slide 47 Burns  Severity  Location  Face and upper airway  Hands  Feet  Genitalia 8/22/2024 Slide 48 Burns  Severity  Age of the patient  Younger than 5 years  Older than 55 years 8/22/2024 Slide 49 Burns  Critical burns  Full-thickness burns involving the hands, feet, face, or genitalia  Burns associated with respiratory injury  Full-thickness burns covering more than 10% of the BSA 8/22/2024 Slide 50 Burns  Critical burns  Partial-thickness burns covering more than 30% of the BSA  Burns complicated by painful, swollen, deformed extremity  Burns encircling any body part 8/22/2024 Slide 51 Burns  Moderate burns  Full-thickness burns of 2% to 10% of the BSA excluding hands, feet, face, genitalia, and upper airway  Partial-thickness burns of 15% to 30% of the BSA  Superficial burns of greater than 50% BSA 8/22/2024 Slide 52 Burns  Minor burns  Full-thickness burns of less than 2% of the BSA  Partial-thickness burns of less than 15% of the BSA 8/22/2024 Slide 53 Emergency Medical Care for Burns  Stop the burning process, initially with water or saline  Remove smoldering clothing and jewelry 8/22/2024 Slide 54 Emergency Medical Care for Burns  Body substance isolation  Continually monitor the airway for evidence of closure  Prevent further contamination  Cover the burned area with a dry sterile dressing  Do not use any type of ointment, lotion, or antiseptic  Do not break blisters  Transport 8/22/2024 Slide 55 Infant and Child Considerations  Relative size  Greater surface area in relationship to the total body  Results in greater fluid and heat loss 8/22/2024 Slide 56 Infant and Child Considerations  Critical burns  Full- or partial-thickness burn greater than 20% BSA  Any burn involving the hands, feet, face, airway, or genitalia  Moderate  Partial-thickness burn of 10% to 20% BSA  Minor  Partial-thickness burn less than 10% BSA 8/22/2024 Slide 57 Infant and Child Considerations  Higher risk for shock (hypoperfusion), airway problem, or hypothermia  Consider possibility of child abuse 8/22/2024 Slide 58 Burns  Chemical burns  Take the necessary scene safety precautions to protect yourself from exposure to hazardous materials  Wear gloves and eye protection 8/22/2024 Slide 59 Burns  Chemical burns  Emergency medical care  Dry powders should be brushed off prior to flushing  Immediately begin to flush with large amounts of water  Continue flushing the contaminated area en route to the receiving facility  Do not contaminate uninjured areas when flushing 8/22/2024 Slide 60 Burns  Electrical burns  Scene safety  Do not attempt to remove patient from the electrical source unless trained to do so  If the patient is still in contact with the electrical source or you are unsure, do not touch the patient 8/22/2024 Slide 61 Burns  Electrical burns  Emergency medical care  Administer oxygen if indicated  Monitor the patient closely for respiratory and cardiac arrest (consider need for AED)  Often more severe than external indications  Treat the soft tissue injuries associated with the burn. Look for both an entrance and exit wound 8/22/2024 Slide 62 Burns  Electrical burn 8/22/2024 Slide 63 Summary  Skin  Function  Layers  Injuries  Closed Injuries  Open Injuries  Emergency Medical Care for Patients with Soft Tissue Injuries  Burns  Classification of Burns  Severity of Burns  Emergency Medical Care for Burn Victims  Special Considerations in Burn Care 8/22/2024 Slide 64