Soft Tissue Injuries: Bandaging and Splinting PDF

Introduction to Care of the Injured External Bleeding  Hemorrhage = bleeding  Bodycannot tolerate greater than 20% blood loss.  Blood loss of 1 L can be dangerous in adults; in children, loss of 100-200 mL is serious. Conditions with Possible Serious Bleeding  Serious inj...

Introduction to Care of the Injured External Bleeding  Hemorrhage = bleeding  Bodycannot tolerate greater than 20% blood loss.  Blood loss of 1 L can be dangerous in adults; in children, loss of 100-200 mL is serious. Conditions with Possible Serious Bleeding  Serious injury  Poor general appearance of patient  Signs of shock  Significant amount of blood loss noted  The blood loss is rapid.  You cannot control external bleeding. Characteristics of Bleeding  Arterial  Blood is bright red and spurts.  Venous  Blood is dark red and does not spurt.  Capillary  Blood oozes out and is controlled easily. Blood Clotting  Bleeding normally stops within 10 minutes  Some medications interfere with clotting  Some injuries will be unable to clot  Patients with hemophilia lack clotting factors Controlling External Bleeding  Follow BSI precautions  Ensurepatient has an open airway and adequate breathing  Provide oxygen if necessary  Thereare several methods to control bleeding Direct Pressure and Elevation  Direct pressure is the most common and effective way to control bleeding.  Apply pressure with gloved finger or hand.  Elevating a bleeding extremity often stops venous bleeding.  Use both direct pressure and elevation whenever possible.  Apply a pressure dressing. Pressure Points  Ifbleeding continues, apply pressure on pressure point.  Pressurepoints are located where a blood vessel lies near a bone.  Be familiar with the location of pressure points. Location of Pressure Points Applying a Tourniquet  Fold a triangular bandage into 4˜ cravat.  Wrap the bandage.  Usea stick as a handle to twist and secure the stick.  Write“TK” and time and place on patient. Tourniquet Precautions  Placeas close to injury as possible, but not over joint.  Never use narrow material.  Usewide padding under the tourniquet.  Never cover a tourniquet with a bandage.  Donot loosen the tourniquet once applied. Bleeding from the Nose, Ears, and Mouth  Causes:  Skull fractures  Facial injuries  Sinusitis  High blood pressure  Coagulation disorders  Digital trauma Controlling a Nosebleed  Follow BSI precautions.  Help the patient sit and lean forward.  Apply direct pressure by pinching the patient’s nostrils.  Or place a piece of gauze bandage under the patient’s upper lip and gum.  Apply ice over the nose.  Provide transport. Bleeding from Skull Fractures  Do not attempt to stop the blood flow.  Loosely cover bleeding site with sterile gauze.  Ifcerebrospinal fluid is present, a target sign will be apparent. ICES  Ice slows bleeding.  Compression over an injury slows bleeding.  Elevation above the level of the heart reduces swelling.  Splinting decreases bleeding and reduces pain. Internal Bleeding Internal bleeding may not be readily apparent. Signs and Symptoms of Internal Bleeding (1 of 2) Ecchymosis: Bruising Hematoma: Bleeding beneath the skin Hematemesis: Blood in vomit Melena: Black, tarry stool Signs and Symptoms of Internal Bleeding (2 of 2)  Hemoptysis: Coughing up blood  Pain, tenderness, bruising, guarding, or swelling  Broken ribs, bruises over the lower chest, or rigid, distended abdomen Types of Injuries  Closed injuries  damage beneath the skin  Open injuries  Break in the surface of the skin  Burns  tissuereceives more energy than it can absorb Contusion  Results from blunt force striking the body  Hematoma  Poolof blood that has collected in the body Crushing Injury  Occurs when a great amount of force is applied to the body for a long period of time Abrasions  Caused by friction Laceration  Smooth or jagged cut Avulsion  Separatio n of various layers of the skin Penetrating Wound  Results from a sharp pointed object Gunshot Wounds  Gunshotwounds have unique characteristics Crushing Open Wound  May involve damaged internal organs or broken bones Emergency Medical Care (1 of 2)  Use proper BSI precautions.  Your treatment priority is CAB — including controlling the bleeding.  Apply a dry, sterile dressing over entire wound Emergency Medical Care (2 of 2)  Maintain pressure and secure dressing with a roller bandage.  Leave original dressing in place if bleeding continues.  Apply a second dressing on top of first and secure.  Splint the extremity. Abdominal Wounds  An open wound in the abdomen may expose organs.  An organ protruding through the abdomen is called an evisceration. Abdominal Wound Management  Do not touch exposed organs.  Cover organs with a moist sterile dressing.  Transport immediately. Impaled Objects  Donot attempt to move or remove the object.  Control bleeding and stabilize object.  Transport patient to the hospital carefully. Amputations  Immobilize a partial amputation with bulky dressings and a splint.  Wrap a complete amputation in a dry sterile dressing and place in a plastic bag.  Put the bag in a cool container filled with ice.  Transport severed part with patient. Burns  Burns account for over 10,000 deaths/year.  Burns are the most serious and painful injuries.  Remember to perform a complete assessment on burn patients for other injuries. Determining Burn Severity  What is the depth of the burn?  What is the extent of the burn?  Are any critical areas involved?  Arethere any preexisting medical conditions or other injuries?  Isthe patient younger than 5 years or older than 55 years of age? Depth of Burns (1 of 3)  Superficial (first- degree) burns  Involveonly top skin layer Depth of Burns (2 of 3)  Partial- thickness (second- degree) burns  Involve the epidermis and some portion of the dermis Depth of Burns  Full- thickness (third- degree) burns  Extend through all layers of the skin Extent of Burns Pediatric Needs  Burns to children are considered more serious than burns to adults.  Children have more surface area relative to body mass than adults.  Many burns result from abuse.  Report all suspect cases of abuse to the authorities. Emergency Care for Burns (1 of 2)  Follow proper BSI precautions.  Move the patient away from the burning area.  Immerse the affected area in cool sterile water or saline solution and cover with a cool, wet dressing.  Give oxygen if the patient has a critical burn. Emergency Care for Burns (2 of 2)  Prevent body heat loss.  Rapidly estimate the burn’s severity.  Check for traumatic injuries.  Treat the patient for shock.  Provide prompt transport. Chemical Burns  Occur whenever a toxic substance contacts the body  Eyes are particularly vulnerable.  Fumes can cause burns.  To prevent exposure, wear appropriate gloves and eye protection. Care for Chemical Burns  Remove the chemical from the patient.  If it is a powder chemical, brush off first.  Remove all contaminated clothing.  Flush burned area with large amounts of water for about 15 to 20 minutes.  Transport to the hospital quickly. Electrical Burns  Make sure the power is off before touching the patient.  There will be two wounds (an entrance and an exit wound) to bandage.  Transport the patient and be prepared to administer CPR. Functions of Dressing and Bandaging  Control bleeding  Protect the wound  Prevent contamination Dressing and Bandages  Sterile dressings  Used to cover wounds  Bandaging  Used to keep dressing in place Fractures  Closed fracture A fracture that does not break the skin  Open fracture  External wound associated with fracture Signs and Symptoms of a Fracture (1 of 2)  Deformity  Tenderness  Guarding  Swelling  Bruising Signs and Symptoms of a Fracture (2 of 2)  Crepitus  False motion  Exposed fragments  Pain  Locked joint Signs and Symptoms of a Dislocation  Marked deformity  Swelling  Pain  Tenderness on palpation  Virtually complete loss of joint function  Numbness or impaired circulation to the limb and digit Signs and Symptoms of a Sprain  Pointtenderness can be elicited over injured ligaments.  Swellingand ecchymosis appear at the point of injury to the ligaments.  Instability of the joint is indicated by increased motion.  Pain Falls  Injurypotential is related to the height of the fall. A fall either 15´ or three times the person’s height is considered significant.  Suspect internal injuries from a significant fall. Considerations for Falls  The height of the fall  The surface struck  The part of the body that hit first Emergency Medical Care  Completely cover open wounds.  Apply the appropriate splint.  Ifswelling is present, apply ice or cold packs.  Prepare the patient for transport.  Always inform hospital personnel about wounds that have been dressed and splinted. Splinting  Flexible or rigid device used to protect extremity  Injuries should be splinted prior to moving patient, unless the patient is critical.  Splinting helps prevent further injury.  Improvise splinting materials when needed. General Principles of Splinting (1 of 3)  Remove clothing from the area.  Note and record the patient’s neurovascular status.  Cover all wounds with a dry, sterile dressing.  Do not move the patient before splinting. General Principles of Splinting (2 of 3)  Immobilize the joints above and below the injured joint.  Pad all rigid splints.  Maintain manual immobilization.  If you find resistance to limb alignment, splint the limb as is. General Principles of Splinting (3 of 3)  Immobilize all suspected spinal injuries in a neutral in-line position.  Ifthe patient has signs of shock, align limb in normal anatomic position and transport.  When in doubt, splint. BANDAGING Head Bandaging Ear and Check Bandaging Burn on Face Bandaging Elbow Bandaging Close Palm Bandaging Open Palm Bandaging Arms and Leg Bandaging Arms and Leg Bandaging Arms and Leg Bandaging Arm sling Arm sling Arm sling Cuff Sling Chest Bandaging Ankle Bandaging with Shoes Ankle Bandage without Shoes Arms and Legs Splinting