© 2011 National Safety Council 17-1 SOFT-TISSUE INJURIES LESSON 17.

© 2011 National Safety Council 17-1

SOFT-TISSUE INJURIESLESSON 17


Introduction

• Wounds common with trauma and burns

• In open wounds, skin is torn or cut and often bleeding

• Muscle and soft tissue may be injured

• Open wounds have risk of infection


Types of Soft-Tissue Injuries

Type and amount of bleeding depend on wound type, location, depth


Closed Wounds

• No break in skin

• Discoloration and swelling from internal bleeding

• Musculoskeletal injuries may be present


Abrasions

• Superficial skin layers scraped off

• Often painful

• Underlying tissues not usually injured

• Capillary bleeding stops itself

• Foreign material can cause infection


Lacerations

• May damage underlying tissue

• May cause severe bleeding

• Laceration through artery may be life-threatening


Punctures, Penetrating Wounds

• Caused by object penetrating skin and deeper tissues

• Little or no external bleeding

• Severe internal bleeding

• May be both entrance and exit wounds

• Likely to trap foreign material

• Increased infection risk


Avulsions

Skin and soft tissue torn partially from body


Traumatic Amputations

• Complete cutting or tearing off of all or part of extremity

• Part may be surgically reattached


Burns

Damage caused to skin and other tissue by heat, chemicals or electricity


General Principles of Wound Care

• Control serious bleeding after primary assessment

• With less serious bleeding, complete assessment and standard patient care first


Always Perform Standard Assessment

• Size up scene

• Complete primary assessment

• Take history

• Perform secondary assessment and physical examination as appropriate

• Complete reassessments


Always Perform Standard Patient Care

• Ensure EMS has been activated

• Use body substance isolation

• Maintain patient’s airway

• Provide artificial ventilation if needed

• Comfort, calm and reassure patient


Additional Care for Soft-Tissue Injuries

• Use needed BSI precautions

• Control bleeding

Cover wound with sterile gauze

Apply direct pressure


Additional Care for Soft-Tissue Injuries (continued)

• With minor wounds:

- Irrigate with large amounts of running water

- Irrigate wound to remove foreign matter from wound

- Pat area dry, apply sterile dressing, bandage

• Prevent contamination with dressing and bandage

• If stitches needed or patient’s tetanus vaccination not current, ensure patient receives medical attention


Wound Cleaning Alert!

• Do not use alcohol, hydrogen peroxide or iodine on wound

• Avoid breathing or blowing on wound

• Do not attempt to remove clothing stuck to wound; cut around clothing and leave in place

• Do not scrub wound


Purpose of Dressings

• Helps control bleeding

• Prevents infection

• Absorbs drainage

• Protects wound while healing


Types of Dressings

• Sterile gauze pads

• Roller gauze

• Non-stick gauze pads

• Adhesive strips

• Bulky

• Occlusive

• Improvised


Improvising Dressings

• If sterile dressing not available, use clean cloth

• Non-fluffy cloth less likely to stick

• Use clean towel, handkerchief, other material

• Avoid cotton balls or cotton cloth

• For bulky dressings, use sanitary pads, towels, baby diapers or many layers of gauze


Ring Dressing

• Don’t put direct pressure over:

- Skull fracture

- Fractured bone protruding from a wound

- Object impaled in wound

• Control bleeding with pressure around object or fracture


Guidelines for Using Dressings

• Wash hands and wear medical examination gloves

• Choose dressing larger than wound

• Do not touch part of dressing that will touch wound

• Lay dressing on wound, cover whole wound


Guidelines for Using Dressings(continued)

• If blood seeps through, do not remove dressing but add more on top

• Use direct pressure to control bleeding if needed

• Apply bandage to hold dressing in place


Purpose of Bandages

• Cover a dressing

• Keep dressing in place on wound

• Maintain pressure to control bleeding

• Support or immobilize musculoskeletal injury


Types of Bandages

• Adhesive compresses

• Adhesive tape rolls

• Tubular

• Elastic roller

• Self-adhering

• Gauze roller

• Triangular

• Improvised


Guidelines for Bandaging

• Should be clean, not necessarily sterile

• Apply bandage firmly but don’t cut off circulation

• Never encircle neck

• Don’t cover fingers or toes

• Check fingers or toes for color, warmth, sensation


Guidelines for Bandaging (continued)

• If reduced circulation, unwrap bandage and reapply

• Keep checking tightness of bandage

• Be sure bandage is secure

• Anchor first end and tie, tape, pin or clip ending section

• Use elastic roller bandage to make pressure bandage around a limb to control bleeding


Guidelines for Bandaging (continued)

• Elastic roller bandages support joints and prevent swelling

• Wrap from bottom of limb upward

• Bandage joint in position it will be kept

• Use wide bandage with evenly distributed pressure for extremities


Puncture Wounds


Puncture Wounds

• May involve unseen deeper injuries

• Check for exit wound

• Carry great risk of infection

• Internal bleeding may be significant


Care for Puncture Wounds

• Follow general principles of wound care

• Remove small objects and dirt but not large impaled objects

• Irrigate the wound with large amounts of water

• With small punctures, gently press wound edges

• Don’t put medication inside or over puncture wound

• Dry the area and apply dressing and bandage

• Seek medical attention if appropriate


Impaled Objects

• Object often seals wound or damaged blood vessels


Impaled Object (continued)

• Removing object could cause more injury and bleeding

• Leave it in place and dress wound around it

• Control bleeding by applying direct pressure at sides of object


Impaled Object (continued)

• Dress wound around object

• Use bulky dressings to stabilize object

• Support object while bandaging dressings in place

• Seek medical attention


Avulsion

• With skin flap, try to move skin or tissue into normal position (unless contaminated)


• Provide wound care

• If avulsed body part completely separated – care for it like an amputation


Amputation

Control bleeding and care for wound first, then recover and care for amputated part


Care for Amputated Part

• Wrap severed part in dry sterile dressing or clean cloth; do not wash

• Place part in plastic bag and seal

• Place sealed bag in another bag or container with ice and water part should not touch water or ice directly or be surrounded by ice

• Do not let part become saturated with water

• Give part to responding EMS


Animal Bites


Seriousness of Animal Bites

• Bleeding and tissue damage can be severe

• Increased risk of infection

• All bites carry rabies risk


Care of Animal Bites


• Clean with large amounts of water with or without soap (except when bleeding severely)


• Dress and bandage


Care of Animal Bites (continued)

• Ensure patient sees health care provider as soon as possible

• Do not try to catch animal but note its appearance

• Report bite to animal control or law enforcement


Chest Injuries


Care for Impaled Object in Chest


• Keep patient still, seated or lying down

• Do not remove object unless it interferes with chest compressions when CPR is needed


Care for Impaled Object in Chest (continued)

• Manually secure object while exposing wound area and controlling bleeding

• Stabilize impaled object with bulky dressings

• Bandage area around object

• Monitor breathing and vital signs

• Treat for shock


Sucking Chest Wound

• Open wound in chest caused by penetrating injury

• Wound lets air move in and out of chest during breathing

• Can be life-threatening

• Use special dressing to allow air to escape through the wound but prevent air from being sucked in


Care for SuckingChest Wound


Closed Chest Injury

• Organ damage or internal bleeding can be serious

• Consider possibility of pneumothorax or hemothorax with any trauma to chest


Pneumothorax

• Air escapes from injured lung into thoracic cavity causing collapse of some or all of lung

• Results in respiratory distress


Hemothorax

• Blood from injury accumulates in thoracic cavity, compressing the lung

• Causes respiratory distress and possibly shock


Signs and Symptoms of Pneumothorax or Hemothorax

• Little or no external evidence of injury

• Signs and symptoms of shock

• Respiratory distress


Care for Chest Injuries

• Perform standard patient care

• Help responsive patient to position of easiest breathing

• Treat for respiratory distress

• Follow local protocol for oxygen


Abdominal Injuries


Open Abdominal Wound

• Usually injures internal organs (intestines, liver, kidneys or stomach)

• Large wound may cause evisceration

Abdominal organs protrude through wound

Serious emergency


Care for Open Abdominal Wounds


• Position patient on back

• Loosen tight clothing

• Cover wound and organs with thick moist dressing


Care for Open Abdominal Wounds (continued)

• Cover dressing with large, occlusive dressing

• Cover area with blanket or towel

• Monitor vital signs, and treat for shock


Genital Injuries


Genital Injuries

• Rare because of protected location

• Occur from blunt trauma, an impact or sexual abuse

• Provide privacy


Care for Genital Injuries

• Injured testicles – support with towel between legs

• Vaginal bleeding – have woman press sanitary pad or clean folded towel to area


Head and Face Injuries


Head and Face Injuries

• Consider possible neck or spinal injury

• Do not move patient’s head while giving emergency care


Scalp Wound

Before controlling bleeding, confirm no signs of skull fracture:

• Deformed area of skull

• A depressed or spongy area in skull

• Blood or fluid from ears or nose

• Eyelids swollen shut or bruising

• Raccoon eyes

• Battle’s sign

• Unequal pupils

• Object impaled in skull


Care for Scalp Wound

• With no signs of skull fracture:

- Apply dressing

- Use direct pressure to control bleeding


• Never wrap bandage around neck


Scalp Wound Without Suspected Skull Fracture

• Replace skin flaps and cover wound with sterile dressing

• Control bleeding with direct pressure

• Secure dressing with roller bandage or triangular bandage


Neck Injuries

• Bruising, swelling, difficulty speaking, airway obstruction may result

• Treat minor wounds like other wounds

• Significant open wounds are medical emergencies bleeding can be profuse


Care for Neck Injuries



• Place occlusive dressing over wound and tape on all sides

• Apply pressure on dressing to control bleeding

• When bleeding is controlled, apply pressure dressing over occlusive dressing

• Do not obstruct airway or compress other blood vessels in neck


Eye Injuries

• Serious because vision may be affected

• Avoid putting pressure on eyeball

• Movement of eye will worsen injury

• Keep unaffected eye covered


For a Blow to the Eye


• If eye is bleeding or leaking fluid, patient needs emergency medical care immediately

• Put cold pack over eye with a barrier, but do not put pressure on eye

• Do not try to remove a contact lens

• Cover both eyes


Care for a Large Object Embedded in the Eye


• Do not remove object

• Stabilize with dressings or bulky cloth (paper cup for large object)

• Cover both eyes


Dirt or Small Particle In Eye

• Do not let patient rub eyes• Wait to see if patient’s tears

flush out object• Gently pull upper eyelid out and

down over lower eyelid to catch particle on lashes

• If particle remains and is visible, try to brush it out

• If particle still remains or patient has any vision problems or pain, cover both eyes and seek medical care


For Chemical or Substance Splashed in Eye


• Have patient lie flat with head tilted to affected side

• Hold eyelid open with gloved hand

• Flush eye with running water or saline until additional EMS providers arrive use specialized solution if available

• Follow local protocol to consult PCC


Ear Injuries

• Bleeding or cerebrospinal fluid from ear is sign of serious head injury

• Do not use direct pressure to stop fluid coming out of ear

• Do not remove any foreign object

• If insect in ear, gently pour lukewarm water into ear to float it out


Care for External Ear Injuries


• Dress wound


Care for Internal Ear Injuries


• Help patient sit up

• Tilt affected ear lower than unaffected ear

• Cover ear with loose sterile dressing

• Don’t apply pressure or plug ear closed


Nose Injuries

• Nose trauma can cause heavy bleeding

• Bleeding from back of nose down throat needs immediate medical attention

• Allow blood to drain from mouth


Care for Nose Injuries


• Patient sits with head slightly forward with mouth open

Don’t remove objects from nose

Don’t tilt patient’s head backward

• Pinch nostrils just below bridge of nose for 10 minutes


Care for Nose Injuries (continued)

• Place cold compress on nose

• After 10 minutes release pressure slowly

• If bleeding continues, pinch nostrils for another 10 minutes

• Put unresponsive patient on side and pinch nostrils

• Don’t pack nostrils with dressing


Cheek Injuries

• Object impaled in cheek (possible airway obstruction)

- Remove it only if airway cannot be controlled

- Place dressing inside mouth between wound and teeth

- Place another dressing on outside of wound

- Apply pressure as needed

• Position unresponsive patient with head turned to side


Teeth and Mouth Injuries

• Control bleeding with direct pressure on dressing

• Priorities:

Ensure airway is open

Ensure blood drains from mouth


Bleeding in Mouth

• Have patient sit with head tilted forward to let blood drain out

• Wound penetrating lip:

- Put rolled dressing between lip and gum

- Second dressing against outside lip

• Bleeding tongue:

- Put dressing on wound and apply pressure

- Do not repeatedly rinse mouth or let patient swallow blood


Tooth Knocked Out

• Control bleeding with rolled gauze over socket

• Save tooth

May be reimplanted if patient sees dentist

Touch only tooth’s crown

Do not clean or scrub tooth

Place in container of milk or clean water

• Get patient and tooth to dentist


Burns


Burns

• Major cause of death and injury

• Caused by sun, heat, chemicals, electricity


Assessing a Heat Burn

• Perform the standard assessment

• Consider:

- Burn depth

- Burn size or extent

- Respiratory involvement

- Specific body areas burned

- Patient’s age and health status


Classification of Burns

• Superficial

• Partial-thickness

• Full-thickness


Superficial Burns

• Also called first-degree burns

• Damage only outer layer (epidermis)

• Skin is red, dry, painful

• Some swelling may occur

• Usually minor except for extensive area


Partial-Thickness Burns

• Also called second-degree burns

• Damage skin’s deeper layer (dermis)


Partial-Thickness Burns (continued)

• Skin is red, mottled, very painful

• Blisters and weeping clear fluid may be present

• Often need medical attention


Full-Thickness Burns

• Also called third-degree burns

• Damage through subcutaneous layer and may include muscle and other tissues


Full-Thickness Burns (continued)

• Skin is charred and blackened or white, yellow, tab

• Burn feels leathery

• Pain is not present but likely in adjacent areas

• Medical emergency


Assessing Burn Size and Severity

Rule of Nines


Emergency Burns by Size

• Burn size influences whether shock and complications develop

• Emergencies:

- Any full-thickness burn >50-cent piece

- Partial-thickness burn >10% of adult body (5% of child or older adult)

- Superficial burn over >50% of body


Assess Burn Location

• Partial- or full-thickness burns on face, genitals, hands or feet need immediate medical care

• Circumferential burns should receive immediate medical attention

• Burns around nose and mouth may affect breathing and are medical emergencies


Assess Burned Patient’sAge and Health

• Burns in those <5 or >55 are more serious

• Chronic health disorders make burns more serious


Principles of Care for Heat Burns

• Cool with cold water except for burn over 20% of body or 10% in child

- Cool as long patient feels pain

- Continually add fresh water

• Protect burned area from additional trauma and pathogens

• Provide supportive care


Emergency Care for Heat Burns



• Remove the heat source and smoldering clothing

• Cool burn with sterile or clean room-temperature water or cold running tap water (except large, full-thickness burns)


Emergency Care for Heat Burns (continued)

• Remove constricting clothing and jewelry

• If clothing sticks cut around it

• Treat for shock

• Cover burn with non-stick dressing use sheet over large area


• Don’t apply cream or ointment

• Don’t break blisters


Emergency Care for Heat Burns (continued)

• Don’t give patient anything to drink

• Monitor breathing and give BLS if needed

• For large burns in children:

- Keep environment warm

- With suspicious pattern of burn marks, consider possibility of child abuse


Smoke Inhalation


Smoke Inhalation

• Airway may swell and make breathing difficult

• Damage to alveoli may affect ability to receive oxygen

• Carbon monoxide poisoning may also have occurred


Signs and Symptoms of Smoke Inhalation

• Coughing, wheezing, hoarse voice

• Possible burned area

• Blackening on face or chest

• Difficulty breathing


Care for Smoke Inhalation


• Get patient to fresh air, or fresh air to patient


• Help position into easy breathing

• Put unresponsive patient in recovery position

• Monitor breathing

• Be ready to give BLS if needed


Chemical Burns


Chemical Burns

• Strong chemicals can burn skin on contact

• Sometimes burns develop slowly

• Acids, alkalis, liquids and solids can cause burns

• Flush substance off skin with water as soon as possible

• Check Material Safety data Sheet in work settings


Signs and Symptomsof Chemical Burns

• Pain or burning sensation

• Chemical on patient’s skin or clothing

• Spilled substance on or around unresponsive patient

• Smell of fumes


Emergency Care for Chemical Burns


• Send someone for the Material Safety Data Sheet

• Wear gloves and eye protection

• Move patient or ventilate area

• With dry chemicals, brush off skin


Emergency Care for Chemical Burns (continued)

• Flush area as soon as possible with copious running water until additional EMS personnel arrive


Emergency Care for Chemical Burns (continued)

• Don’t try to neutralize an acid with an alkaline or vice versa

• Remove clothing and jewelry while flushing

• With a splash injury, consider possibility of an eye burn

• With chemical in the eye, flush with running water until additional EMS personnel arrive


Electrical Burns and Shocks


Electrical Burns and Shocks

• Occur when body contacts electricity

• Typical injuries occur with faulty appliances or power cords or appliance in contact with water


Injuries From Electricity

• External burns caused by heat of electricity

• Electrical injuries caused by electricity flowing inside body

• High-voltage electricity in body can cause heart rhythm irregularities that threaten circulation or cause heart to stop

• Patient may be in cardiac arrest on your arrival


Signs and Symptoms ofElectrical Injury

• Source of electricity nearby

• External entrance and exit wounds

• Unresponsiveness, seizures, changing levels of responsiveness

• Breathing abnormalities

• Weak or irregular pulse

• Can cause unseen severe internal injuries


Emergency Care for Electrical Burns


• Don’t touch patient until area is safe

• Stop burning and cool area

• Remove clothing and jewelry

• Cover burn with a sterile dressing

• Treat for shock

• Maintain normal body temperature


Emergency Care for Electrical Burns (continued)

• Keep unresponsive patient in recovery position

• Monitor breathing and vital signs

• Assume patient with lightning strike or high-voltage shock has spinal injury stabilize head and neck

• Care for shock and give BLS as needed

© 2011 National Safety Council 17-1 SOFT-TISSUE INJURIES LESSON 17.

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Transcript of © 2011 National Safety Council 17-1 SOFT-TISSUE INJURIES LESSON 17.