Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues...

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Transcript of Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues...

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Soft-Tissue Injuries Slide 2 Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves Slide 3 Major functions of the skin Protection Water balance Temperature regulation Excretion Shock absorption Layers Epidermis Dermis Subcutaneous Slide 4 Closed wounds Internal injury, impact from blunt object Types Contusion Hematoma Larger blood vessels Crush injury severe bleeding and shock Slide 5 Patient Assessment MOI and presence of shock Care Standard precautions ABCs and O2 Splint painful, swollen, deformed extremities Be observant for vomiting Monitor for shock Rapid Transport Slide 6 Open Wounds Abrasions Lacerations Punctures penetrating perforating; entrance and exit wound Avulsions Slide 7 Amputation Crush injuries Care Standard precautions Initial assessment ABCs Severe bleeding Slide 8 Expose the wound Clean Control bleeding If serious, care for shock Prevent further contamination Bandage after bleeding controlled Keep pt. still and reassure In addition Slide 9 Abrasions and lacerations *Check PMS *Distal injury Puncture Wounds *May go to bone *May cause serious internal bleeding *GSW can fx. Bone, causing extensive sof- tissue and injury to organs Slide 10 *Immobilize the spine when patients head is injured *Transport Impaled Objects *Do not remove or put pressure on the object *Stabilize *If needed contact medical direction *Care for shock *Keep Pt. at rest Slide 11 *Transport carefully and ASAP Objects impaled in the cheek *If possible remove same direction it entered *If not possible turn for drainage *Suction as needed *Dress outside, taking care material doesnt enter airway Slide 12 *Monitor mental status *O2 *Care for shock Eye Injury; puncture/impaled object *Stabilize; cup or cone *Dress and bandage uninjured eye *O2 *Care for shock Reassure and provide emotional support Slide 13 Avulsions *Clean *Gently fold the skin back in position *Control bleeding *Dress using bulky pressure dressing Slide 14 *Saving an avulsed part Amputations *Control bleeding bulky pressure dressing *Amputated parts Slide 15 Wounds to the neck *Bleeding control *Remember the characteristics of bleeding arterial venous *Danger of air embolism Slide 16 Care Airway Place gloved hand over wound Occlusive dressing Place dressing over occlusive dressing If needed apply direct pressure do not apply pressure to both carotids at the same time Slide 17 Once bleeding is controlled bandage; do not restrict airway, or arteries and veins when doing so If MOI indicates, immobilize Slide 18 Chest Injuries Pericardial Tamponade Flail chest Sucking chest wound Spontaneous pneumothorax Pneumothorax Subcutaneous Emphysema Slide 19 Chest Injuries Blunt trauma Penetrating trauma Compression Flail Chest Paradoxical motion Slide 20 Pt. Assessment MOI Signs of shock and hypoxia Pt. may become fatigued Care Initial assessment Airway management and O2 Stabilize with bulky dressing Carefully monitor Slide 21 Open Chest Injuries; *Skin of chest wall is broken *Considered to be life-threatening *Assess for perforating puncture wound and treat accordingly Slide 22 Sucking chest wound Care May be gasping for air BLS as indicated Seal O2 Care for shock Rapid transport on injured side if possible Slide 23 Pneumothorax Diminished lung sounds JVD Tracheal deviation Shock Spontaneous pneumothorax Slide 24 Hemothorax and hemopneumothorax Vessels rupture Extensive bruising of face and neck May have bulging eyes, JVD, broken blood vessels in face Signs of shock Slide 25 Traumatic Asphyxia Sudden compression of the chest Severe pressure on the heart and lungs forcing blood out of the right atrium and up into the jugulars Bulging eyes, distended neck veins, and broken blood vessels in the face Slide 26 Cardiac Tamponade Blood in the pericardial sac JVD Signs of shock Narrowing pulse pressure Slide 27 Aortic injury and dissection Injury penetrating trauma Dissection blunt trauma; deceleration injury May complain of pain in chest, abd or back Signs of shock Different pulse/b/p in Right/left arm/leg Do not palpate any pulsating mass Slide 28 Subcutaneous emphysema Slide 29 Abdominal injuries Evisceration Signs and symptoms of abdominal injuries Pain; mild intolerable Cramps Nausea Weakness Thirst Obvious lacerations and puncture wounds Slide 30 Laceration and puncture wounds to the middle and lower back or chest wounds near the diaphragm Large bruised area Intense bruise on the ABD Signs of shock coughing or vomiting of blood Rigid or tender ABD ABD distension Lies still with legs drawn Slide 31 Care Monitor for and manage vomiting Airway Position on back with legs flexed O2 Care for shock NPO Monitor vs Slide 32 Control external bleeding and dress all wounds Do not touch or replace eviscerated parts Do not remove any impaled objects Leave patients legs in place Slide 33 Burns Patient Assessment Classified in three ways Agent and source Depth Severity Slide 34 Agent and source Never assume Gather information scene size-up bystanders patient interview Slide 35 Depth Superficial {1 st degree} Epidermis Reddening Possibly swelling Slide 36 Partial thickness burn Dermis Intense pain Noticeable reddening Blisters Mottled appearance Slide 37 Full thickness All layers Charred black or brown or areas that are brown or white Slide 38 Layers: Epidermis: Outermost most layer Dermis: Deeper layer of the skin; contains sweat and sebaceous glands, hair follicles, blood vessels, and nerve endings Subcutaneous: The third layer of human skin is called the subcutaneous (meaning under the skin) fatty layer. It is made up of fat cells, connective tissue, and blood vessels. It also contains hair roots, from which hair growth takes place. The fat in this layer supplies nutrients to the other two layers. It also cushions the body and protects it from the cold. Slide 39 Severity Agent or source Body region groin, genitalia, buttocks can be serious Circumferential burns can be very serious Depth Extent of burn rule of nines Age infants, children 55 are at greatest risk for death Slide 40 Other illnesses and injuries heart disease, respiratory dis., diabetes Classifying burns by severity Order and type of care, order of transport and destination Infants at higher risk of shock, airway compromise and hypothermia Slide 41 Treating specific types of burns Thermal burns Dry, sterile dressing Never apply ointment, spray or butter Never break blisters Do not apply ice Keep clean Keep pt. warm Slide 42 Chemical burns Scene safety Requires immediate care Flush; copious amts. Of water at least 20 min. Remove all jewelry and clothing without contaminating other areas of body without contaminating yourself Slide 43 If dry chemical, brush off Apply sterile dressing or burn sheet Treat for shock Transport Chemical burns to eyes Immediately flush avoid flushing contaminate to other eye Slide 44 Flush medial to lateral Flush for at least 20 minutes After washing, cover eyes with moistened pads If reoccurring burning or irritation, flush another 5 minutes Slide 45 Specific chemical burns Mixed or strong acids Unidentified substances Continue flushing even if pt. c/o no pain/discomfort Dry lime Brush Take care not to contaminate eyes Slide 46 Flush only after lime has been brushed away from body; should be done quickly and continuously Carbolic acid embalming fluid; herbicides Do not mix with water If available use alcohol for initial flush then flush with water Slide 47 Sulfuric acid Heat is produced but preferable to flush other than leaving on skin Hydrofluoric acid Even if burns arent evident, flush Rapid transport to find neutralizing agent Slide 48 Inhaled vapors High concentration O2 Rapid transport Slide 49 Electrical Injuries Electrical current Lightning Skin is burned where current entered and where it flows to the ground Tissue damage along the path Chemical s takes place in nerves, heart and muscle Slide 50 Scene safety Make sure source of electricity is still active until a qualified person tells you otherwise Do not attempt rescue unless trained and have necessary equipment and personnel Slide 51 Pt. Assessment Burns {entrance and exit wounds} Paralysis disrupted nerve pathways Muscle tenderness, with or without muscle twitching Respiratory distress, or failure, or arrest Irregular heartbeat or cardiac arrest Slide 52 Elevated B/P or hypotension with s/s of shock Restless or irritability if conscious Loss of consciousness Visual difficulties Fractures and dislocations from severe muscle contractions or from falling Seizures; in severe cases Slide 53 Care Airway care may be swelling Cardiac arrest management Care for shock O2 Care for spinal; head injuries and fractures Serious pts should be fully immobilized Slide 54 Elevate electrical burns Cool the burn areas and any smoldering clothing the same as for a flame burn Apply dry, sterile dressing to burn sites Rapid transport Slide 55 Dressing and bandaging Dressing Bandage Dressing open wounds Standard precautions Do not remove unless to control bleeding Slide 56 Bandaging Not too tight, not too loose Do not cover tips of fingers or toes When bandaging a joint, do not bend once wrapped Slide 57