Ch 26, Soft Tissue Injury Flashcards
Closed Injuries
Soft tissue damage occurs beneath the skin or mucous membrane
Open injuries
Break in the surface skin or mucous membrane
Burns
Soft tissue damage is from thermal heat, frictional heat, toxic chemicals, electricity, or radiation
Primary Blast Injury
Caused by the blast wave itself
Secondary blast injury
Caused by flying debris propelled by the force of the blast
Tertiary blast injury
Injuries to the body from being thrown by the force of the explosion
Contusion
Bruise, causes bleeding under the skin without breaking the skin.
Ecchymosis
Coloration of the bruse. Blue/black
Crushing injury
When body is put under significant force. The damage depends on how long it is under that force
Crush syndrome
Area of body is trapped longer than 4 hours, arterial blood flow is compromised
What does ALS do before removing the object crushing the patient and why?
Administer an IV. So harmful byproducts of cell death are less harmful when circulation is returned.
Compartment syndrome
Edema and swelling within a closed soft tissue compartment. Can interfere with circulation. Can lead to renal failure and death. Relieved by performance of a Fasciotomy (a surgical procedure where the fascia is cut to relieve tension or pressure). Common in crush injuries
Contamination
Presence of infectious organisms or foreign bodies in the wound
Four types of open, soft tissue wounds
Abrasions
Lacerations
Avulsions
Penetrating
3 rules for an impaled object
- Do not move or remove UNLESS it is causing airway obstruction OR you need to do CPR and it is in the chest blocking you from doing so.
- Remove clothing covering the injury. Control bleeding with bulky dressings and surround the object with them (stabilize it)
- Protect object from being moved during transport
Avulsion
Injury in which the soft tissue is torn completely loose or is hanging as a flap
Contact burn
Burn caused by direct contact with a hot object
Dermis
Inner layer of skin containing hair follicles, sweat glands, nerve endings and blood vessels
Epidermis
Outer layer of skin that acts as a watertight protective covering
Evisceration
The displacement of organs outside of the body – do not touch or attempt to replace in the body, instead cover with a large moist dressing (no 4x4s)
Excited delirium
Serious behavioral condition in which a person exhibits agitated behavior combined with disorientation, hallucinations or delusions, also called agitated delirium or exhaustive mania
Fascia
The fiberlike connective tissue that covers arteries, veins, tentons and ligaments
Flame burn
Burn caused by an open flame
Flash burn
Burn caused by exposure to very intense heat such as in an explosion
Full-thickness burns
Third degree burn that affects all skin layers and may affect the subcutaneous layers, muscle, bone and internal organs. Characterized by dry, leathery, white/gray, dark brown or charred skin
Hematoma
blood collected within the body’s tissues or in a body cavity. Occurs when a large blood vessel is damaged and bleeds
Incision
A sharp, smooth cut in the skin
Occlusive dressing
dressings made of petroleum (vaseline) gauze, aluminum foil or plastic that prevent air and liquids from entering or exiting a wound
Partial-thickness burn
Second degree burn that affects the epidermis and some portion of the dermis but not the subcutaneous layer, characterized by blisters and skin that is white to red, moist and mottled
Rule of nines
Assigns percentages to sections of the body, allowing the calculation of the amount of skin surface area (BSA) involved in a burn
ADULT: Head (9), Arm (9), Arm (9), Chest (18), Back (18), Leg (18), Leg (18), Genitalia (1)
CHILD: Head (12), Arm (9), Arm (9), Chest (18), Back (18), Leg (16.5), Leg (16.5), Genitalia (1)
INFANT: Head (18), Arm (9), Arm (9), Chest (18), Back (18), Leg (13.5), Leg (13.5), Genitalia (1)
Scald burn
Burn caused by contact with hot liquids
Steam burn
Burn caused by exposure to hot steam
Superficial burn
First degree burn that affects only the epidermis and characterized by red skin that is not blistered
Thermal burns
Caused by heat (111 degrees F or higher)
GSW
Gunshot wound, the amount of energy transmitted by a GSW is directly related to the speed of the bullet. GSW create multiple paths of missiles (shots) and create a large surface area and volume of tissue damage
Air embolism
When enough air is sucked into a blood vessel it can block the flow of blood into the lungs and cause cardiac arrest
Animal bites
Consider all small animal bites as contaminated
Severe burn
Any full-thickness burn
Partial-thickness burns covering more than 20% BSA
Moderate burns
Partial-thickness burns covering 10-20% BSA
Minor burns
Partial-thickness burns covering less than 10% BSA
Burns/soot around mouth or nose or singed nasal hair
If any of these findings are present in the Secondary Exam, open the patient’s mouth and examine for burns or swelling to the tongue. Ask the patient to cough and assess for black spit, which is a sign of smoke inhalation
Inhalation burn
Inhalation injuries that occur when burning takes place in enclosed spaces without ventilation and the upper airway is exposed to excessive heat and can seriously compromise the airway.
CO Intoxication
Should be considered whenever a group of people in the same place all report a headache or nausea. Patients appear “Cherry Red” ad may have a normal O2 saturation
Chemical burns
Burns from contact with toxic substances. Treatment may be specific to the toxic agent (i.e. flush phenol burns with alcohol). Dust away if a dry chemicals, remove patient’s clothing, flush the area with large amounts of water
Radiation burns
Three types of ionizing radiation:
Alpha – easily stopped by skin
Beta – greater penetrating power but can be blocked by protective clothing
Gamma – threat is directly proportional to wavelength
Mild sickness at ~1-2 grays (100-200 rads)
Moderate sickness at ~2-5gy
Severe Sickness at ~4-6gy
Irrigate open wounds, increase patient distance from source, HazMat
Inhalation burns
Burning of the airway because of superheated air/gasses
Chemical Burn
Toxic substance contacts the body
Radiation burns (particles)
Alpha, beta, and gamma particles
Alpha particles
Easily stopped by skin
Beta particles
Can penetrate body but can be blocked by special use clothing
Gamma particles
The most dangerous, can pass through body and materials
Radiation sickness levels
Mild 1-2 Gy
Moderate 2-5 Gy
Severe 4-6 Gy
Death 8 or above
More extensive closed injuries ma involved significant swelling and bleeding beneath the skin, which could lead to _________
Hypovolemic shock
Because shootings usually end up in court it is important to factually and completely document _______
The treatment given
Splinting an extremity even when there is no fracture may ___________
make it easier to move the patient
Treatment for an abdominal evisceration includes _________________________
Flexing the knees and legs to relieve pressure on the abdomen
________ burns cause intense pain
Second-degree/Partial-thickness
The most important consideration when dealing with electrical burns is _______
Scene safety
Treatment of electrical burns should NOT include
Immersion in water
Using elastic bandages to secure a dressing may result in ___________ if the injury swells or if the bandages are applied improperly
Additional tissue damage