Ch.27 Softtissueinjuries

Question 1

Injury causes by pressure to enclosed body surfaces, for example, from too much pressure in the lungs. Commonly seen in blast injury victims

Answer 1

Barotrauma

Question 2

Death resulting from soft-tissue injury is often related to___. Uncontrolled hemorrhage can quickly lead to shock and death. When the skin barrier is breached, invading pathogens— bacteria, fungi, and viruses-can cause local or systemic infection. Infection can be life or limb threatening, especially in children, older adults, and people with diabetes or other conditions that may compromise the immune system.

Answer 2

hemorrhage or infection

Question 3

The___ is our first line of defense against external forces and infection. It is also the largest organ in the body. Although it is relatively tough, skin is still quite susceptible to injury. Injuries to soft tissues range from simple bruises and abrasions to serious lacerations and amputations. Soft-tissue injury may result in exposure of deep structures such as blood vessels, nerves, and bones. In all instances, you must control bleeding, prevent further contamination to decrease the risk of infection, and protect the wound from further damage. Therefore, you must know how to apply dressings and bandages to various parts of the body.
Skin varies in thickness, depending on a person’s age and the area the skin covers. The skin of the very young and the very old is thinner than the skin of a young adult. The skin covering the scalp, the back, and the soles of the feet is quite thick, whereas the skin of the eyelids, lips, and ears is very thin. Thin skin is more easily damaged than thick skin.

Answer 3

skin

Question 4

The skin has two principal layers : the ___ and the __

Answer 4

Epidermis and the dermis

Question 5

The epidermis is the tough, external layer that forms a watertight covering for the body. The epidermis contains several layers. The cells on the surface layer of the epidermis are constantly worn away. They are replaced by cells that are pushed to the surface when new cells form in the___ at the base of the epidermis. Deeper cells in the____ contain pigment granules. Along with blood vessels in the dermis, these granules produce skin color.

Answer 5

germinal layer

Question 6

The___ is the inner layer of the skin. It lies below the germinal cells of the epidermis. The___ contains the structures that give the skin its characteristic appearance: hair follicles, sweat glands, and sebaceous glands.

Answer 6

dermis

Question 7

The __ primary function is to cool the body. They discharge sweat into the surface of the skin through small pores, or ducts, that pass through the epidermis

Answer 7

The sweat glands

Question 8

___ produce sebum, the oily material that waterproofs the skin and keeps it supple. Sebum travels to the skins surface along the shaft of adjacent hair follicles.

Answer 8

Sebaceous glands

Question 9

___ are small organs that produce hair. There is one follicle for each hair, each connected with a sebaceous gland and a tiny muscle. This muscle pulls the hair erect whenever a person is cold or frightened

Answer 9

Hair follicles

Question 10

___in the dermis provide the skin with nutrients and oxygen. Small branches reach up to the germinal cells,
but___ do not penetrate farther into the epidermis. The dermis also contains specialized nerve endings.

Answer 10

Blood vessels

Question 11

The skin covers all external surfaces of the body. The various openings in the body, including the mouth, nose, anus, and
vagina, are not covered by skin. Instead, these openings are lined with__. Similar to skin, these membranes provide a protective barrier against bacterial invasion, but____ differ from skin in that they secrete a watery substance that lubricates the openings. Therefore, mucous membranes are moist, whereas skin is generally dry.

Answer 11

mucous membranes

Question 12

The linings of body cavities and passages that communicate directly or indirectly with the environment outside the body

Answer 12

Mucous membranes

Question 13

The___ serves many functions. It protects the body by keeping pathogens out and fluids in, and it helps regulate body temperature. The nerves in the___ report to the brain on the environment and on many sensations. It is this nerve pathway connection that allows the body to adapt to environments through responses in the skin and surrounding tissues.

Answer 13

skin

Question 14

The skin is the body’s major organ for regulating temperature. In a cold environment, the blood vessels in the skin____, diverting blood away from the skin and decreasing the amount of heat that radiates from the body’s surface. In hot environments, the vessels in the skin. The skin becomes flushed or red, and heat radiates from the body’s surface. In addition, sweat glands secrete sweat to help cool the body. As the sweat evaporates from the skin’s surface, the body temperature drops, and the person begins to cool down.

Answer 14

constrict

dilate

Question 15

Any break in the skin allows bacteria to enter and increases the possibilities of____, fluid loss, and loss of temperature control. Any one of these conditions can cause serious illness and even death. Soft tissues are often injured because they are exposed to the environment.

Answer 15

infection

Question 16

There are three types of soft-tissue injuries

Answer 16

Closed injuries
Open injuries
Burns

Question 17

In which soft-tissue damage occurs beneath the skin or mucous membrane but the surface of the skin or mucous membrane remains intact

Answer 17

Closed injuries

Question 18

In which there is a break in the surface of the skin or the mucous membrane, exposing deeper tissues to potential contamination

Answer 18

Open injuries

Question 19

In which the soft tissue damage occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation

Answer 19

Burns

Question 20

Wounds heal in a natural process that involves several overlapping stages, all directed toward the larger goal of maintaining____ or balance. Ultimately, the goal is for the body to return to a functional state, although the injured area may not always be restored to its preinjury state.

Answer 20

homeostasis

Question 21

Among the primary concerns in wound healing is the cessation of__. Loss of blood, internal or external, hinders the provision of vital nutrients and oxygen to the affected area. It also impairs the tissue’s ability to eliminate wastes. The result is abnormal or absent function, which interferes with homeostasis. To stop the flow of blood, the vessels, platelets, and clotting cascade must work in unison.

Answer 21

bleeding

Question 22

During____ (the next stage of wound healing), additional cells move into the damaged area to begin repair. White blood cells migrate to the area to combat pathogens that have invaded exposed tissue. Foreign products and bacteria are also removed from the body. Similarly, lymphocytes (a type of white blood cell) destroy bacteria and other pathogens. Mast cells release histamine as part of the body’s response in the early stages of inflammation. Histamine dilates blood vessels, increasing blood flow to the injured area and resulting in a reddened, warm area immediately around the site. Histamine makes capillaries more permeable, and swelling may occur as fluid seeps out of these “leaky” capillaries. Inflammation ultimately leads to the removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site.

Answer 22

inflammation

Question 23

In the outer layer of__, cells are stacked in layers. To replace the area damaged in a soft-tissue injury, a new layer of cells must be moved into this region. This is the next stage of wound healing. Cells quickly multiply and redevelop across the edges of the wound. Except in cases of clean incisions, the appearance of the restructured area seldom returns to the preinjury state. For example, large wounds or injuries that result in significant disruption of the skin will often not complete this process. People with lightly pigmented skin may see a pink line of scar tissue signaling the presence of collagen, a structural protein that has reinforced the damaged tissue. Despite the changed appearance, the function of the area may be restored to near normal. Tissue injuries may be difficult to detect in dark skin.

Answer 23

skin

Question 24

During the next stage of wound healing, new___ form as the body attempts to bring oxygen and nutrients to the injured tissue. New capillaries bud from intact capillaries that lie adjacent to the damaged skin. These vessels provide a channel for oxygen and nutrients and serve as a pathway for waste removal. Because they are new and delicate, bleeding might result from a very minor injury. It may take weeks to months for the new capillaries to be as stable as preexisting vessels

Answer 24

blood vessels

Question 25

___is a tough, fibrous protein found in scar tissue, hair, bones, and other connective tissues. In the last stage of wound healing,___ provides stability to the damaged tissue and joins wound borders, thereby closing the open tissue. Unfortunately, collagen cannot restore damaged tissue to its original strength.

Answer 25

Collagen

Question 26

A__, or bruise, is an injury that causes bleeding beneath the skin but does not break the skin.___ result from blunt forces striking the body. The epidermis remains intact, but cells within the dermis are damaged, and small blood vessels are usually torn. The depth of the injury varies, depending on the amount of energy absorbed. As fluid and blood leak into the damaged area, the patient may have swelling and pain. The buildup of blood produces a characteristic blue or black discoloration called ecchymosis

Answer 26

contusion

Question 27

A___ is blood that has collected within damaged tissue or in a body cavity (FIGURE 27-3). A___ occurs whenever a blood vessel is damaged and bleeds into the surrounding tissues. It is often associated with extensive tissue damage. A hematoma can result from a soft-tissue injury, a fracture, or any injury to a blood vessel. In severe cases, the hematoma may contain more than 1 liter of blood.

Answer 27

hematoma

Question 28

A ____occurs when significant force is applied to the body (FIGURE 27-4). The extent of the damage depends on how much force is applied and how long it is applied. In addition to causing direct soft-tissue damage, continued compression of the soft tissues cuts off circulation, producing further tissue destruction. For example, if a patient's legs are trapped under a collapsed pile of rocks, damage to the leg tissues will continue until the rocks are removed

Answer 28

crushing injury

Question 29

When an area of the body is trapped for longer than 4 hours and arterial blood flow is compromised,___ can develop. When a patient's tissues are crushed beyond repair, muscle cells die and release harmful substances into the surrounding tissues. The oppressing force prevents blood from returning to the injured body part, so these harmful substances are released into the body's circulation only after the limb is freed and blood flow is returned. For this reason, when possible, if a patient has been trapped with a crushing object for a prolonged period of time, advanced life support (ALS) providers should administer intravenous (IV) fluid before the crushing object is lifted off the body. Freeing the limb or other body part from entrapment results in the release of the by-products of metabolism and harmful products of tissue destruction, and as a result it can create the potential for cardiac arrest and renal failure. Consider requesting ALS assistance for situations of prolonged entrapment prior to extrication.

Answer 29

crush syndrome

Question 30

Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods. This can lead to renal failure and death

Answer 30

Crush syndrome

Question 31

___develops when edema and swelling result in increased pressure within a closed soft-tissue compartment. Because tissues are limited in the amount they can stretch or expand, pressure increases within the compartment, which interferes with circulation. Compartment syndrome commonly develops in the extremities and may occur in conjunction with open or closed injuries or when swelling occurs under restrictive immobilization devices such as a cast. As pressure develops, delivery of nutrients and oxygen is impaired and by-products of normal metabolism accumulate. This causes pain that worsens with passive movement of the tissues within the compartment. Signs of impaired circulation may also be present. The longer this situation persists, the greater the chance for tissue death. Continually reassess skin color, temperature, and pulses distal to the injury site during transport if compartment syndrome is suspected. Severe closed injuries can also damage internal organs. The greater the amount of energy absorbed from the blunt force, the greater the risk of injury to deeper structures. Therefore, you must assess all patients with closed injuries for more serious hidden injuries. Remain alert for signs of shock or internal bleeding, and begin treatment of these conditions if necessary.

Answer 31

Compartment syndrome

Question 32

Swelling in a confined space that produces dangerous pressure; mat cut off blood flow or damage sensitive tissue

Answer 32

Compartment syndrome

Question 33

Open injuries differ from closed injuries in that the protective layer of skin is damaged. This can produce extensive bleeding. A break in the protective skin layer or mucous membrane also means that the wound is contaminated and may become infected.____ is the presence of infectious organisms (pathogens) or foreign bodies, such as dirt, gravel, or metal, in the wound. You must address excessive bleeding and contamination in your treatment of open soft-tissue wounds. There are four types of open soft-tissue wounds that you must be prepared to manage: • Abrasions • Lacerations • Avulsions • Penetrating wounds

Answer 33

Contamination

Question 34

An___ is a wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a 967 rough or hard surface. An____ usually does not penetrate completely through the dermis, but blood may ooze from the injured capillaries in the dermis. Also known as road rash, road burn, strawberry, and rug burn, abrasions can be extremely painful because the nerve endings are located in this area

Answer 34

abrasion

Question 35

A____ is a jagged cut in the skin caused by a sharp object or a blunt force that tears the tissue, whereas an____ is a sharp, smooth cut. The depth of the injury can vary, extending through the skin and subcutaneous tissue, even into the underlying muscles and adjacent nerves and blood vessels (FIGURE 27-6). Lacerations and incisions may appear linear (regular) or stellate irregular) and may occur along with other types of soft-tissue injury. Lacerations or incisions that involve arteries or large veins may result in severe bleeding.

Answer 35

laceration incision

Question 36

An___ is an injury that separates various layers of soft tissue (usually between the subcutaneous layer and fascia) so they become either completely detached or hang as a flap (FIGURE 27-7). Often there is significant bleeding. If the avulsed >7 tissue is hanging from a small piece of skin, the circulation through the flap may be at risk. If you can, replace the flat avulsed flap in its original position as long as it is not visibly contaminated with dirt and/or other foreign materials. If an avulsion is 9 complete, you should wrap the separated tissue in sterile gauze and take it with you to the ED. This type of avulsion often has serious risk for infection. Never remove an avulsion skin flap, regardless of its size.

Answer 36

avulsion

Question 37

An___ is an injury in which part of the body is completely severed. Chapter 32, Orthopaedic Injuries, covers this topic in detail. We usually think of amputations as involving the upper and lower extremities. But other body parts, such as the scalp, ear, nose, penis, or lips, may also be totally avulsed or amputated. You can easily control the bleeding from some amputations, such as a finger, with direct pressure and pressure dressings. If an amputation involves a large area of muscle mass, such as a thigh, there may be massive bleeding. In this situation, you should stop the bleeding, which often requires a tourniquet, and treat the patient for hypovolemic shock. For more information see Chapter 26, Bleeding.

Answer 37

amputation

Question 38

A___ (or puncture wound) is an injury resulting from a piercing object, such as a knife, ice pick, splinter, or bullet. Such objects leave relatively small entrance wounds, so there may be little external bleeding (FIGURE 27-8). However, these objects can damage structures deep within the body and cause unseen bleeding. If the wound is to the chest or abdomen, the injury can cause rapid, fatal bleeding. Assessing the amount of damage caused by a puncture wound is difficult and is reserved for the physician at the hospital.

Answer 38

penetrating wound

Question 39

Objects that penetrate the skin but remain in place are referred to as___. The concerns with this type of injury include the amount of damage to structures deep inside the body and the presence of foreign materials deep inside the tissue. The damage to underlying structures is difficult to determine and manage, and the presence of foreign materials inside the tissue results in a significantly higher risk of infection. An impaled object also requires specific treatments and care, described later in this chapter.

Answer 39

impaled objects

Question 40

Treat all penetrating wounds of the neck, chest, back, and upper abdomen with an___ to prevent the possible movement of air into the vascular space, thoracic cavity, and/or abdominal cavity.

Answer 40

occlusive dressing

Question 41

___: Injuries to the body caused by the blast wave itself; damage to the body is caused by the sudden pressure changes generated by the explosion.

Answer 41

Primary blast injury

Question 42

___: Injuries caused to the body from being struck by flying debris propelled by the force of the blast. These small objects may cause multiple penetrating wounds.

Answer 42

Secondary blast injury

Question 43

___: Injuries to the body from being thrown or hurled by the force of the explosion into an object or onto the ground

Answer 43

Tertiary blast injury

Question 44

A patient with massive hemorrhage may require a tourniquet___ the airway is opened. If the patient has obvious life-threatening external bleeding, control the bleeding first, before airway and breathing, then assess and treat the XABCs, and treat for shock.

Answer 44

before

Question 45

Estimating blood loss is very difficult, and even the most skilled providers are often not able to accurately estimate blood loss, especially when blood has been absorbed into fabrics or porous surfaces. Note that blood has soaked through a towel, an article of clothing, or the number of bandages used to control the patient's bleeding as these are valuable descriptors for the ED staff.

Answer 45

Words of wisdom

Question 46

Small contusions generally do not require special emergency medical care, but you should note their presence when trying to determine the true extent of the patient's injuries. More extensive closed injuries may involve significant swelling and bleeding beneath the skin, which could lead to hypovolemic shock. Depending on the time the injury occurred and the response time, the injuries might not have had time to cause swelling or bruising. Closely watch any area of injury throughout the time you are caring for the patient, no matter how minor it may look on initial assessment. Treat a closed soft-tissue injury by applying the mnemonic RICES:

Answer 46

• Rest. Keep the patient as quiet and comfortable as possible • Ice. Use ice or cold packs to slow bleeding by causing blood vessels to constrict and to reduce pain. • Compression. Apply pressure over the injury site to slow bleeding by compressing the blood vessels. • Elevation. Raise the injured part just above the level of the patient's heart to decrease swelling. • Splinting. Immobilize a soft-tissue injury or an injured extremity to decrease bleeding and reduce pain.