Chap 26 Flashcards
Bite wound
infections tend to be higher
Different injuries during a blast
A. Pressure wave/ Primary injury -Pressure injuries B. Blast wave/ Secondary injury -Pieces of projectile causing injury C. Patient Displacement/ Tertiary injury -Blast wind may propel the patient D. Patient exposed to hazardous material or structural collapse/ Quaternary injury
Hard tissue
Teeth
bones
cartilage
Soft tissues
Skin fatty tissues muscles blood vessels connective tissue membranes (tissue that line or cover organs) glands nerves
MSDS
Material safety data sheet
Electrical injuries
Alternating current, direct current, and lightning
-Damage is cause by heat and forceful contraction of muscle tissue
Signs and symptoms
- Burns where energy enters and exit the body
- Disrupted nerve pathways displayed as paralysis
- Muscle tenderness, with or without muscular twitching
- Respiratory difficulties or respiratory arrest
- Irregular heartbeat or cardiac arrest
- Elevated blood pressure or low blood pressure with the signs and symptoms of shock
- Restlessness or irritability if conscious or loss of consciousness
- Visual difficulties
Abrasions
a scratch or scrape
Outer layer is damaged but inner layers intact
Range in severity from skinned elbows and knees, road rash, mat burns, rug burns and brush burns
May be no detectable bleeding or only minor ooze of blood from capillaries
Classification of burns in children under 5
Minor burns
-Partial thickness burns of less than 10%
Moderate burns
-Partial thickness burns of 10-20%
Critical burns
-Full thickness burns of any extent or partial thickness burns of more than 20%
hydrofluoric acid
Acid used for etching glass. Burns may be delayed. Flood affected area with water
Radiological burns
Radiation is a form of energy in which electromagnetic waves travel through space and through matter such as human bodies.
- Sun burns is a benign immediate radiation burn
- Delayed radiation burn effects develop in the form of radiation sickness
pressure dressing
a dressing applied tightly to control bleeding
aseptic
free from contamination caused by harmful bacteria, viruses and other microorganisms
High pressure injection injuries
Machines that inject substances (grease, paint, air) into the patient at high pressures. Damage from extensive tissue damage and from toxic substances. Can have no apparent injury on outside.
Treatment- Elevate and splint limb. Although the patient complains of pain, do not apply cold.
Treatment for impaled objects
- Expose the wound
- Control profuse bleeding by direct pressure
- Manual stabilization of object till stabilizing dressings are secured in place
- Secure the dressings on place
- Cravats should be no less than 4 inches in width once folded
- Care for shock
- Keep the patient at rest
- Transport
- Reassure
Mixed or strong acids or unidentified substances
The pain produced from the initial chemical burn may mask any pain being caused by renewed burning due to small concentration left on skin.
-Continue to wash patient even though patient claims he is no longer experiencing pain
Amputation
Never immerse in water or saline
Don’t let the part come in direct contact with ice
Universal dressing (multitrauma)
a bulky dressing
Full thickness burn
- all layers of skin are damaged.
- 3rd degree burns
- Charred black or brown or areas of dry and white
- may complain of severe pain or no pain if nerve endings have been damaged
- May require skin grafting
Subcutaneous layers
Shock absorption and insulation layer made of fat and soft tissue
Rule of palm (Palmar method or rule of one)
Uses the patients own hand too approximate the surface area. Each palm is equal to 1%
Care for thermal burns
- Stop the burning process
- Flame-Wet down, smother, then remove any affected clothing
- Semi-solid (grease, tar, wax) Cool with water. Do not removed the substance.
- Ensure airway. assess breathing
- Look for signs of airway injury
- Complete primary
- Treat for shock
- Evaluate burns by depth, extent (rules of nines) and severity
- Do not clear debris. Remove clothing and jewelry
- Wrap with dry sterile dressing
- Burns to hands and feet. Separate fingers or toes with sterile gauze pads
Dry lime
-Dry lime is a burn agent, do not wash the burn site with water. Use water only after the lime has been brushed from the body
Steps for open wounds
- Expose wound
- Clean wound if bleeding isn’t a priority
- Control bleeding
- Provide care for shock if needed
- Prevent further contamination
- bandage the dressing in place after you have controlled the bleeding. If an extremity, check distal pulse
- Keep the patient lying still
- Reassure the patient
Contusion
A bruise, the most frequently encountered type of closed wound. In a contusion the epidermis remains intact but cells and blood vessels in the dermis are damaged. Pain, swelling and discoloration occur at the wound site. Swell and discoloration may occur immediately or may be delayed as much as 48 hours
Sulfuric acid
Heat is produced when water is added but it is still preferable to wash rather than leave the contaminant on the skin
Critical burns
All burns complicated by injuries of the respiratory tract, other soft tissue injuries, and injuries of the bones.
- Partial thickness or full thickness burns involving the face, hands, feet, genitalia or respiratory tract
- Full thickness burns of more than 10%
- Partial thickness burns of more than 30%
- Burns complicated by musculoskeletal injuries
- Circumferential burns
Potential harmful chemicals in fires
Carbon monoxide and hydrogen cyanide
occlusive dressing
any dressing that forms an airtight seal
- Two types
- Plastic wrap
- Petroleum-gel-impregnated gauze occlusive dressing
Hematoma
Occurs when blood collects at the site of an injury. A hemotoma differs from a contusion in that hemotomas involve a larger amount of tissue damage, including damage to larger blood vessels with greater internal blood loss. as much as a liter of blood can be loss
Burn classified and evaluated 3 ways
- By agent and source
- By depth
- By severity (surface area)
Moderate burns
- Fill thickness burns of 2-10% excluding the face, hands, feet, genitalia or respiratory tract
- Partial thickness burns of 15-30%
- Superficial burns of more than 50%
Dressing bandage
any material used to cover a wound that will help control the bleeding and prevent additional contamination
Carbolic acid (phenol)
Doesn’t mix with water. use alcohol for the initial wash of unbroken skin, followed by a steady wash with water
Agents and sources of burns
Thermal- Flame radiation; excessive heat from fire, steam, hot liquids and hot objects
Chemical- Various acids, bases and caustics
Electricity- Alternating current, direct current, and lighting
Light (typically involving the eyes)- Intense light sources; ultraviolet light can also be considered a source of radiation burns
Radiological- Usually from nuclear sources; ultraviolet light can also be considered a source of radiation burns
Minor burns
- Full thickness burns of less than 2% excluding face, hands, feet, genitalia, or respiratory tract
- Partial thickness burns of less than 15%
- Superficial burns of 50% or less
Dermis
the inner second layer of the skin found beneath the epidermis. Rich with blood vessels, nerves, sweat glands, sebaceous (oil) glands and hair follicles
lacerations
A cut
- Often caused by an object with a sharp edge, such as a razor blade, broken glass, or jagged piece of metal
- lacerations can also result from a severe blow or impact with a blunt object
Two special problems occur when bandaging an extremity
- Point pressure can occur if you bandage around a small area. It is best to wrap a large area, ensuring a steady, uniform pressure
- You can bandage across joints, but don’t bend the limb once the bandage is in place. Doing so may restrict circulation
Burns less than 10%
apply moist dressing for partial thickness burns to less than 10% and dry dressings for more severe cases
Superficial burn
- Epidermis
- 1st degree burns
- reddening of the skin and perhaps swelling
Crush injury
an injury caused when force is transmitted from the bodys exterior to its internal structures. Bones can be broken; muscles, nerves and tissue damaged and internal organs ruptured, causing internal bleeding
bandage
any material used to hold a dressing in place
amputation
the surgical removal or traumatic severing of a body part, usually an extremity
Electrical injuries care
- Provide airway and breathing care
- Provide basic cardiac life support
- Care for shock and apply O2
- Care for spine injuries, head injuries and severe fractures
- Evaluate electrical burns, looking for at least two external burn sites
- Cool the burn areas and smoldering clothes as you would for a flame burn
- Apply dry sterile dressing to the burn site
- Transport
Inhaled vapors
caustic chemicals
-Provide high O2
Circumferential burns
- burns that encircle the body or a body part
- Can be very serious because they constrict the skin. When they occur to an extremity, they can interrupt circulation to the distal tissues
Avulsions
flaps of skin and tissue are torn loos or pulled off completely
Partial thickness burn
- Epidermis is burned through and the dermis is damaged
- 2nd degree burns
- Deep intense pain
- Reddening, blisters and a mottled (spotted) appearance to the skin
- Swelling and blisters for 48 hours after injury, as plasma and tissue are released and rise to the top layer of skin
Epidermis
outer layer of skin. composed of mostly dead skin
Burns to eyes
Do not open the patients eyelids if burned. Be certain the burn is thermal, not chemical. Apply sterile gauze pads to both eyes to prevent sympathetic movement. If burn is chemical, flush eyes for 20 minutes en route to the hospital
Puncture wound
an open wound that tears through the skin and destroys underlying tissue.
A perforating puncture wound has both an entrance and exit wound
Blast injuries
High velocity winds and overpressure High velocity penetrating trauma ruptured hollow organs liquid filled organs Air filled organs
Usually not as evident as external injuries
Rules of nines
a method for estimating the extent of a burn. Each of the following areas of an adult represent 9%. -Head and neck -Each upper extremity -Chest -Abdomen -Upper back -Lower back -Buttocks -front of each lower extremity -Back of each lower extremity -1% for genital region
Infants and children equals 101 -Head and neck-18 -Chest and abdomen- 18 -Back-18 -Each upper extremity- 9 -Each lower extremity- 14 -Genital region- 1 Some systems count the lower extremities as 13.5 to equal a total of 100
