Chapter 25 and 26: bleeding and soft tissue injuries Flashcards
Uncontrolled bleeding is the most common cause of ___________ following a traumatic injury
Hypoperfusion (shock)
The cardiovascular system consists of three parts:
The pump (heart) A container (blood vessels) The fluid (blood and body fluids)
The largest artery in the body
Aorta
Smallest arteries that reach the capillaries
Arterioles
Smallest blood vessels that leave the capillaries
Venules
Perfusion
The circulation of blood within an organ or tissue in adequate amounts to meet the cells current needs for oxygen, nutrients, and waste removal.
The body cannot tolerate an acute blood loss of greater than _______ of the total blood volume
20%
Hypovolemic shock
A condition in which low blood volume results in inadequate perfusion and even death.
Coagulation
A clot that plugs a hole and sealing the injured portions of the blood vessel.
Things you should consider for bleeding to be severe:
- poor general appearance and has no response to external stimuli
- signs and symptoms of shock (hypoperfusion)
- significant amount of blood loss
- blood loss is rapid and ongoing
- you cannot control bleeding
- associated with a significant MOI
Hemophilia
Lacking one or more of the bloods clotting factors
Broken bones (especially ribs) may
Cause serious internal blood loss
Often, the only signs and symptoms of bleeding internally are…
Local swelling and bruising (contusion, or ecchymosis)
In older patients, what may be the first sign of non traumatic internal bleeding
Dizziness, faintness, or weakness
Ulcers or other gastrointestinal problems may cause:
Vomiting of blood or bloody diarrhea
Hemoptysis
The coughing up of bright red blood
Bleeding into the chest cavity or lung may cause:
Dyspnea, tachycardia, hemoptysis, and hypotension.
Hematoma
A mass of blood that has collected in the soft tissue beneath the skin.
Blood in the urine
Hematuria
Signs and symptoms of internal bleeding in trauma and medical patients:
- Hematemesis (vomiting of the blood)
- melena (black, foul-smelling, tarry stool that contains digested blood)
- pain, tenderness, bruising, guarding, or swelling
- broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen
What is the first sign of hypovolemic shock?
Change in mental status (anxiety, restlessness, or combativeness)
Later signs of hypovolemic shock suggesting internal bleeding include the following:
- tachycardia
- weakness, fainting, or dizziness at rest
- thirst
- nausea and vomiting
- cold, moist (clammy) skin
- shallow, rapid breathing
- dull eyes
- slightly dilated pupils that are slow to respond to light
- capillary refill time longer than 2 seconds in infants and children
- weak, rapid (thready) pulse
- decreasing blood pressure
- altered level of consciousness
2 things to care for external bleeding
- Control the bleeding
2. Provide high-flow oxygen
The most commonly used methods for controlling bleeding include:
- direct, even pressure
- pressure dressings and/or splints
- tourniquets
The method that is by far the most effective way to control bleeding
Applying direct, local pressure
Hemostatic agent
Any chemical compound that slows or stops bleeding by assisting with clot formation.
If direct pressure does not control extremity bleeding, what do you use?
Tourniquet
A pelvic binder
Reduces the width of pelvic ring injuries. Helping to control internal bleeding, specifically bleeding associated with a life-threatening open-book pelvic fracture.
Epistaxis
Nosebleed
If someone is suffering from internal bleeding, you should
Provide high flow oxygen and cover with a blanket to maintain body temperature.
A blunt injury occurs when
The energy exchange between the patient and an object is more than the tissues can tolerate
Do blunt injuries penetrate the skin?
No
Barotrauma
Refers to injuries that result from sudden or extreme changes in air pressure
Commonly seen in blast injury victims
When the skin barrier is breached…
Invading pathogens can cause local or systemic infection.
Dressings:
Control bleeding and prevent further contamination
Steps to dealing with skin that is breached
Control bleeding
Prevent further contamination to decrease the risk of infection, and protect the wound from further damage.
Epidermis
The tough external layer that forms a watertight covering for the body
Dermis
The inner layer of the skin. Lies bellow the epidermis. Contains: Hair follicles Sweat glands And sebaceous glands
The sweat glands primary function..
To cool the body
Sebaceous glands produce..
Sebum
The oily material that waterproofs the skin and keeps it supple.
Hair follicle
Small organ that produce hair
Mucous membranes:
Cover the mouth, nose, anus, and vagina.
Provide a protective barrier against bacterial invasion, but mucous membranes differ from skin in that they secrete a watery substance that lubricates the openings
The skin..
Protects the body by keeping pathogens out and fluids in
Also helps regulate body temperature.
The body’s major organ for regulating temperature
The skin
In cold environments, the blood vessels in the skin do what?
Constrict, diverting blood away from the skin and decreasing the amount of heat that radiates from the body’s surface.
Three types of soft tissue injuries:
Closed injuries
Open injuries
Burns
Closed injuries
When soft tissue damage occurs beneath the skin or mucous membrane
Open injuries
When there is a break in the surface of the skin or mucous membrane
Burns
When the soft tissue damage occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation.
Contusion:
(Bruise) is an injury that causes bleeding beneath the skin but does not break the skin.
Ecchymosis
The buildup of blood that produces a characteristic of blue or black discoloration of the skin
Hematoma
Blood that has collected within damaged tissue or in a body cavity
Crushing injury
Occurs when significant force is applied to the body
Crush syndrome
When an area of the body is trapped for longer Than 4 hours and arterial blood flow is compromised
When a patient’s tissues are crushed beyond repair, muscle cells die and…
Release harmful substances into the surrounding tissues. They do not travel throughout the body until the crushing object is removed.
For this reason ALS providers should administer IV fluid before the crushing object is lifted off the body.
Compartment syndrome
Develops when edema and swelling result in increased pressure within a closed soft tissue compartment. (This can cause a limb to die)
Contamination:
The presence of infections organisms or foreign bodies in the wound.
Four types of open soft tissue wounds:
Abrasions
Lacerations
Avulsions
Penetrating wounds
Abrasions
A wound of the superficial layer of the skin, caused by friction when the body part rubs or scrapes across a rough or hard surface.
Laceration
A jagged cut in the skin caused by a sharp object or a blunt force that tears the tissue
Incision
Sharp, smooth cut
Avulsion
An injury that separates various layers of soft tissue so they become either completely detached or hang as a flap.
Never remove an avulsion skin flap, regardless of its size.
Amputation
An injury in which part of the body is completely severed
Penetrating wound
(Puncture wound) is an injury resulting from a piercing object, such as a knife, ice pick, splinter, or bullet.
Objects that penetrate the skin but remain in place are referred to as
Impaled objects
Since a penetrating object can pass completely through the body…
Always count the number of penetrating injuries (or holes) especially with gunshot wounds.
The mechanism of injury from a blast is generally due to three factors:
Primary blast injury
Secondary blast injury
Tertiary blast injury
Primary blast injury
Injuries to the body caused by the blast wave itself
Secondary blast injury
Injuries caused to the body from being struck by flying debris, propelled by the force of the blast.
Tertiary blast injury
Injuries to the body from being thrown or hurled by the force of the explosion into an object onto the ground.
Quaternary blast injury
Burns from hot gases, respiratory injury from inhaling toxic gas, crushing injury from collapsing objects.
The primary assessment for a patient with a closed or open injury should focus on…
Identifying and managing life-threatening concerns and identifying transport priority.
This list will help guide you in determining the types of patients that need immediate transportation:
Poor initial general impression Altered level of consciousness Dyspnea Abnormal vital signs Shock Severe pain
Treat closed soft tissue injury by applying the mnemonic RICES:
Rest Ice Compression Elevation Splinting
Most commonly used methods to control external bleeding:
- direct, even pressure and elevation
- pressure dressings and/or splints
- tourniquets
By applying a sterile dressing you are…
Reducing the risk of further contamination.
Evisceration
When organs protrude through a wound
When dealing with an eviseration:
Do not touch or move the exposed organs
Cover the wound with sterile gauze moistened with sterile saline solution
And secure with an occlusive dressing.
Because the open abdomen radiates body heat quickly and because exposed organs lose fluids rapidly you must:
Keep the organs moist and warm
Use moist sterile dressings, covered and secured in place with a bandage and tape.
The only exception to the rule of not removing an impaled object are objects in the…
Cheek or mouth that obstruct breathing and objects in the chest that directly interfere with performing CPR on a patient who is already in cardiac arrest.
If enough air is sucked into a blood vessel it can..
Block the flow of blood into the lungs and cause cardiac arrest.
Air embolism
Air sucked into the blood vessel that blocks the flow of blood into the lungs and cause cardiac arrest.
To control bleeding of the neck and prevent the possibility of air embolism:
- Cover the wound with an occlusive dressing.
- Apply manual pressure, but do not compress both carotid vessels at the same time
- secure a pressure dressing over the wound by wrapping roller gauze loosely around the neck and then firmly through the opposite axilla.
Consider all small animal bites as..
Contaminated and potentially infected wounds that require the removal of damaged tissue, antibiotics, and tetanus prophylaxis.
Emergency treatment of bites consists of the following steps:
- Apply a dry, sterile dressing.
- Promptly immobilize the area with a splint or bandage.
- Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy.
A burn occurs when
The body, or a body part, receives more radiant energy that it can absorb, resulting in an injury.
Thermal burns can occur when skin is exposed to temps of higher than
111 degrees Fahrenheit
When a person is burned, the skin barrier is destroyed; the victim is now at a high risk for…
Infection
Hypothermia
Hypovolemia
And shock
Circumferential burns
Burns that surround an extremity.. can compromise breathing and lead to compartment syndrome, resulting in neurovascular compromise and irreversible damage
Five factors that will help determine the severity of a burn:
1- what is the depth of the burn?
2- what is the extent of the burn?
These first 2 are the most important
3- are any critical areas involved?
4- does the patient have any predicting medical conditions or other injuries?
5- is the patient younger than 5 or older than 55 years?
Three types of burns:
Superficial burns
Partial-thickness burns
Full-thickness burns
Superficial burns
First degree burn, involve only the top layer of skin, the epidermis
Partial- thickness burns
Second degree burn, involve the epidermis and some portions of the dermis
Typically, the skin is moist, mottled, and white to red. Blisters are present.
Full-thickness burns
Third degree burns; extend through all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs.
Nerve endings have been destroyed, a severely burned area may not have feeling and the surrounding less severely burned areas may be extremely painful.
Rule of nines
Divides the body into sections, each of which is approximately 9% of the total surface area.
The size of the patients palm is roughly equal to 1% of the patiet’s total body surface area
When you assess the respiratory system of a burn patient, look specifically for the following findings:
1- soot around the mouth
2- soot around the nose
3- singed nasal hairs
Thermal burns
Caused by heat
Flame burn
Very often a deep burn, especially if a person’s clothing catches fire
Scald burn
Most commonly seen in children and handicapped adults but can happen to anyone, particularly while cooking.
Flash burn
Produced by an explosion
All patients with large surface burns should have…
Dry sterile dressing applied to help maintain body temperature, prevent infection, and provide comfort.
A chemical burn occurs whenever
A toxic substance contacts the body. Most chemical burns are caused by strong acids or strong alkalis.
Eyes are particularly vulnerable to chemical burns.
Always brush off dry chemicals from the..
Skin and clothing before flushing the patient with water.
What is larger, the exit or entrance wound?
Exit wound
Electrical current can cross the chest and cause
Cardiac arrest or dysrhythmias.
There are three types of ionizing radiation:
Alpha, beta, and gamma
Alpha particles
Have little penetrating energy and are easily stopped by the skin
Beta particles
Have greater penetrating power and can travel much farther in air than alpha particles
In general, dressings and bandages have three primary functions:
- to control bleeding
- to protect the wound from further damage
- to prevent further contamination and infection
Occlusive dressings
Made of petroleum (Vaseline) gauze, aluminum foil, or plastic, prevent air and liquids from entering (or exiting) the wound
They are used to cover sucking chest wounds, abdominal eviscerations, penetrating back wounds, and neck injuries.
Bandages:
Keep dressings in place during transport, you can use soft roller bandages, rolls of gauze, triangular bandages, or adhesive tape.
