Chapter 26 Soft Tissue Trauma Flashcards
Puncture wound
An open wound that tears through the skin and destroys underlying tissues.
- A penetrating puncture wound can be shallow or deep
- A perforating puncture wound has both an entrance and an exit wound
- May have internal organ damage
Total surface area of skin
More than 20 ft.² for an average adult
Treatment of Hydrofluoric Acid
This acid is used for etching glass
- Burns from this may be delayed so treat all patients that have come into contact with this chemical
- flood affected area with water then transport immediately
- Fluoride released From the acid combines with calcium and magnesium in the tissue until the fluoride is used up
Epidermis
Outer layer of the skin
Treating an Avulsion
- clean the wound surface
- fold the skin back to its normal position as gently as possible
– control bleeding and dress the wound using bulky pressure dressing’s
• If skin or another body part is Torn from the body, Control bleeding, dress the wound using a bulky pressure dressing
• save the date of avulsed part and wrap it in a sterile dressing kept moist with sterile saline.
Make certain that you label the avulsed part with patients name, date and time that part was wrapped and bagged.
• Also keep part cold but not touching ice
Treatment of object impaled in eye
- Stabilize the object - Place a roll of 3 inch gauze bandage on either side of object a long vertical axis of head in a manner that will stabilize the object
- Apply rigid protection – fit a disposable paper drinking cup or paper cone over the impaled object
- Stabilize dressing and cup
- Dress and bandaged The uninjured eye. Will reduce sympathetic eye movement
- Care for shock
Closed crush injuries
An injury caused when a force is transmitted from the bodies exterior to its internal structures.
- Bones can be broken; muscles, nerves, and tissue damaged;
- internal organ damage: crushed or ruptured, causing internal bleeding: liver and spleen injury or rupture
Contusion
Contusion is a bruise, the most frequently encountered type of closed wound
- epidermis remains intact
- Cells and blood vessels in the dermis or damaged
- pain swelling and discoloration
• swelling caused by collection of blood under skin/inflammation
Treating impaled objects
- Expose the wound area - cut and expose
- Control profuse bleeding by direct pressure, Do not put pressure on the object, positioning hands on sides of object
- Continue stabilization, have another trained rescuer place several layers of bulky dressing around the injury site to stabilize object and provide pressure
- Secure the dressing in place
- Treat and care for shock
Treating Sulfuric Acid
Preferable to wash off with continuous flow of water.
*note heat is produced when water mixes with acid
Critical burns -Classifications by thickness, percent of body surface area, and complicating factors
- 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% of the body surface
- partial thickness burns of more than 30%
- Burns complicated by musculoskeletal injuries
- circumferential burns
Occlusive dressing
Any dressing that forms in airtight seal, usually used for open wounds to the abdomen, external bleeding from large neck veins and for open wounds to the chest
Minor burns - classifications. By thickness, percent of body surface area, and complicating factors
Minor burns
- full thickness(3 degree burns) burns of less than 2% of body surface, excluding the face, hands, feet, genitalia, respiratory tract
- partial thickness (second degree burns) burns of less than 15% of the body surface
- superficial burns (first degree burns) 50% of the body surface or less
Circumferential burns
Burns that encircle the body or a body part
- very serious because they constrict the skin.
- When they occur to an extremity they can interrupt circulation to the distal tissues.
- When they occur around the chest, they can restrict breathing by limiting chest wall movement
- Circumferential burns occur to joints the chest and abdomen where scarring tends to limit normal functions
Dressing
Any material preferably sterile used to cover a wound that will help control bleeding and prevent additional contamination
Dermis
Layer of skin below the epidermis
- layer is rich with blood vessels, nerves, and specialized structures such as/sweat glands, sebaceous (oil) Glands, hair follicles
- Specialize nerve endings in dermis involved with senses of touch cold heat and pain
- once dermis open contamination and infection become major problems
Hard tissues of the body include
Teeth, bones and cartilage
Blast injuries
Include both open and closed wound types
Significant blunt force trauma from explosions
- most common closed injuries associated with blast trauma are
•rupture of hollow organs
- air filled organs such as lungs and eardrums burst
- liquid filled organs like: stomach, intestines and urinary bladder are also high risk with these kinds of injuries
- bones can be broke, organs crushed, blood vessels lacerated
Treating abrasion and lacerations
– Direct pressure over a dressing usually works well
– how much static dressings
– tourniquet
Do not underestimate the facts of a laceration. When evaluating check CSM. Patient may need stitches, plastic surgery, antibiotics, or tetanus shot. So do not leave patient at scene
Blast injuries
Open and closed injuries can be the result
- primary injuries can include damage to any air or fluid filled body organ or cavity from pressure wave/blast wave
- secondary injury is the result of projectiles (shrapnel) such as debris hitting the patient
- Tertiary (third level) injuries occur if the patient is thrown by the blast, occur both from the force of the blast and as a result of the violent landing after being thrown
Butterfly bandage
Made up of thin strips of adhesive bandaging and is designed to bring the sides of a laceration together
- bandage a gauze dressing over the butterfly strip
Lacerations
A cut
- Caused by an object with a sharp edge
- Also result from a severe blow by a blunt object
- Bleeding will be considerable if significant blood vessels have been torn
Types of open wound injuries
- abrasions
- lacerations
- punctures
- avulsions (flap of skin and tissues are torn)
- amputations
- crush injuries
- blast injuries
- high pressure injection injuries
Rule of palm
A method for estimating extent of a burn. The palm and fingers of the patients own hand, which equals about 1% of the body surface area, as compared with the patients burn to estimate it size
High pressure injection Injuries
Uncommon injury
- occurs when a patient is working with a machine that injects grease, paint, air, or some other substance under high-pressure
- can lead to significant injury
- when injected substance can travel a significant distance, moving through most or all of a limb
• If patient does not get the appropriate treatment early enough, high probability that at least part or perhaps all of the patients Limb will have to be amputated
Treatment:
- elevating and splinting the limb
- do not apply cold
Shrapnel
Objects thrown by the blast including bomb materials and debris
Abrasions
Include simple scrapes and scratches in which the outer layer of the skin is damaged but not all the layers are penetrated
- can be severe
- High risk of infection
Classifications by thickness and percent of body surface area for
children less than five years of age
Minor burns - partial thickness burns of less than 10% of the body surface
Moderate burns Dash partial sickness burns of 10 to 20% of the body surface
Critical burns – full thickness burns of any extent or partial thickness burns of more than 20% of the body surface
Patient’s age is a major factor in considering the severity of Burns
Infants, children under five, and adults over age 55 have the most severe responses to burns and the greatest risk of death
Object impaled in the cheek
- Examine the wound site
- palpate gently, look in mouth, probe only what you can see - Remove object if you find perforation and you can see both ends of the object, pull it out in the direction that it entered
- If tip of object is impaled into a deeper structure stabilize the object. Do not try to remove it - Position patient to make certain that you allow for drainage
- Monitor patient’s airway be prepared to suction as necessary
- Dress the outside of the wound using a pressure dressing
- Care for shock
Bandage
Any material used to hold a dressing in place
Amputation
The surgical removal or Traumatic severing of a body part, usually an extremity
- May or may not have massive bleeding
Soft tissues of the body include
Skin, fatty tissues, muscles, blood vessels, connective tissues, membranes like tissues that line or a cover organs, glands, and nerves
Treating penetrating trauma
Bullet wounds, star balloons, air guns fired at close range can all be considered serious
- gunshot wound’s are puncture wounds that can fracture bones and cause extensive tissue and organ damage
- bullet may deflect off a bone, fragmented, Or exploded inside the body
- Air gun is fired at close range can cause serious damage by injecting air into the tissues
- stabbing should be considered serious, especially when they involve the head, neck, chest, abdomen, or groin and proximal to knee or elbow
Determining the severity of Burns
– Agent or source of the burn – body regions burned – depth of the burn – extent of the burn – age of the patient – other illnesses and injuries
Electric current May cause only small areas of skin injury but poses a great risk of severe internal injury And C spine injury
- Chemical burns are of special concern since the chemical may remain on skin and continue to burn for hours or even days eventually entering bloodstream. Sometimes the case with certain alkaline chemicals
- burn to face is of special concern since it may involve entry to airway or eyes
- hands and feet also are areas of concern, scarring may cause loss of movement of fingers or toes Dash when moving patient prevent damage tissues from sticking to one another
- groin, genitalia, buttocks, or medial thighs are burned, potential bacterial contamination can be far more serious than initial damage
Hematomas
The swelling caused by the collection of blood under the skin or in damage tissues as a result of an injured or broken blood vessel
Different from contusions in that hematomas involve a larger amount of tissue damage
Characterized by much more severe bleeding
As much as a liter of blood may accumulate in a hematoma
Superficial burns (first-degree burns)
Burn that involves only the epidermis, the outer layer of the skin. It is characterized by reddening of the skin and perhaps some swelling, a common example is a sunburn. Also called a first-degree burn
Partial thickness burn (second-degree burn)
A burn in which the epidermis (first layer of skin) is burn through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering and a mottled appearance
- Deep, intense pain
- Can cause swelling and blistering for 48 hours after injury
Rule of nines
A method for estimating the extent of a burn. For an adult, each of the following areas represent 9% of the body surface:
The head and the neck, each upper extremity, the chest, abdomen, upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining 1% is assigned to the genital region.
• For an infant or child, the percentages are modified so 18% is assigned to the head, 14% to each lower extremity
Treating carbolic acid (phenol)
This acid does not mix well with water.
- Wash off with alcohol if available
- Followed by long steady wash with water
Avulsions
Flaps of skin and tissues are torn loose or pulled off completely
Ex:
- nose or ears cut or torn off
- Degloving avulsion - skin pulled from arm/hand
- eye avulsion - eye pulled from socket
Moderate burns - Classifications by thickness, percent of body surface area, and complicating factors
- Full thickness (3rd degree burns) burns of 2-10% of the body surface, excluding the face, hands, feet, genitalia, or respiratory tract
- partial thickness burns (second degree burns) of 15 to 30% of the body surface
- superficial burns (first degree burns) that involve more than 50% of the body’s surface
- Burns usually classified as moderate are considered critical in adults over 55 years of age
Major functions of the skin
- protection
- Water balance - Helps prevent water loss stops environmental water from entering body preserves chemical balance of body fluids and tissues
- temperature regulation - blood vessels increase in diameter allowing heat to radiate away from body; Decrease in diameter (construction) when body needs to conserve heat
- excretion - Schultz carbon dioxide and excess water can be released through skin
- Shock absorption - layers of fat help protect the underlying organs
Agents and sources of Burns
- Thermal
- flame; radiation;Excessive heat from fire, steam, hot liquids, and hot objects - Chemicals
- various acids, bases, and caustics (chemicals that burn or corrode) - Electricity
- Alternating current, direct current, and lightning - 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
What are the three types of closed wounds
- contusion
- hematomas
- crush injuries
Full thickness burn (third-degree burn)
A burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white
- May complain of severe pain, or if enough nerves have been damage may not feel pain at all
Treating Dry Lime
Do not wash burn site with water - will create a corrosive liquid
- Brush off dry lime from skin, hair, clothes
- Make sure to not contaminate patient eyes or airway
- Only after you’ve brushed off as much dry lime possible is it okay to wash off quickly and continuously with water
Subcutaneous layers
The layers of fat and soft tissue below the dermis are called sub subcutaneous layers
- Shock absorption and insulation are major functions
- When injured problems of tissue and blood stream contamination, Bleeding and pain
