Chapter 27- Bleeding And Soft Tissue Trauma

Question 1

State the major functions of the skin

Answer 1

*Helps regulate body temperature, senses heat, cold, touch pressure and pain, *maintains fluid balance * protects underlying tissue from injury

Question 2

List the layers of the skin

Answer 2

Epidermis is the outermost layer and it provides with a waterproof barrier and create skin tone
Dermis contains connective tissue, hair follicles, and sweat glands
Subcutaneous layer helps conserve body heat

Question 3

Define wound and differentiate between an open wound and a closed wound

Answer 3

A wound is an injury to the soft tissues

An open wound is when the skin breaks, a close wound is when the skin does not break but soft tissue is still damaged

Question 4

Differentiate among arterial, venous, and capillary bleeding

Answer 4

Arterial bleeding: is the most serious type of bleeding, color is bright red, blood spurts with each heartbeat and is difficult to control
Venous bleeding: is bleeding from the veins, dark red or maroon color, flows steadily and is easier to control Than arterial bleeding. However bleeding from deep veins may be hard to control
Capillary bleeding: most common bleeding, dark red blood, loses slowly and often clots and stops itself within a few minutes

Question 5

Establish the relationship between standard precautions and bleeding and soft tissue injuries

Answer 5

Never touch body fluid with bare hands.
Always use PPE
If hands are visibly dirty or soiled with blood or another body fluid, wash your hands with soap and water
Use alcohol-based hand gel if your hands are not visibly dirty
Throw PPE away in labeled biohazard bin
Report all exposures to your supervisor

Question 6

Describe methods of controlling external bleeding

Answer 6

1. Applying direct pressure to the wound. This allows clotting which stops blood flow
2. Applying a splint, explain is a device used to limit movement of an arm or leg and to reduce bleeding
3. Applying a Tourniquet, which is a tight bandage that surrounds the arm or the leg. Consider a Tourniquet when hemorrhage can’t be controlled

Question 7

Establish the relationship between mechanism of injury and internal bleeding

Answer 7

You can use the MOI to try to predict where internal bleeding occurs. For example, if someone is stabbed in the chest, you could use that to predict the place of internal bleeding

Question 8

List the signs of internal bleeding

Answer 8

• pain, tenderness, or discoloration of skin in the injured area
• A week rapid pulse
• vomiting or coughing up bright or dark blood
• pale moist skin, or broken ribs or chest bruising
• bleeding from a body opening, stool with blood in it

Question 9

List the steps in the emergency medical care of the patient with signs and symptoms of internal bleeding

Answer 9

• conduct scene size up, determine MOI or NOI and wear PPE
• perform primary survey, treat any life-threatening injuries, manage air way and cervical spine if needed
• do a physical exam and acquire signs and symptoms of internal bleeding
• give O2
• Watch breathing and suction as needed
• internal bleeding is a priority patient, keep patient warm and reassess every five minutes
• document all patient care information

Question 10

Differentiate between open and closed soft tissue injuries

Answer 10

An open soft tissue injury is associated with a break in the skin, a closed injury is when the skin remains in tact

Question 11

List the types of closed soft tissue injuries

Answer 11

When the body is struck by a blunt object. A contusion is a bruise which is the most common internal bleeding. A hematoma forms if large blood vessels are torn beneath a bruised area. Crush injury is a strong compressing force applied to the body

Question 12

Describe the emergency care of a patient with a closed soft tissue injury

Answer 12

• perform a scene size up, identify MOI or NOI, and wear PPE
• Perform a primary survey and treat for life-threatening injuries
• perform physical exam, taking vital signs and medical history
• splint any bone or joint injuries
• apply ice or a cold pack, but put layer in between skin and the pack
• Comfort calm and reassure the patient
• Record patient healthcare information

Question 13

List the types of open soft tissue injuries

Answer 13

Abrasion: a scrape impacting the epidermis
Laceration: a cut or tear in the skin of any kind, and when you’re laceration is a sharp instrument cut and A stellate laceration is from a blunt object
Puncture: wound when the skin is pierced with a sharp object
Avulsion: when a piece of tissue or skin is pulled loose or off
Amputation: when a body part is separated from the rest of the body

Question 14

State the emergency care for somebody with a open soft tissue injury

Answer 14

Conduct scene size up, identify MOI and NOI and wear PPE.
Conduct primary survey and treat for any life-threatening injuries, stabilize spine if needed, expose wound and treat for shock if needed
Apply sterile dressing once severe bleeding has stopped
Perform physical exam, take vital signs and medical history
Splint any bone or joint injuries
Comfort calm and reassured patient. Reassess when needed
Document care info

Question 15

Discuss the emergency medical care considerations for a patient with a penetrating chest injury

Answer 15

Sucking chest wound: a sucking or gurgling sound in the chest wound due to air moving in plural cavity through the wound. Treat every chest wound as a sucking chest wound. Put a dressing over the wound and tape three sides preventing air to suck through the wound, then give 02

Question 16

Describe the emergency medical care of the patient with an evisceration:

Answer 16

Evisceration: when an organ sticks out through an open wound. Do not touch the organ, lightly cover it with a moist dressing in water or Saline. Secure the bandage in place with large bandage

Question 17

Describe the emergency medical care of the patient with an impaled object

Answer 17

Impaled object: an object that remains in bedded in an open wound. Do not attempt to remove object Unless it interferes with the airway, place bulky dressings over the object to keep it in place

Question 18

Describe the emergency medical care of the patient with an amputation

Answer 18

Control bleeding at the stump of amputated body part. Ask an assistant to find the amputated part, do not tell the patient that it will be reattached. Gently rinse amputated part in the lacerated ringer’s solution and wrap in gauze moistened with lacerated ringer’s solution and put in dry plastic bag or container

Question 19

Describe the emergency medical care of the patient with an open neck injury

Answer 19

Put gloved finger over when to stop bleeding immediately. Cover the world with airtight dressing, put bulky bandage over occlusive bandage and apply pressure to control bleeding. Apply a pressure bandage (under armpit and around neck) and treat for shock

Question 20

Describe the emergency medical care when someone has an Eye injury

Answer 20

If flushing is necessary, do it from nose side to ear. If the object is long, stabilize it with gauze, Then put a Styrofoam cup over the eye and cover both eyes. If there is a chemical burn, remove contacts asap. Flush Eye for 15 to 20 minutes and call for immediate transport. A non-chemical burn should be treated with a moist pad over both eyes and a dark room

Question 21

Describe the emergency medical care of the patient with a mouth injury

Answer 21

A lower jaw fracture might make the tongue lock the airway, suspect a fracture if the patient can’t move lower jaw from side to side without pain.

Question 22

Describe emergency medical care of the patient with an ear laceration

Answer 22

Place a loose dressing over the ear to absorb drainage. Never put anything in the ear. Treat of avulsed part of ear like amputated part. An ear laceration is treated like any other soft tissue injury

Question 23

Identify factors that determine the severity of a burn

Answer 23

The depth of a burn, the extent of the burn, location of the burn, medical or surgical conditions present before the burn, patient’s age, associated factors

Question 24

List the classifications of burns

Answer 24

Burns are classified by deepness of skin layers affected
Superficial, “1st° burn”
Partial thickness, “2nd° burn”
For thickness, “3rd° burn”

Question 25

Define superficial burn

Answer 25

Affects only the epidermis

Question 26

List the characteristics of a superficial burn

Answer 26

Results in only minor tissue damage, heels in 2 to 5 days, no scarring, skin is red and tender and painful but blistering does not occur

Question 27

Define partial thickness burn

Answer 27

Involves epidermis and dermis

Question 28

List the characteristics of a partial thickness burn

Answer 28

Can result from hot liquid or flash burns from gasoline. Produces intense pain and some swelling, blistering may occur. Skin is pink, red or mottled and heals from 5 to 34 days. Scarring may or may not occur

Question 29

Define full thickness burn

Answer 29

Destroys epidermis and dermis, may include subcutaneous tissue, muscle and bone

Question 30

List the characteristics of a full thickness burn

Answer 30

Skin may turn from yellow or pale to black, skin has leathery appearance, may not feel it because nerve endings are destroyed. Partial thickness and superficial burns may occur around it, fluid loss is common so prepare to treat for shock

Question 31

Discuss the use of the rule of nines to estimate the total body surface area burn

Answer 31

The rule of nines is a guide to estimate the total body surface area burned. Add the percentages of areas burned to get the full BSA

Question 32

Describe the emergency medical care of a patient with a thermal burn

Answer 32

If a patient was exposed to smoke or in a confined space, keep watch for inhalation problems
Cool the burn with 59 to 77°F water until pain is relieved
Cover burned area with dry dressing, loosely place dressing over blisters and keep patient dry and covered for warmth. Do not attempt to pop blisters
Remove jewelry and wrap guys around each finger so the skin doesn’t melt together
Treat for possible fractures and shock, and keep burned extremities over the heart

Question 33

Describe the emergency care for a chemical burn

Answer 33

Flush wet chemical out, brush dry chemical and then flush for 20 minutes
Fully decontaminate the patient, if not you need to let the hospital know

Question 34

Describe emergency care for an electrical burn

Answer 34

If you are unsure if the patient is still in contact with an electrical source, do not touch them, call other services
Watch for cardiac arrest, have a defibrillator
Look for an entrance and exit wound

Question 35

List the functions of dressing and bandaging

Answer 35

Helping to stop bleeding, absorbing blood and drainage from a wound, protecting the wound from further injury, reducing contamination and risk of infection

Question 36

Describe the purpose of a bandage

Answer 36

A bandage is applied to keep a dressing in place

Question 37

Describe the steps in applying a pressure dressing

Answer 37

1. Cover wound with several sterile dressings or a bulky dressing
2. Secure the dressing firmly in place with a bandage
3. Apply direct pressure to the wound
4. Try not to cover fingers or toes, because the coloration of fingers or toes can determine circulation