Chapters 18-22 Flashcards
Emergency care of open wounds
1.) don the appropriate protective equipment for the situation. Gloves and eye protection are the minimum level of protection for managing open wounds.
2.) perform a primary assessment and ensure an open airway and adequate breathing. Do not let the unpleasant site of an open wound distract you from more important priorities.
3.) expose the wound. Cut away clothing over and around an open wound.
4.) remove the superficial foreign matter from the surface of the wound with a sterile gauze pad.
5.) control the bleeding with direct pressure. A tourniquet should be used if direct pressure and a pressure Band-Aids do not control the bleeding.
6.) administer oxygen as per local protocols
7.) prevent further contamination by using a sterile dressing or clean cloth to cover the wound. After the bleeding has been controlled, bandage the dressing in place. If applying a roller bandage to a limb, it is standard practice to begin at the distal side of the wound and wrap to the proximal end.
8.) keep the patient lying still and care for shock.
9.) reassure the patient and initiate transport as appropriate.
Emergency care of specific injuries
When dealing with any puncture wound, assume that there is internal injury and internal bleeding. Always check for an exit wound, realizing that exit wounds can be more serious than entrance wounds (in the case of a gunshot injury). Care for entrance and exit wounds as you would any open wound. in most instances, you want to stabilize the impaled object in place and not to remove it. There is a chance that the object is plugging holes vessels deep in the wound. Removing the object could allow those wounds to bleed freely. If a puncture wound contains an impaled object, such as glass, a knife, wood, metal, or plastic, do the following:
1.) take appropriate BSI precautions.
2.) expose the wound without disturbing the impaled object.
3.) do not remove an impaled object.
4.) control the bleeding. Administer oxygen as per local protocols
5.) stab the impaled object by using a bulky dressings.
6.) keep a patient at rest and provide care for shock.
Avulsions and amputations
Emergency care for avulsions and amputations are the same. If skin or another body part is torn from the body, or if a flap of skin has been torn loose, care for wound with bulky dressings and direct pressure. Follow these steps:
1.) take appropriate BSI precautions
2.) expose the wound.
3.) control bleeding and provide Care as you would for any open wound
4.) if the wound is an avulsion, gently fold the skin back to its normal position prior to applying direct pressure. Follow local protocols.
5.) provide care for shock. Administer oxygen per local protocols.
Save and preserve an avulsed or amputated part. This is best done by wrapping the body part in a sterile dressing and placing it into a plastic bag or wrapping it in plastic wrap. If possible, keep the part cool (not cold; avoid freezing). Do not place the avulsed or amputated part in water or indirect contact with ice because it can damage the skin.
Protruding organs
A deep, open wound to the abdomen, can cause organs such as the intestines to protrude through the wound opening. This is known as evisceration. Follow these guidelines when caring for an open abdominal wound:
- Do not try to push protruding organs back into the body cavity
- place a thick, moist dressing over the protruding organs and cover the dressing with a plastic, covering to contain the moisture and heat
- Provide care for shock. Do not give the patient anything by mouth.
Scalp injuries
Injuries to the scalp can be difficult to care for because of the numerous blood vessels found there. Many of these vessels are close to the surface of the skin, producing profuse bleeding from even minor wounds. Additional problems arise, if the bones of the skull are involved.
- control bleeding with a dressing held in place with a gentle pressure. Avoid exerting excessive pressure if there are signs of a fractured skull or the injury site feels spongy
- A roller bandage or gauze, can be wrapped around the patient’s head to hold dressings in place once the bleeding has been controlled. If there is any indication of neck or spinal injuries, use caution to keep the patient’s head immobilized when applying the bandage.
- there are no signs of skull fracture or injuries to the spine, neck, or chest, you may position the patient so the head and shoulders are elevated
Facial wounds
The first concern when caring for facial injuries is to make certain that the patient’s airway is open and breathing is adequate. Even though bleeding may appear to be external only, check the airway and ensure blood is not causing an obstruction continue to watch the patient to be sure the airway remains open and clear of fluids and obstructions. Caring for patient with facial injuries, you should do the following:
1.) ensure an open and clear airway, being careful to note and properly Care for neck and spinal injuries.
2.) control bleeding by direct pressure, being careful not to press too hard because many facial fractures are not obvious.
3.) apply a dressing and bandage.
If you find the patient has an object that has passed through the cheek wall and it is sticking into the mouth, you may have to remove it. It is also appropriate to remove an impaled object if it interferes with your ability to perform proper CPR. Do so only if the object blocks the airway or is loose and could fall into the airway. To remove an impaled object from the cheek, follow these steps:
1.) look into the math to see if the object has passed through the cheek wall.
2.) if you find penetration carefully pull or push the object out of the cheek wall, back in the direction from which the object entered
3.) If you remove an impaled object, place the dressing material between the wound and the patient’s teeth, leaving some of the dressing outside the mouth, so it can be held to prevent swallowing it. Watch closely to be sure the dressing does not work its way loose and into the airway.
4.) position the patient so blood will drain from the mouth. Use dressing material packed against the inside wound to control the flow of blood. If bleeding is difficult to control and you suspect neck or spinal injuries, roll the patient while maintaining manual stabilization of the head and neck.
5.) dress and bandage the outside of the wound.
6.) provide care for shock
Eye injuries
The following are a few important points that must be emphasized when caring for an injury to the eye:
- Do not remove any impaled objects
- Do not try to put the eye back into its socket
- Do not apply a pressure directly to an injured eyeball
Problems resulting from foreign objects in the eye are common. These problems can range from minor irritations to permanent injury. If the patients own tears do not wash away a foreign object, use running water to remove it. Do not apply the wash if there are impaled objects or cut in the eye. Applied the flow of water at the corner of the ice socket closest to the patient’s nose. You may have to help the patient hold to open the eyelids. As you pour the water, direct the patient to look from side to side and up and down. before completing the wash, have the patient blink several times. When possible, continues the wash for at least 20 minutes or for the time recommended by medical direction. If there are sharp objects in the patient’s eye, do not direct the patient to move the eyes during the wash. After the wash cover both eyes with dry dressings. whenever you are patient with eye injuries, you will have to cover both of the patients eyes because of sympathetic movement.
Burns to the eyes must always be considered serious, requiring special in hospital care. As an EMR, you may have to provide emergency care for burns to the eyes caused by heat, light, or chemicals. The following are guidelines to follow when caring for the various types of burns to the eyes:
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thermal (heat) burns: Do not try to inspect the eyes if there are signs of thermal burns to the eyelids. With the patient’s eyelids closed, cover the eyes with loose, moist dressings. If you have no means to moisten the dressings, apply dry dressings. Do not apply any burn ointment to the eyelids.
-light burns: “ snow blindness” and “ welders blindness” are two examples of light burns close the patient’s eyelids and apply dark patches over both eyes. If you do not have a dark patches, use thick dressings or dressings, followed with a layer of an opaque material such as dark plastic.
-** chemical burns**: Many chemicals, cause of rapid, severe damage to the eyes. Flush the eyes with water. Do not delay emergency care by trying to locate sterile water. Use any source of clean drinking water. If possible, continue the washing flow for at least 20 minutes. After washing the patients eyes, close the eyelids and apply loose, moist dressing.
If you find an object impaled in the globe of a patient’s eye, you should:
1.) use several layers of dressing or small rolls of gauze to make thick pads. Place them on the sides of the object. If you only have enough material for one thick pad, cut a hole equal to the size of the eye opening in the center of the pad. Set the pad over the patient’s eye, allowing the impaled object to stick out through the opening cut into the pad
2.) Fit a disposable cardboard, drinking cup, or paper cone over the impaled object. This will serve as a protective shield to come in contact with the impaled object.
3.) hold the pad and protective shield in place with a roller bandage or with a wrapping of gauze or other cloth material.
4.) use the dressing material to cover the uninjured eye and ab bandage dressing in place. This will reduce sympathetic eye movements.
5.) provide care for shock.
6.) provide emotional support to the patient.
If the eye is pulled out of the socket (avulsed eye), the care provided is the same as for an object impaled in the eye
Ear injuries
Emergency Care for external ear injuries includes the following:
- cuts. Apply dressings and bandage in place.
- tears. Apply bulky dressings, beginning with several layers behind the torn tissue.
- avulsions. Use a bulky dressings bandaged into place. Save the avulsed part in a plastic bag or plastic wrap. Keep a part dry and cool. If no plastic is available, then wrap in dressing material. Be certain to label the bag, wrap, or dressing with the patient’s name.
Internal ear injuries may appear as bleeding from the ears. Any such bleeding must be considered a sign of serious head injury. Blood or clear fluids draining from the ear may indicate the presence of a skull fracture. For such cases, assume there is serious injury and provide the necessary care. Do not pack the external ear canal. If there is bleeding or clear fluid leaking from the ears, apply external dressings Sterile if possible, and hold them in place with bandages. Report this bleeding to the transport crew. Do not attempt to remove foreign objects from inside the ear. Apply external dressings, if necessary, and provide emotional support to the patient. If the patient tells you that it feels like his or her ears are “clogged” or “stopped up”, suspect possible damage to the eardrum, fluids in the middle ear, or objects in the ear canal. These conditions must be treated in a medical facility.
Nose injuries
When dealing with injuries to the nose - when there are no suspected skull fractures or spinal injuries - you will have two duties: maintain an open airway and control bleeding.
For a nose bleed in a responsive patient, maintaining an open airway. Have the patient assume a seated position, leaning slightly forward. This position will help prevent blood and mucus from obstructing the airway, or draining down the throat and into the stomach, which can cause nausea and vomiting. Next, have the patient pinched the nostrils. Bleeding is usually controlled when the nostrils are pinched shut. If the patient cannot pinch them shut, you will have to do so. do not pack the patients nostrils. Do not allow the patient to blow his or her nose.
For a nosebleed in an unresponsive patient or in a patient injured in such a way that he or she cannot be placed in a seated position, placed them on one side with the head turned to provide drainage from the nose and mouth. Attempt to control bleeding by pinching the nostril shut. Do not pack the nose. Do not remove objects or probe into the nose.
For an avulsion of the nose, apply a pressure bandage to the site. Save the avulsed part in a plastic bag, wrapped in a plastic wrap, or a sterile or clean dressing. Keep the body part cool.
Neck wounds
As an EMR, be aware of the following signs that indicate soft tissue wounds to the neck:
- Difficulty speaking, loss of voice
- difficulty swallowing
- obvious swelling or bruising of the neck
- Pain swallowing or speaking
- Obvious cuts or puncture wound
Follow these steps when caring for an open wound to the neck:
1.) immediately applied direct pressure to the wound, using the palm of your gloved hand.
2.) apply an occlusive dressing or some type of plastic over the wound. Use tape to seal the dressing on all sides. This will minimize the possibility that air can be drawn into the wound, causing an air embolism.
3.) provide care for shock provide oxygen if allowed. Follow local protocols.
Injury to the genitalia
Because of the location, the genitalia are not a common site of injury. The pelvis and the thighs are usually prevent injury to these organs, which are known as the external genitalia. When injury does occur, two types of soft tissue injuries are commonly seen:
-blunt trauma. Such an injury is very painful, but little can be done by the EMR. An ice pack, if available can help.
-cuts. Direct pressure should control bleeding. A sterile dressing or a sanitary pad should be used if either is not available, then use any clean, bulky dressing.
Emergency care for all soft tissue injuries applies when caring for injuries to the genitalia: do not remove impaled objects, save avulsed parts, wrapping them in plastic, sterile dressings, or any clean dressing.
Try your best to save the patient from embarrassment and keep the patient’s privacy. You will need to provide emotional support and understanding. For cases of suspected abuse, you must remember that you are mandated to report your suspicions to law enforcement.
Classification of burns
Burns are classified in several ways. One way is to categorize Burns based on the agent that caused the injury (source of the injury). This information should be gathered and forwarded to more highly trained personnel during transfer of care. Categories of burns based on source include:
- heat (thermal) burns, which may be caused by fire, steam, or hot objects
- Chemical burns, which may be caused by caustics, such as acids and alkalis
- Electrical burns, which originate from outlets, frayed wires, and faulty circuits
- Lightning Burns, which occurred during electrical storms
- light burns, which occur with intense light. Light from the ark, welder or industrial laser will damage unprotected eyes. Also, ultraviolet light, including sunlight can burn the eyes and skin.
- Radiation, which result from nuclear sources
Most often and burns are categorized, according to the depth of the burn. Superficial burns involve the top layer of skin, known as the epidermis. Signs and symptoms include reddening of the skin and pain at the site. A common example is sunburn. Partial thickness burns involve both the epidermis and the dermis (the top two layers of skin) present with intense pain, white to red skin that is moist and mottled (in light skinned patients), and blisters. A classic example is a steam burn. Full thickness burns extend through our skin layers, and may evolve, subcutaneous layers, muscle, bone, organs. Full thickness burns can be dry and leathery, and may appear white, dark, brown, or chard. Because there’s often nerve damage present, there may be no sensation of pain.
Severity of burns
An important aspect of emergency care is being able to assess the severity of a burn, or extent of the damage. Defining the severity of a burn will involve a evaluating the depth of the burn, as well as the total body surface area affected. A superficial or partial thickness burn that involves less than 9% of the patient total body surface area is considered a minor burn. The exceptions are if the burn involves the respiratory system, face, hands, feet, groin, buttocks, or a major joint. Any burn to the face, other than sunburn should be considered a serious burn. Other serious burns include any partial thickness burns covering a large area of the body or burns involving the feet, hands, groin, buttocks, or major joints. One of the tasks you will need to perform caring for a patient with a burn injury is to estimate the amount of body surface area BSA, affected by the burn. A common system used for estimating the amount of body surface area burned is called the role of nights. For adults, the head and neck, chest, abdomen, each arm, the front of each leg, the back of each leg, the upper back, and the lower back and buttocks are each considered equal to 9% of the total bodies surface area. This gives a total of 99%. The remaining one percent is assigned to the general area.
For infants and children, a simple approach assign 18% to the head and neck, 9% to upper limb, 18% to the chest and abdomen, 18% to the back, 14% to each lower, and one percent to the genital area. This method adds up to a total of 101%.
By using the role of nines, you can add up the areas affected by burns to determine how much of the patient’s body has been injured.
Emergency care of burns
Regardless of the system used to evaluate burns, follow these guidelines:
- perform a primary assessment and ensure an airway and adequate breathing
- Provide care for auburns, even the most minor or superficial ones
- The following partial thickness burns should be considered serious and should be evaluated by healthcare provider: Burns, to the hands, feet, face, groin, buttocks, thighs, and major joints; burn that encircles a body part; burns estimated at greater than 15% of the patient’s body; burns that include respiratory and involvement.
- when in doubt, overestimate the amount of area affected
- Always considered the effects of a burn to be more serious of the patient is a child, older adult, the victim of other injuries, or someone with the medical condition such as respiratory disease
For emergency care of a patient with burns, take BSI precautions. Then follow these steps:
1.) stop the burning process immediately. This may require the patient to stop, and drop, and roll to extinguish the flames. You might also have to smother the flames and wet down or remove smoldering clothing.
2.) flush superficial burns with water or saline for several minutes. For partial or full thickness burns, do not flush with water unless they involve an area of less than 15% of the total body surface area. Flushing, large burn areas may cause the patient become chilled. Follow local protocols.
3.) remove smoldering clothing and jewelry. Do not remove any clothing that is melted on the skin
4.) continually monitor the airway. Any burns to the face or exposure to smoke may cause airway problems. Administer oxygen as per local protocols.
5.) prevent the contamination. Keep the burned area clean by covering it with a dressing. Infection is common with burns.
6.) partial and full thickness burns with a dry, sterile dressings if available. And some EMS systems you may be instructed to Moisen dressings before placing them on the patient. Otherwise, place to dry, sterile dressings onto the burned area. Follow local protocols.
7.) if the eyes or eyelids have been burned, place, clean dressings or pads over them. Moisten these pads with sterile water if possible.
8.) if a serious burn involves hands or feet, always place a clean pad between toes or fingers before completing the dressing.
9.) provide oxygen and care for shock.
Chemical burns
Chemical burns to the eyes require immediate attention. Assume that both eyes are involved. When caring for chemical burns to the eyes, you should:
1.) take a appropriate BSI precautions
2.) perform a primary assessment and ensure an airway and adequate breathing.
3.) immediately flush the eyes with clean water.
4.) keep the water flowing from my faucet, bucket, or other source into the eye. Use caution not to contaminate the good eye, if one eye is not affected, as you flush. Keep the good eye high up and the injured eye down to prevent cross-contamination.
5.) continue flushing for at least 20 minutes.
6.) after flushing the eyes, cover both with moistened pads
7.) remove the pads and flush again if the patient begins to complain about increased burning, sensations or irritation..
If dry lime is the agent, causing the burn, do not be begin by flushing with water. Instead, use a dry dressing to brush the substance off the patient skin, hair, and clothing. Also, had the patient remove any contaminated clothing or jewelry. Once this is done, you may flush the area with water.
