EC Chp 26 Soft-Tissue Trauma Flashcards
Soft Tissue Trauma Info
Soft tissues of the body include
Skin, fatty tissues,
muscles, blood vessels, connective tissues,
membranes, glands, and nerves
membranes are
tissues that cover the organs
Hard tissues are:
Teeth, bones, and cartilage
The Skin is the larges organ in humans and an average total surface are of?
20 sq. ft.
What are the3 functions of the Skin:
Protection
Water Balance- preserve chemical balance of body fluids
Temperature regulation
skin does what when they went to expel heat?
blood vessels in skin dilate (increase in diameter) to carry more blood to the skin allowing heat to radiate away
what are the 3 layers of the skin
Epidermis- outer layer
Dermis- rich in blood vessels and nerves
Subcutaneous- layers of fat and soft tissues
A contusion is a…
bruise where the epidermis remains intact but the dermis blood vessels are damaged
Hematoma is a
swelling caused by the collection of blood under the skin or in damaged tissues as a result of injured or broken blood vessel
hematoma differs from a contusion in that
hematoma’s involve a larger amount of tissue damage, larger blood vessels, and with greater internal blood loss. can be as much as 1 liter of blood accumulated
crush injury is when
a force is transmitted from the body’s ext to interior that can cause the internal organs to be crushed or ruptured causing internal bleeding
blast injuries include both open and closed wounds types but also what trauma due to winds and over pressure produced
blunt force trauma where internal damage is much higher
Most common closed injuries from blast trauma is
rupture of hollow organs and that they frequently will not be evident just by viewing the surface of the skin
Internal bleeding can also be demonstrated with bleeding from the
ears and nose. blood in their eyes or in their sputum
Puncture wounds penetrate the skin and are often caused by objects such as…
bullets, nails, icepicks, splinter, or knives
an Avulsion is
when flap of skin and tissues are torn loose or pulled off completely. Tissue is avulsed, it is cut off from its oxygen supply and will soon die
examples of Avulsions are
nose is cut off/torn, degloving of hand, an eye pulled from its socket (extruded)
With Blast injuries patient may sustain a combination of avulsions, amp, contusions, but they also may sustain damage from exposure t chemicals toxins, burns and crush injuries. These are referred to as ____ injuries?
Quarternary (4th level injuries)
High pressure injuries are uncommon but occur when a patient is working with a machine that does what?
injects, grease, paint, air or other substance under high pressuer
with High pressure injection injuries sometimes the wound is very little but it is much worse than it shows as it can
cause extensive tissue damage from the force and pressure and toxic nature of some solutions
If a person with High pressure injection injury does not get hep within a few hours tissue will die and they may need to
amputate the affected area
Treatment for High pressure injection injuries include
elevating and spinting the limb,
you Do NOT apply cold to High pressure injection injuries because
it causes vasoconstriction and further tissue damage and death from lack of perfusion.
In treating abrasions and lacerations, your main concern is ?
wound contamination,
Direct pressure over a dressing
with gunshot wounds you should know that
the seriousness of the wound CANNOT be determined by the caliber of the bullet or the point of entry or exit
close range shootings often have
burns around the entry wound
Although rare you may encounter an impaled object that is long enough to make transport impossible. in this situation you should
contact medical direction for instructions. Also, Someone may have to hold the object, keeping it very stable, while you gently cut
what type tool should be used to cut an impaled object from a patient when instructed to?
A fine-toothed saw with rigid blade support (hacksaw or reciprocating saw)
When treating an impaled object you should:
- Expose the wound area
- Control profuse bleeding by direct pressure
- Stabilize the object and control bleeding
- secure dressing in place
- Care for shock
If you find a person with an impaled object in the cheek you can look to remove the object only if
you find perforation and you can see both ends of the object. Pull it out in the direction that it entered ONLY if it can be easily done
for puncture wound in the eye you should
apply LOOSE dressing to the eye
For an object impaled in the eye you should
stabilize with roll of 3in gauze or folded 4x4 on either side along the vertical axis of the head,
Apply rigid protection and stabilize
then dress and bandage the uninjured eye to reduce sympathetic eye movements
why do you dress and bandage the uninjured eye?
to reduce sympathetic eye movements
When treating avulsions you should first clean the wound surface than attempt to
fold the skin back to its normal position as gently as possible
In an attempt to save the skin or body part torn from the body you can
warp it in sterile dressing and kept moist with sterile saline, and label, name date, and time the part was wrapped.
Do NOT immerse the avulsed part in ice, cooled water or saline you should just
place it in a cooler in a container which it is on top of the cold pack or ice.
Similar to avulsed parts, for amputations you should also NOT
immerse the amputed part directly in water or saline. Instead keep it on top of cold area and ensure it does not come in direct contact with as it could freeze
Blood at the meatus (external opening for urine flow) is an indication of what?
disruption of the urethra possibly from blunt trauma, fracture of the pelvis
what are the 3 ways burns can be classified and evaluated
- By agent and Source
- By Depth
- By Severity
Burn agent and source could be from 5 different ones
Thermal Chemicals Electricity Light Radiological
Classifying burns via depth refer to 3 different categories what are they?
Superficial- only on the epidermis
Partial thickness burn- 2nd degree through the epidermis
Full thickness burn- 3rd degree all layers of skin
What are signs of Partial Thickness Burn
reddening, blistering mottled appearence
Full Thickness burn signs usually present as
charred black areas or areas that are dry and white, patient may not feel pain only on the periphery of the burn and may damage, muscle, bone and organs.
determining severity of the burn includes these factors:
Agent or source of burn Body regions burned Depth of the burn Extent of the burn Age of the patient other illness or injuries
An example of a burn that can continue to burn for hours or even days?
Alkaline Chemical burns
what is more of concern when burns to groin, genitalia, buttocks or medial thighs?
the potential for bacterial contamination
Circumferential burns encircle the entire body or body part, this is very serious because?
they can interrupt circulation to distal tissues. Ex. around the chest, they can restrict breathing by limiting chest wall movement.
The amount of skin surface involved can be calculated quickly by using the
rule of 9s. For each adult each of the following areas represents 9% of the body surface. this makes up 99% with 1% for the genital region.
Rule of Palm (rule of ones) method to estimate burns uses
the palm and fingers of the patients own hand which equals to 1% of the body’s surface area
what age groups have the most severe reaction to burns?
under age 5 and over age 55
Minor Burns are classified by
full thickness burns less than 2%
partial of less than 15%
Superficial of 50% or less
Moderate Burns are classified severity by:
Full thickness burn of more than 2-10%
Partial of 15-30%
superficial of more than 50%
Critical Burns are classified by
All Burns complicated by injuries of the resp tract, soft tissue and injuries to the bones
Partial or Full Thickness burns to face, hands, feet, genitalia or resp tracxt
Full thickness more than 10%
Partial thickness more than 30%
Circumferential burns
Note for Geriatric patients burns usually classified as moderate would be considered
critical in adults over 55
for Children Moderate burns are
Partial Thickness burns of 10-20% of body
With Children Critical Burns are considered for
Full thickness burns of any extent or partial of more than 20%
First thing to do in treating thermal burns is to:
stop the burning process/cooling the area
- Flame : wet down and remove affected clothing
- semi-solid: grease, tar, cool w/ water do NOT remove substance
what kind of burns can indicate abuse
immersion burns, and liquid scald burns
Most EMS systems treat Patrial and Full burns by wrapping with a…
dry sterile dressing or burn sheet.
Where as burn centers recommend moist dressings for partial thickness burns to less than 10%
If a dry chemical is involved, for patient care you should first
brush away as much as the chemical as possible then flush the skin.
In what type of burn do you NOT wash the burn site with water
Dry Lime burn agent. you should brush it off the patient and use water only after the lime has been been brushed
For Carbolic Acid(phenol) what should you use for your initial wash of unbroken skin?
alcohol, then a long steady wash with water
When water is mixed with Sulfuric acid what happens even though its still recommended>
heat is produced but still preferable then leave to contaminate further
Hydrofluoric acid is used for etching glass and can have a delayed burn affect what should you do if no evidence?
still flood with water as it penetrates more deeply than other acids and causes more internal damage
Alkali burns should be irrigated longer because
they break down proteins and liquify damaged tissue which is a process called Sapnification
Electrical injuries can have the following signs
Burns where the energy enters & exits the body
Disrupted nerve pathways (paralysis)
muscle tenderness, with or without twitching
Respiratory difficulties
Irregular heart beat or cardiac arrest
Elevated BP or low BP with shock symptoms
Visual difficulties
Seizures in Severe cases
A dressing is
any material applied to a wound in an effort to control bleeding and prevent further contamination.
Should be sterile
Universal dressing also known as
Bulky dressing used for large wound and must be covered
Pressure Dressing
A dressing applied tightly to control bleeding but remember to check distal pulse to ensure not cutting off circulation
An Occlusive dressing is when
a dressing forms an airtight seal
Ex. caring for open wounds to abdomen, neck bleeding
when you are wrapping the bandage you should apply it from the ____ to ____ end
distal to proximal end or Smaller to larger diameter of the limb.
the one exception to the rule of not removing dressing once applied is when…
a bulky dressing has become soaked with blood it may be necessary to remove the dressing so direct pressure can be reestablished for a new bulky dressing
