Hemorrhaging & soft tissue injuries Flashcards
blood functions
- transport waste, gas, nutrients
- protect against disease
- maintain body temperature
- blood loss can be internal or external
Arterial bleed
- bright red blood
- spurt w each heart beat, high pressure
- rapid + profuse = large, severe blood loss
venous bleeding
- dark red
- steady flow, less pressure
- can be severe if enough vessels are damaged
capillary bleeding
- red colour
- ooze, low pressure
- coagulate quick
blood loss amounts before critical
- adult normal = 6.6L
lethal = 2.2L - adolescents normal = 3.3L
lethal = 1.3L - child normal = 1.5-2L
lethal = 0.5-0.7L - infant normal = 300mL
lethal = 30-50mL
phases of wound healing
executive (1): bring in fibrin, collagen and clog the wound
resorptive (2): scavenger cells remove dead cells and germs
proliferative (3): new cells formed and fill wound
repair (4): cell form around edge of wound, wound closes
Recovery time for areas w/ good and poor blood supply
good (face) = 5-6 days
poor (knee) = ~17 days
granulation
- occur due to gap in wound edges
- new tissue grow from inside out
- scar tissue
- slow healing
healing
primary intention: edges close together, not need new cells
secondary intention: bigger gap, need new tissues to fill cells and more scarring happens , not as strong
infection
- minor: wash for 5 min under running water
- major: RTD, bleed control (more important than clean)
- use sterile, non adherent, do not touch, wear gloves
s/s of local infection
- swelling, redness to the area
- warm to touch
- throbbing pain
- pus discharge
s/s of systemic infection
life threat!
- flu like (fever, nausea, malaise)
- red streaks running from wound to heart
- swollen lymph nodes
tetanus
MOI: bacterial spores from Clostridium tetani (soil, dust, animal feces)
- spores develop into bacteria that like low O2 (puncture wounds are at greatest risk)
- affect CNS
- irreversible once in nervous system
S/S of tetanus
- difficulty swallowing
- irritable
- headache
- fever
- muscle spasms near affected area
gangrene and it’s S/S
bacterial infection thrive in low O2 or loss of blood supply
S/S
- sudden pain and swell
- local tissue discoloration
- brownish, smelly watery discharge
- low grade fever
- shock
- can lead to necrotizing fasciitis (flesh-eating disease)
pressure bandage
- for minor-moderate amounts of bleeding
place dressing to apply direct pressure (add more when saturated through) to wound, which compresses the blood vessels, restricts the blood flow and allows clotting
rules for dressing and bandages
- patient seated or recumbent position
- place direct pressure w/ gloved hand
- apply sterile dressing place your gloved hand over the dressing and apply firm pressure
- apply bandage over dressing to maintain direct pressure and hold in place
- if blood soak through add more (DO NOT remove)
- if bleed continues apply tourniquet if you can
- avoid covering fingers/toes
- distal to proximal
- avoid digging into tissue and restrict circulation
Stitches
close a wound that might not heal cleanly
- speed healing process
- prevent infection
- reduce scarring
- first few hours of injury
wounds that need stitches
- hemorrhaging
- jagged edges
- > 2.5 cm (1”) long
- on face or head
- gape wide or show bone/muscle
- on joint, hands, feet
- large/deep puncture or embedded object
- human or animal bite
tourniquet
- blocks blood completely from extremity
- used w bandage/dressing, as last resort
- use in mass casualty
- 2-4in prox to injury site
- tighten until bleeding stop, secure
- document time applied
- RTD
internal bleed
- hemorrhaging btwn organs/structures of the body
KEYS - MOI/HIstory
- difficult to reconize should always suspect if MOI indicates
- Major fractures can puncture organs
- might become visible in secondary assessment
internal bleed s/s
- discolouration of skin (bruising)
- cool/moist/pale/blue skin
- rapid, weak pulse
- decrease LOR or BP
- nausea/vomiting
- anxiety, restless
- ST is tender, swollen, firm
- tachypnea
- excessive thirst
internal bleed treatment
minimize movement of person/limb
keep patient calm
monitor ABC and vitals
administer O2
maintain normal body temp
RTD
epistaxis
nose bleed
MOI: direct blow, sinus infection, dry nasal membrane, foreign bodies, hypertension, altitude changes
- pinch nostril, lean forward
- nasal plug/gauze pads
- ice bridge of nose
- avoid rub, blow, pick 2-3hrs
- ask if they have blood thinners
- Bleeding not controlled w/in 10-15 RTD
closed wounds
any wound occur w/o breaking the skin (not worry about infections, more internal bleeds)
- abscess
- dermatitis
- subungual hematoma
abscess
localized collection of pus w/in tissues
- rupture on own, do not pop
- often around hair follicle
- alternate hot, warm compresses
- cover w sterile dressing
- monitor for saturation and infection
- face, neck, groin, buttocks or pain = physician
subungual hematoma
collection of blood/fluid under nail bed
- clean area, place finger on firm surface, drill into nail to relieve pressure (last resort)
- clean and apply sterile dressing
dermatitis
inflammation of the skin
MOI: direct contact w chemical or allergy
- red, irritated, swell
- itchy, pain
- thickening or cracking of epidermis
- blisters
- avoid touch; dress it; physician
open wound
an injury in which the skin is interrupted, exposing the tissue beneath
- abrasion
- laceration
- avulsion
- puncture
- control external bleed, protect against infection, check for internal injuries
Abrasion
(most common)
-epidermis has been scraped away
- capillaries only blood ves effected
- nerve endings exposed
- infection is concern because dirt and other matter is easily embedded
cleaning wound is IMPORTANT
Laceration
cut, usually from sharp object
- jagged or smooth ends
- sharp or blunt object is MOI
- deep lacerations can affect muscle and fat, damage nerves and blood vessels
- watch for shock
Avulsion
Portion of the skin + soft tissue partially/fully turn away
- leave attached
- bleeding and infection control are priorities
Puncture
skin pierced with pointed object
- entrance and exit wound
- usually seal around object, little bleeding
- high infection risk (tetanus) clean thoroughly
- ex. bullet wound
Impaled object
object penetrate skin and remain in the body
- not a lot of blood, act as a plug
- do not remove! splint around for support, stop the bleed
impaled object exception
only remove an impaled object if it interferes with the patient’s airway or breathing
- neck, mouth, lungs
major soft tissue trauma
amputation
crush injuries
compartment syndrome
blast injuries
high-pressure injection injuries
Amputation
body part fully/partly severed from the body
- multiple injuries (muscle, bone, blood vessel)
- not a lot of blood (vessels constrict, retract)
- rinse w saline
- wrap in non adherent gauze, cool amputated part; label with day, name, time
-RTD
crush injuries
body subjected to intense blunt force
- hard to tell internal injuries (fracture, bleed, etc)
- dead tissue become systemic, toxins build up and spread due to low O2
- crush syndrome
- RTD
crush syndrome
Patient subjected to crushing force >1hr hypoxic tissues function anaerobically, cause toxins made. When the force is released the toxins become systemic.
- impaired heart, kidney failure
- life threat; RTD
compartment syndrome
pressure in muscle compartments build up to dangerous level, blocking O2 to cells.
- swell/bleed cause pressure on caps, which collapse
- lack of O2 and nutrients cause nerve/muscle death
MOI: trauma, badly bruised muscle, post-surgery complications, crush injury, anabolic steroids
RTD, limb threat
6 P’s of compartment syndrome
- pain
- pressure
- paresthesia (n/t)
- paresis (muscle weakness)
- pallor
- pulselessness
- all 6 = irreversible (death, disability)
blast injuries
heat & pressure waves from explosion strike, pass thru body
MOIs: blast itself, shrapnel, thrown by blast
- internal bleed, hemorrhage, edema, pulmonary embolism
- RTD
- primary(blast itself), secondary (debris, thrown) & tertiary (crush injur. propelled into solid object)
high pressure injections (HPI) injuries
a substance injected into the body under high pressure
- industrial work (grease gun, pressure washer)
- small puncture visible (2000 psi enough to break skin)
- RTD
burns
area of body receive more heat producing energy than it can absorb w/o injury to contact tissue
- thermal: flame, steam, hot items
- chemical: acids or alkalines
- electrical: lightning, electrical outlet
- radiation: nuclear source, sun
superficial burn
1st degree
- epidermis damaged
- red, dry, painful
- 5-6 days recovery
- clean, running water
Partial thickness
2nd degree
- epidermis and dermis damaged
- red, pain, swollen skin, blisters
- recover 3-4wks
- clean surrounding area, no pressure/wrap
- damaged nerve endings
full thickness burn
3rd degree
- epidermis, dermis, underlying structures damaged
- charred skin, deep tissue white, painful OR pain-free
- surrounded by partial thickness burn
- can be life threat (lose body fluid)(hypovolemic shock)
immediate advanced care for burns
- any full thickness burn
- partial thickness >10%
- partial/full burn to child/elderly
- inhalation or respiratory injuries from burn
- burn mouth, hands, nose, feet, genitals
- chemical, explosive, electrical burns
- lots of pain
- unresponsiveness
Rule of 9’s
Head and neck = 9%
Upper Ex = 9% each
Lower Ex = 9% each
Front trunk = 18%
Back trunk = 18%
estimate amount of body that is burned
- varies if a child vs adult
