Open And Close Wound Injury

Question 1

Abrasions

Answer 1

1. Minor injuries that violates the protective barrier of skin.
2. Involves scraping and abrasive action that remove the upper dermis and epidermis
3. Can cause bleeding from superficial artery, veins, capillaries and cause infections

Question 2

Laceration/ Incisions

Answer 2

1. Penetrates more deeply into the dermis than abrasion caused by a sharp object
2. Endanger deep and significant vasculature such as nerve, artery, organ, vein, ligament and tendon
3. Risk of infection

Question 3

Punctures

Answer 3

1. Involve small entrance wound with damages that extend to the body’s interior
2. Risk of infection as the penetrating object introduces pathogen deep into the wound.
3. Normally seals off and does not reflect the extent of injury

Question 4

Impaled object

Answer 4

1. Wound complication associated with punctures and lacerations.
2. Improper removal of penetrating object causes additional damage and uncontrollable haemorrhage, embedded object temporarily blocks the bleeding loss

Question 5

Avulsion

Answer 5

1. A flap of skin
2. Seen in blunt trauma on head, animal bite and machinery injuries
3. Severity depends on the area, condition of circulation to the injury site and degree of contamination.
4. Degloving injury is a mechanism of injury that tears the skin of the underlying connective tissue, muscle, bones and blood vessel.

Question 6

Amputation

Answer 6

1. Partial or complete severance of digit or limb

2. Limited haemorrhage if cut is clean but severe and continuing if the wound is jagged or crash.

Question 7

Causes of burn

Answer 7

1. Thermal, electric, radiation and chemical

Question 8

Burns in general

Answer 8

1. Range from small to life threatening.

2. Severe regardless of sizes and can result in serious disabilities.

Question 9

First degree burn (superficial burn)

Answer 9

1. Pain, redness, dehydration due to sunburn and flash burn
2. Low risk of infection and quick healing.
3. Minor epithelial damage of epidermis.
4. Does not count to the total body surface area.

Question 10

List the percentages of each burn area

Answer 10

Head - 9%
Anterior trunk - 18%
Posterior trunk - 18%
Thigh (each) - 18%
Arms (each) - 9%
Private area - 1%

Question 11

2nd Degree Burn (Partial Thickness)

Answer 11

1. Blisters, glistening and wet appearance of base
   2a. Superficial Partial Thickness Burn: burn involves epidermis and papillary dermis (loose connective tissue)
   2b. Deep Partial Thickness Burn: extends to reticular dermis (collagen and elastic fibre)
2. Remaining dermis is pink, moist with weeping blisters, high risk of scar formation and pain

Question 12

Third Degree Burn (Full Thickness)

Answer 12

1. Thick, dry, leathery, charred appearance with visible thrombosis of deep vein
2. Slow healing of un-burn area
3. Destroy epidermis, entire dermis and underlying tissue.
4. Hypovolemic shock results from fluid loss, infection and scarring

Question 13

Fourth Degree Burn

Answer 13

1. Burns all layers of skin, fats, muscle, bones and internal organs
2. Debridement of dead and devitalised tissue result in extensive soft tissue defects

Question 14

Contusions (Bruises)

Answer 14

1. Blunt trauma and non-penetrating injuries that crush and damage the small red blood vessels.
2. Blood drawn from inflamed tissue causing erythema (reddening).
3. Blood leaked into surrounding interstitial spaces through damaged red blood vessels
4. Loses oxygen turn dark red then bluish causing blue black - ecchymosis

Question 15

Hematoma

Answer 15

1. Soft tissue injury occurs within the soft tissue can be significant if large artery or vessels are involved.
2. Blood separates from tissue and pool into a pocket.
3. Visible in head trauma but not visible on other body parts.
4. Hematoma on thigh contains massive amount of blood before swelling becomes obvious

Question 16

Crush injuries

Answer 16

1. Body compressed by heavy objects sustaining deep injuries in the muscle, blood vessels, bones and other internal organs.
2. Massive damage but minimal signs shown on skin

Question 17

Complications of Crush Injuries

Answer 17

1. Large area of tissue is destructed with minimal circulation leading to growth of bacteria.
2. Uncontrollable haemorrhage and unable to find the source or blood vessels involved.
3. Potentially results from destruction of skeletal muscle cells leading to accumulation of myoglobin, phosphate, potassium, lactic acids and toxic. Once pressure is released, the harmful substances is released into the bloodstream causing “metabolic acidosis”. High level of myoglobin accumulation in the renal tubules can cause renal failure especially among Hypovolemic shock patient.
4. Tissue hypoxia and acidosis cause muscle rigor and difficult to apply direct pressure on limb.
5. Hyperkalaemia induces arrhythmia causing death as cardiac muscle cannot respond to electric stimuli
6. Hypovolemic shock due to leakage of sodium, chloride and water into the damage tissue.
7. Hyperphosphatemia can lead to abnormal calcification in the vasculature and nervous system
8. Reoxygenation enables cells to resume aerobic process by which uric acid is produced again and increase cellular acid and injuries