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PCT > Soft Tissue > Flashcards

Soft Tissue Flashcards

1
Q

What % of body weight is skin

A

16%

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2
Q

Functions of the skin

A
  • Keeps invading pathogens out
  • keeps.fluid and substances in
  • senses
  • temperature control
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3
Q

Structural features of skin

A

Durable
Pliable
Accommodating tissue
Highly capable of self repair ( first tissue to experience affects of trauma )

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4
Q

What makes up integumentary system

A

Epidermis
Dermis
Subcutaneous layer

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5
Q

Trauma to integumentary system may present as (4)

A
  1. Open injury
  2. Closed injury
  3. Uncontrolled blood loss
  4. May seriously affect health
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6
Q

What are open injuries

A 
Abraisions
Lacerations 
Incisions
Punctures
Avulsions
Amputations
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7
Q

What are closed injuries

A

Contusions hematoma and crush injuries

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8
Q

What is uncontrolled blood loss

A

Hypovolemia or shock

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9
Q

What is uncontrolled blood loss

A

Hypovolemia or shock

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10
Q

In what way can trauma of integumentary system affect health

A

Severe blood/fluid loss, infection and hypothermia

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11
Q

Who is more prone to soft tissue trauma

A

School aged children
Elderly
Alcohol or drug abuse
Certain occupations

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12
Q

What is appearance of arterial blood

A

Bright red

Spurting / pulsing

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13
Q

What is appearance of venous blood

A

Dark red

Flowing

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14
Q

What is appearance of capillary blood

A

Red oozing

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15
Q

What is hemorrhage

A

Blood loss

  • can be minor to life threatening
  • can be from artery, vein, capillary or any combo of those
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16
Q

Management of hemorrhage

A
  • usually easy to control with diret pressure
  • may need surgery or sutures
  • important to determine amount of blood loss (to find tx plan)
  • type of injury important (clean or jagged cut)
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17
Q

What would be the result of a clean cut laceration

A

Cause smooth muscle in vessel walls to constrict and decrease lumen size, assisting in blood loss and initiating clotting

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18
Q

What would jagged cut lacerations cause

A

Cause vessel expansion with every muscle contraction, increasing blood loss if not controlled by pressure

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19
Q

When does wound healing begin

A

Immediately following injury and may take months to fully repair
- important in management of homeostasis

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20
Q

What are the stages of healing

A 
Hemostasis 
Inflammation 
Epithelialization
Neovascularization
Collagen synthesis 
(Some stages may overlap)
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21
Q

What is hemostasis

A

Bloods natural ability to stop bleeding, the ability to clot blood

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22
Q

When does hemostasis begin

A

Almost immediately following injury

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23
Q

How does hemostasis work

A

Muscular layers begin constricting, longitudinal muscles pull cut ends into contracted muscle to reduce loss.
- platelets begin clotting process, vessel walls and platelets themselves become sticky in turbulent blood flow

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24
Q

How is platelet plug formed

A

Platelets sticking to vessel and themselves causes an initial clot (platelet plug) that is unstable

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25
Q

What happens to capillaries when cut (re: hemostasis)

A

Nothing; they have no muscular layer so cannot constrict; they continue to bleed

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26
Q

What happens when tunica intima is disrupted

A

Collagen and other structural proteins are exposed to blood

  • complex series of enzyme reactions change certain blood proteins to fibrin strands
  • strands catch RBCs and make gelatinous mass that binds with platelets = coagulation
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27
Q

What is the last part of hemostasis wound healing

A
  • over time, the clot shrinks and contracts, pulling wound edges closer
  • when clot not needed anymore, body reabsorbs it and superficial scab falls away naturally
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28
Q

What is inflammation

A

Complex process of local cellular and biochemical changes as a consequence of injury or infection (an early stage of healing)

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29
Q

What is involved in inflammation

A

Involves WBCs, proteins that are involved in immunity, hormone like chemicals that signal cell to mobilize

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30
Q

What are chemotactic factors of inflamtion

A

Chemicals released by WBCs that attract more WBCs to area of inflammation
- bring phagocytes

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31
Q

What are 2 types of phagocytes

A 
Granulocyte= WBCs with primary purpose of neutralizing foreign bacteria 
Macrophages = immune system cells that can recognize and ingest foreign pathogens
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32
Q

What is phagocytosis

A

Process where a cell surrounds and absorbs a bacterium or other particle

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33
Q

What do Lymphocytes and immunoglobulins do

A

Released to attackers invading pathogens directly

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34
Q

What starts the inflammatory process

A

Chemotactic factors

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35
Q

What is release by mast cells based on chemotactic factors responses

A

Histamine

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36
Q

What does histamine do

A

Dialates precapillary vessels

- increases cap permeability and blood flow (increased Oxygenation) to injured site

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37
Q

What produces swollen, red and warm appearance at site of injury

A

Histamine

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38
Q

What is the result of the inflammatory process

A

Clear away dead/ dying tissue, remove bacteria and prep damaged area for rebuilding

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39
Q

What is epithelialization

A

Early stage of wound healing where epithelial cells migrate over surface of the wound

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40
Q

How does epithelialization work

A

Stratum germinativum divide and regenerate rapidly to make a new layer of skin cells along healing site

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41
Q

How soon after wound is made does epithelialization begin

A

As early as 48hrs with very clean wound

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42
Q

What is result of epithelialization

A
  • Thinner, different pigment and lacking hair follicle (compared to regular skin)
  • usually functional and cosmetically similar but not exact
  • larger wounds cause new layer to be incomplete so pink color/ scar of collagen to show through
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43
Q

What is neovascularization

A

New growth of capillaries in response to healing; come from surrounding, undamaged capillaries and spread into wound

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44
Q

How long does it take for new capillaries to be strong enough for wound to protect them

A

It takes months and they are more fragile and may bleed easily until strengthened enough

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45
Q

What is required for neovascularization to be initiated

A

Well-oxygenated, nutrient rich blood supply

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46
Q

What is collagen

A

Tough, strong protein that makes up most of body’s CT

  • main structural protein
  • also in hair and bones
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47
Q

What are fibroblasts

A

Specialized cells that form collagen when brought to the wound site
- they continue to work at strengthening scar and tissue even after scab falls off

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48
Q

How strong and elastic is repaired tissue vs undamaged tissue

A
  • only 60% as strong even after scar development

- collagen causes wound to be bound together

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49
Q

How long does it usually take scar to fully develop

A

Usually 4 months after scarring occurs

- why scars can reopen if aggravated

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50
Q

What is Remodeling

A

Stage in wound healing where collagen is broken down and relaid in an orderly way
- may take 6 - 12 months to complete

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51
Q

What are contusions

A

Injuries that crush and damage small blood vessels

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52
Q

What causes erythema in contusion

A

•Blood drawn into Inflamed tissue

- general reddening of skin from dilation of superficial capillaries

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53
Q

What causes color of contusions

A
  • blood leaks into interstitial spaces through damaged vessels
  • hgb in free blood loses O2, becomes dark red then blue = ecchymosis
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54
Q

What is ecchymosis

A

Blue-black discoloration of the skin ; typical “bruising”

- may not develop fast enough to be seen during prehospital care

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55
Q

Where will ecchymosis be more pronounced

A

Where blunt force mechanism and skeletal structure trap skin
- ex: steering wheel and ribs/ sternum

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56
Q

What is a hematoma

A

Collection of blood beneath the skin or trapped within a body compartment
- blood can actually separate tissue and pool in a pocket

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57
Q

Where are hematomas very visible

A

In areas directly above a solid bone structure (like head injury)

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58
Q

Where are hematomas less pronounced

A

Areas of the body with large “free” space/ body cavities

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59
Q

What is a risk with severe hematomas

A

May contribute to hypovolemia

- ex: the thigh can contain more than 1 L of blood before swelling is noticeable

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60
Q

What is a crush injury

A

Nowhere tissue is compressed by high pressure forces

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61
Q

What is crush syndrome

A

Systemic disorder of severe metabolic disturbances, resulting from the crush of a limb or other body part
- concidered life threatening

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62
Q

What happens if crush injury has pressure remain in place for several hours

A

Destruction of skeletal muscle cells leads to accumulation of large quantities of myoglobin (cell protein) , potassium, lactic acid, uric acid and other toxins

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63
Q

What happens when pressure of crush injury released after several hours

A

Built up toxins enter blood stream and cause severe metabolic acidosis
- which is toxic to heart and kidneys

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64
Q

What is abraision

A

Scraping or abrading away of the superficial layers of the skin ( epidermis and upper layer of dermis)

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65
Q

Symptoms of abraisions

A
  • bleeding usually limited (just superficial capillaries)

- if it involves larger area of epidermis can lead to serious infection

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66
Q

What are incisions

A
  • Very smooth or surgical lacerations,
  • usually knife, scalpel, razor blade, piece of glass
  • bleeds freely but heals well with proper care
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67
Q

What are lacerations

A
  • Open wound, normally a tear with jagged borders

- usually over small surface area but goes more deep into dermis layer

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68
Q

Risks associated with lacerations

A
  • higher risk of infection than abrasion
  • endangers:
    Arteries, arterioles, veins, venules, nerves, muscles, tendons, ligaments, organs in that area
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69
Q

Affect of attention lines with lacerations

A
  • Cut across tension line = wound pulls apart, spreads widely or gapes
  • cut parallel to tension line = spreads very little (easily repaired)
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70
Q

What is static tension lines

A

Areas with limited movement of tissue and structures beneath (like skin over abdo)

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71
Q

What are dynamic tension lines

A

Areas subject to great movement (skin over joints)

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72
Q

What complicates skin repair

A

Increased motion

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73
Q

What are punctures

A

Deep, narrow wound to the skin and underlying organs

  • increased danger of infection
  • if deep enough, many structures may be involved
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74
Q

What is risk with puncture wounds

A
  • infection from opening to environment and foreign object carrying bacteria into body.
  • internal, deoxygenated area is warm and moist = colonization of bacteria
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75
Q

What are impailed objects

A

Not a wound themselves, but associated with lacerations and punctures

76
Q

Critical considerations with impailed objects

A
  • consider damage that may be caused if prematurely removed
  • > may be corking great vessel hemorrhage
  • > may be entangled in arteries, nerves, structures
77
Q

What is avulsion

A
  • forceful tearing away or separation of body tissue (may be partial or complete)
  • often from blunt trauma to skull, animal bites, or machinery accidents
  • severity depends on: area and surface area involved, compromise of circulation, and degree of contamination
78
Q

What is a degloving injury

A

Avulsion in which MOI tears the skin off the underlying muscle tissue, blood vessels and bone

79
Q

Where is degloving most often seen

A

Farming and industrial setting

- also watches and rings

80
Q

Progrnosis of degloving injury

A

Poor for use of digit or extremity

- unless vasculature is not completely damaged

81
Q

What is amputation

A

Severance, removal or detachment either partial or complete of a body part
- usually complete loss of limb or digit

82
Q

Why might there be only limited hemorrhage in amputation

A

As vessel ends spasm and contract back into surrounding muscle tissue

83
Q

What is surgical repair of amputated limb/digit

A
  • may include reattaching the detached part (including surgical repair of blood vessels)
  • may involve using skin from detached part to graft the end of remaining limb/digit
  • if skin too tight or unavailable, may have to cut more bone and muscle to to have enough skin to close wound
  • surgical reatachment usually only possible with clean severed limb/digit
84
Q

Ratio of wounds that usually get infected

A

1:15
Most common complication of open wounds
- can be isolated, involve surrounding tissue or cause sepsis

85
Q

What is most common cause of skin infections

A

Staphylococcus and streptococcus bacteria families

  • gram positive, aerobic, and very common in the environment
  • staphylococcus colonized on surface of skin (easily pushed into open would when injured)
86
Q

What are pseudomonas aeruginosa

A

Infection in diabetics and foot puncture wounds

Gram negative and less common

87
Q

What are pasturella multocida

A

Infection from cat or dog bite

Gram negative and less common

88
Q

When do infections appear

A

At least 2 to 3 days after injury (bacteria must multiply in numbers)

89
Q

Symptoms of infection

A

Present with pain, tenderness, erythema, increased warmth to the area,

  • may have pus (collection of WBCs, cellular debris, and dead bacteria)
  • > thick, pale yellow green in color and has foul smell
90
Q

What is lymphangitis

A

Inflammation of lymph channels, usually from distal infection
-> visible red streaks extending from wound margins up the affected extremity

91
Q

Other symptoms of infection as sepsis sets in

A

Fever and generalized weakness

92
Q

General considerations that increase risk of infection

A

Pts health
type/ location of injury
Associated contamination
Treatment provided

93
Q

What pts tend to heal more slowly or less effectively

A

Diabetics, elderly, hospitalized, chronically ill

94
Q

What pts do not initiate immune or tissue repair response as efficiently

A

Pts with cancer, anemia, hepatic failure, cardiovascular disease

95
Q

What health conditions attacks immune system

A

Human immunodeficiency virus (HIV)
which causes
Acquired immune deficiency syndrome (AIDS)

96
Q

What is smoking’s affect on risk of infection

A

Smoking constricts blood vessels

- robs healing tissue of oxygen and nutrients

97
Q

What meds inhibit body’s ability to fight infection

A
  • Corticosteroids (prednisone & cortisone)
  • NSAIDS (ibuprofen & motrin)
  • Colchicine (med for gout) - decrease immunity response
  • Neoplastic agents (chemotherapy) - disrupt cell regeneration at wound
98
Q

Wound type / location effect on infection

A
  • puncture traps contamination within tissue
  • Avulsion tears away tissue and blood cells, decreasing available blood supply
  • Crush injuries ( and other large wounds) cause large dead/ devitalized area - larger environment for bacterial growth
  • Areas of higher vascularity (scalp & face) ward off infection more efficiently; distal areas of poor circulation are higher risk
99
Q

What causes some of most serious infections

A

Human and animal bites

100
Q

Paramedic role in preventing infection

A
  • clean gloves (protect PCP and Pt)
  • sterile dressings and water flushing wounds
  • closing wound (ex: sutures) increase infection risk but better for healing cleanly
101
Q

Treatment of infections

A

Antibiotics and tetanus shots are best within an hour of injury

  • especially puncture wounds to feet, GSW, stabbings, or if foreign part remains in skin
  • antibiotics after the fact may increase infection if pt is resistant to the meds or has resistant microorganisms
102
Q

What is gangrene

A

Deep space infection usually caused by the anaerobic bacterium Clostridium perfringens

103
Q

Symptoms of gangrene

A
  • Produce gas deep in wound causing subcutaneous emphysema and foul smell with gas escape
  • can spread quick once developed
  • can = sepsis and death if not treated rapidly and aggressively (sometimes with hyperbaric oxygenation)
  • if antibiotics dont work may need to amputate
104
Q

What is tetanus

A

Aka Lockjaw

Caused by anaerobic bacterium Clostridium tetani which produces potent toxin that spreads systemically

105
Q

Treatment of tetanus

A

Tx is slow and prolonged as antidote only neutralizes circulating toxins
- immunizing 3 x as child then every 10 years has drastically reduced cases

106
Q

Symptoms of tetanus

A

Less local involvement (wound site) and more widespread pain and muscle contraction

107
Q

Best current form of tx of infection

A

Antibiotics

Aka chemical bactericidals

108
Q

How to treat Gram- positive infections

A

Antistaphylococcal penicillin, cephalosporin, erythromycin (for pts allergic to PNC)

109
Q

How to treat Gram- Negative infections

A

Psudomonas require 2 meds together

Pasturella is treated with penicillin

110
Q

How to treat abscess (accumulation of pus)

A

Lancing to allow drainage may be required

111
Q

When might you need to surgically remove bateria-infested tissue

A

If antibiotics are too slow or ineffective

112
Q

What is impaired hemostasis and its affect on wound repair

A
  • anticoagulation therapy prolongs clotting time and efficiency by anti-platelet aggregation or break down of clot protein fibres ( ASA, heparin, coumadin)
  • penicillin may also increase clotting time and blood cell production
  • abnormalities in proteins involved in fibrin formation (hemophiliacs) delay clotting
113
Q

What is rebleeding and effect on wound repair

A
  • movement of underlying structures or dressing may disrupt clotting
  • more absorbent dressing may hide active bleed ( monitor all dressings that blood loss is not accumulating)
  • reopening of partially healed wound
114
Q

What pts suffer from delayed healing and extra care needed

A

Chronically ill, diabetic, elderly, malnourished pts, pts with very large wounds, chronically infected wounds, wounds in area with less circulation

  • may have incomplete or halted healing
  • serous fluid (cellular component of blood like plasma) may drain from partially healed wounds
  • home care for dressing changes and antibiotics
115
Q

What is keloid scar formation

A

Formation resulting from overproduction of scar tissue; scar extending past injury borders
- common in dark pigmented skin; on sternum, abdo, upper extremities and ears

116
Q

What is hypertrophic scar formation

A

Excessive scar tissue within injury borders

- common at dynamic tension points like joints

117
Q

What is compartment syndrome

A

Muscle ischemia that is caused by rising pressures within anatomical fascial space

  • usually in closed wounds
  • usually extremity injury causing swelling /edema in deep tissues due to limited room for expansion
118
Q

What happens in compartment syndrome if pressure rises above 45-60 mmHg

A
  • blood flow compromised to muscle/ tissue (ischemia)
  • muscle mass may die interfering with limb function
  • resulting scar tissue shortens length of muscle strand and produces Volkmann’s contracture (interfering with.limb usefulness)
119
Q

What is area at greatest risk of compartment syndrome

A

Calf because of its bulk and fascial anatomy

120
Q

What are pressure injuries

A

Caused by prolonged compression of skin and tissue beneath

121
Q

Who might get pressure injuries

A

Chronically ill pts (bed-ridden), pt who falls and remains in one position (especially if unconcious) for multiple hours

  • alcohol intoxication, stroke, drug OD, elderly who cant get up alone
  • pt immobile on spinal board or splint too long
  • weight of pt against ground compresses tissue and induces hypoxic injury
122
Q

What is difference of pressure injury and crush injuries

A

Similar but pressure injury is more passive (more likely to go unoticed)

123
Q

What is minor crush injury and massive crush injury

A

Crush injury = tissue subjected to severe compressive forces
Minor = maybe just a finger
Massive = much or all of the body
MOI are varied

124
Q

What is disrupted in crush injury

A 
Muscles
Blood vessels
Bone
Occasionally internal organs 
Skin may remain intact or be open 
Structure may be normal or deformed
125
Q

Why would hemorrhage be difficult to control in crush injury

A
  • source of bleeding may be hard to find
  • large vessels can be damaged
  • structural damage may prevent direct pressure
126
Q

What does palpation of tissue hypoxia and acidosis feel like

A

They cause muscle rigor so muscle may be very hard

127
Q

Additional injuries from crush injury

A

Hypothermia, dehydration, depending on MOI

128
Q

What is injection injury

A

Results when a bursting high- pressure line (like hydraulic line) injects fluid through pts skin and into subcutaneous tissue

  • with strong pressure, fluid may push btw tissue layers and travel along limb
  • fluid damages surrounding tissues
  • body cant remove fluid
129
Q

How can injection injury compromise limb

A
  • direct physical damage
  • chemical damage from injection material
  • from infection that follows injury
130
Q

What level is affected in 1st degree burn

A

Superficial

131
Q

What layer is 2nd degree burn

A

Partial thickness, blistering

132
Q

What layer is 3rd degree burn

A

Full thickness, partially or fully charred

133
Q

What layer is 4th degree burn

A

Complete thickness, likely into muscle and bone

134
Q

Major concerns with burns

A

Infection
Hypovolemia
Hypothermia
Pain

135
Q

What is dressing and 5 kinds

A

Material placed directly over a wound to control bleeding

  • steril/ non sterile
  • occlusive/ nonocclusive
  • adherent / nonadherent
  • absorbent / non-absorbent
  • wet/ dry
136
Q

What is bandage and 5 kinds

A

Material used to hold a dressing In place and apply direct pressure to co trolls hemorrhage

  • roller/ king
  • gauze
  • adhesive
  • elastic
  • triangular
137
Q

Sterile dressing

A

Cotton or other fiber pad
Free of microorganisms
Packed individually and remain sterile till open
Direct contact with wound

138
Q

Non sterile dressing

A

Clean but not free of microscopic contamination
Not meant to go directly on wound
Place over sterile dressing
Adds bulk and absorption

139
Q

Occlusive dressing

A

Prevent fluid movement and air aspiration into chest wounds ( sucking chest wound) or open neck wound (air emboli into jugular vein)
- sterilized plastic and petroleum gauze

140
Q

Nonocclusive dressing

A

Most dressing material are nonocclusive category

- breathable and not resistant to fluid movement

141
Q

Adherent dressing

A

Cotton or fiber pads that stick to drying blood and fluid

  • promote blood clot formation (reduce hemorrhage)
  • removal likely to break clot and cause rebleeding
142
Q

Nonadherent dressing

A

Specifically treated with chemicals like polymers

  • stoos fluids and clotting materials from sticking to dressing
  • proffered for uncomplicated wounds
143
Q

Absorbant dressing

A

Readily soak up blood and other fluid

  • similar to a sponge
  • helpful in heavy bleeding situations
  • most dressings are absorbant
144
Q

Nonabsorbant dressing

A

Absorb little to no fluid and used when a barrier to leaking is needed
- typically used over IV sites

145
Q

Wet dressing

A

Applied to specific types of wounds (burns)

  • help with healing post OP wounds
  • sterile non- saline is used to wet dressing
  • provide medium for movement of infectious material into wound
  • used prehospitally for eviscerations or other injuries where tissue is exposed
146
Q

Dry dressing

A
  • most often employed in pre- hospital setting

- any dressing not dampened by saline = dry dressing

147
Q

What is self-adherent roller bandage (kling)

A
  • most common and convenient pre hospital bandage material
  • resists unraveling as it rolls over itself
  • confirms easily with body contours ( useful circumferentially)
  • usually 4” and 6” in ambulance
148
Q

What is gauze

A
  • convenient for securing dressing
  • do not stretch (dont contour linked kling)
  • can increase pressure associated with tissue swelling at injury site
149
Q

What are adhesive bandages

A

Strong plastic, paper or fabric material with adhesive applied to one side
- effectively secure small dressing where circumferential wrapping is impractical
(If wrapped circumferentially would prevent room for swelling and causes pressure to accumulate)

150
Q

What are elastic bandages

A
  • stretch and conform to body contours

- very easy to apply to much pressure ( may need to loosen bandage while swelling increases)

151
Q

What are triangle bandages

A
  • usually used to make slings/ swathe since they are not elastic
  • do not provide direct pressure, but may be used to affix a splint
152
Q

When doing scene assessment on arrival to musculoskeletal injury make sure to:

A
  • make sure what caused trauma to pt is not risk to you paramedic
  • consider additional PPE ( eye protection, gown, face shield based on extent of hemorrhage)
  • for severe bleeding, consider applying 2 pairs of gloves( can easily slip off top pair if become too bloody)
153
Q

Primary survey pt with soft tissue trauma

A
  • always, ABCs and any life threatening gross hemorrhage come first
  • consider rapid transport for pt with sign of shock, uncontrolled bleeding, or estimated large blood loss. Significant MOI also
154
Q

Add to you assessment of soft tissue trauma

A
  • inspect wounds for debris and ID what caused trauma to anticipate level of contamination
  • any pt with altered LOC or distracting injury make sure you do hands on secondary assessment on way to hospital
  • inspect wound well, need to dress it and describe it to the ER
155
Q

Objectives of soft tissue management (4)

A
  1. Control hemorrhage
  2. Keep wound clean
  3. Immobilize wound site to prevent clot disruption
  4. Prevent further injury/ pain
156
Q

How to manage and control hemorrhage

A

~RED~
Rest
Elevate
Direct Pressure

Consider cold pack above wound site to assist in hemorrhage control and swelling

157
Q

When can you consider additional care like tourniquets

A

If hemorrhage does not stop

- but always attempt direct pressure first

158
Q

What to always check with circumferential bandaging and splinting

A

Monitor distal circulation

159
Q

Treatment of sort tissue injury includes 2

A
  • choose appropriate dressing for wound

- flush wound with sterile water if debris is present

160
Q

What is presentation of scalp injuries

A

They are very vascular so often cause injury to look worse

161
Q

Why do you need to make sure you asses underlying bone structure of scalp injury before applying pressure

A

If skull fx = gentle digital pressure around would d

No fx= direct pressure

162
Q

Does scalp injury usually account for shock/ hypovolemia

A

Rarely

163
Q

What to assess on pt with scalp injury

A

Signs of
Head injury
Concussion
Ocular disturbances

164
Q

What to do if brain or CSF matter is evident when dressing wound

A

Brain matter = cover with moist, sterile dressing and consider plastic/foil to retain heat
CSF = apply loose dressing over any wound that appears to have CSF draining

165
Q

Anatomical considerations for face injury

A
  • often significant bleeding
  • avoid or relieve airway obstruction, may need to suction
  • may need gauze and tape to dress face wounds
166
Q

What do you do if tooth is displaced

A

Attempt to put it back and have pt bite on gauze

Or bring it to hospital

167
Q

Prepare for what if pt swallows blood

A

Blood is gastric irritant

- be prepared for nausea and or vomiting

168
Q

How to dress a ear wound

A

Apply directly to ear and then wrap with kling wrap for external hemorrhage/ trauma

169
Q

What to do if pt bleeding from ear canal

A
  • check for CSF and then cover loosely with gauze

- if you prevent flow of CSF it may cause increased intracranial pressure

170
Q

What kind of dressing do you use on neck

A
  • never apply circumferential pressure dressing around the neck
  • be aware of airway complications from tight bandages
171
Q

If you need to apply continuous direct pressure to neck wound what should you be careful to avoid

A

Putting pressure on both carotids at the same time

172
Q

How can you put pressure on wound with c- collar

A

Put bulky dressings under it to apply pressure

173
Q

When to consider occlusive dressing to neck

A

If there is any risk of air entering the vasculature of the neck

174
Q

What to watch for with soft tissue injury in abdomen

A

Watch for developing signs of contusions

- potential for organ damage

175
Q

What to keep in mind with thorax injuries

A

External wound may be only a small part of the picture- internal damage may be significant
- watch for signs of pneumo/ hemothorax

176
Q

How to dress sucking wounds on thorax

A

Occlusive 3 sided dressing

177
Q

How to dress minimal thorax wound

A

Consider dressing with tape

178
Q

What is may be a good way to manage significant hemorrhage of thorax

A

Wrapping around chest

179
Q

How to manage an amputation wound

A
  • gently rinse with saline if contaminated
  • wrap exposed end part with moist, sterile gauze and plastic/ foil
  • apply ice or submerge in cold water
  • bring amputated part to hospital in a bag that is dry and sealed and placed in cold water on ice
180
Q

How to manage impaled object wound

A
  • stabilize in place with gauze or triangle “donut” to prevent movement
  • prevent excessive limb movement
  • remove object only.if interferes with CPR or airway
  • secure dressing in place to increase direct pressure on external hemorrhage
181
Q

How to manage crush/ compartment syndrome

A
  • care for underlying injury/ hemorrhage
  • splint and immobilize where required
  • apply cold packs to any developing contusions
  • provide fluid resuscitation
  • prepare for risk of rapid decompensation if pt had been trapped for an extended period of time
    (Constantly monitor vitals as can crash quickly)
182
Q

What is max time of cooling a burn to avoid hypothermia

A

Less than 30 mins

183
Q

How to manage 1st degree burns

A

Moist, sterile dressing and the cover with a dry dressing

184
Q

How to manage 2nd degree burn

A

Less than 15% of body
Moist sterile dressing and then cover with dry dressing
More than 15% of body
Dry sterile dressing and keep them.warm

185
Q

How to manage 3rd degree burn

A

Dry sterile dressing

186
Q

How to bandage burns to fingers and toes

A

By wrapping a dressing in between each digit before wrapping whole hand /foot

PCT (9 decks)

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