Soft Tissue Flashcards
What are the 3 layers of the body?
- Integumentary system and skin
- Muscular system and muscles
- Skeletal system and bones
What are the functions of the skin?
- Maintenance of body temperature
o Produces sweat from glands, in response to high body temperatures
o Will produce goose bumps in low heat to retain temperature - Receive stimuli
o Touch, temperature, pressure and pain - Excretion
o Water, salts and other organic compounds - Synthesis of Vitamin D
o Convert procuress to vitamin D3, follows pathway to kidney and liver to make the active form of vitamin D, kelsithrow - Immunity
o Actively fight infection, through Langham cells in the epidermis - Protection
What are the three layers of the skin?
- Epidermis – the outer most layer
- Dermis – middle layer, houses many structures of the integumentary system.
- Subcutaneous layer – made up of adipose tissue
How many layers can the Epidermis be split into?
5
What are the four principle cells of the Epidermis, and what are their functions?
- Keratinocytes – protection o Also found in, skin hair and nail cells - Melanocytes – pigment o Found at the base and synthesised by uv light and determines the colour of our skin - Langerhans cells – immunity o Migrate from bone marrow o Apart of immune response from antigens - Merkel cells – sensation o Meccano receptor
What is the role of blood vessels in the Dermis?
- Provide nutrients to the skin, helps regulate body tempreature
- For example, heat allows blood vessels to dilate, allowing large amounts to circulate near the skin surface were the built-up heat can be released.
o Opposite affect for the cold.
What nerve endings are found in the dermis?
- Nociceptors – sensation to pain
- Mechanoreceptors – touch and pressure
- Thermoreceptors – temperature
What is the significance of sweat glands to paramedicine?
- Aids in cooling the body, through temperature and sympathetic response.
What is the purpose of Hair follicles?
- Act as a sense organ
- Protection
- Regulation of body temperature
What does the subcutaneous layer contain?
- Fatty tissue
- Blood vessels
- Nerves
- Adipose tissue that firmly attached to underlying organs
What factors in Ambulance make understanding skin relevant?
- Iv insertions
- Burns
- Adhesive tapes
- Wounds and future scarring
- Elderly skin
- Skin turgor
What is wound or soft tissue trauma?
- When there is disruption to the integumentary system which results in vascular and inflammatory reactions.
What is the clotting Process?
- Vascular spasm
- Platelet plug formation
- Blood coagulation
What are the four stages of wound healing?
- Hemostasis phase
- Inflammatory phase
- Fibroblastic phase
- Maturation phase
What is a Hemostasis response?
- The process of the wound being closed by vasoconstriction and coagulation.
What is the inflammatory response in wound healing?
- The second stage of wound healing
- The injured blood vessels leak transiate, this cause localised swelling
- The inflammation controls bleeding and infection
- The fluid allows healing cells to move to the site of the wound.
- During this phase, damaged cells, bacteria and infections are pushed out of the area
- White blood cells create the area of redness, swelling and pain
- This process of wound healing is only problematic if the process is prolonged.
What is the fibroblastic phase?
- When the wound is rebuilt from collagen and extracellular matrix.
What are the characteristics of heathy granulation tissue site?
- Bright red
- Moist
- Shiny
- Does not bleed
What are the characteristics of unhealthy granulation tissue site?
- Dark red
- Dehydrated
- Dull
- Bleeds easily
What occurs during the Maturation or remodelling phase?
- Collagen is remodelled from type 3 to type 1 when the wound fully closes.
- Collagen is aligned along tension lines, unlike during the fibroblastic phase where it is thick and uneven.
- Allows collagen fibres to lie much closer together and cross linked.
o This reduces scar thickness and skin stronger - Cells that are no longer needed are removed.
What types of soft tissue injuries are there?
- Closed wounds o Contusions - Open wounds o Abrasion o Laceration o Puncture o Avulsion o Incision o Amputation
Define a contusion
- A blunt trauma that results in swelling, pain and ecchymosis (bleeding under the skin capillaries)
o The soft tissue beneath the skin is damaged but the skin on the surface is intact.
What is swelling beneath skin that is caused by blood called?
- Haematoma
What is the best way to treat a contusion?
- The RICE acronym o Rest o Ice o Compression o Elevation
What Abrasions commonly referred to as?
- Scrapes, scratches
o For example, Gravel rash, carpet burn.
What occurs when an abrasion has formed?
- Part of the skin surface has been lost but the inner layers remain intact.
- They may involve minor bleed/weeping
- Due to the amount of nerves and sensors on the epidermis these injuries can be quite painful for some people.
What are lacerations?
- Tissue is torn leaving rough, non-uniform edges (this may affect the healing process)
- Lacerations result from an object with irregular edges, broken glass, knives, tools and machinery.
- Lacerations may penetrate through the skin surface to underlying structures that may cause significant bleeds.
What is a puncture?
- Punctures are caused by a penetrating object, for example, nail, long point object or bullet.
Should you remove an object from a puncture wound if it is embedded?
- No
Are you able to gather all the details from the outside presentation of a puncture wound?
- No, a small wound on the outside may have penetrated deep to underlying structures and require further investigation.
What are important things to look for in the penetrating wound victim?
- Good secondary survey for the following
o Other wounds that the Pt is not aware of
o Exist sites
What is an Avulsion
- A large portion of skin and tissue which is torn partial or completely off from the tissue and other underlying structures
What are common sites of Avulsion?
- Nose ears, eyes, hands and feet.
- For example, de gloving of the hand
What are ways to manage Avulsion injuries in the prehospital setting?
- Manage the PT’s pain
- Irrigate the wound with normal saieline and apply moist gauze
- Apply dry combined dressing above the gauze ↑
- Apply a pressure bandage to help stop bleeding
- Immobilize the limb
- Elevate limb to help with haemorrhage control
What should you do with amputated limbs or body parts?
- Body part should be placed in a sterile bag,
- Placed in cool water
- Boyd part should not be allowed to freeze or receive cool burns
- Regardless of limb condition it should be transported with the PT.
Describe an Incision
- Smooth even cuts that are generally made with a knife. The wound are generally longer than they are deep. However, the may occasionally be very deep and cut into muscle tissue, tendons or major blood vessels.
- These wounds will haemorrhage freely and are difficult to control.
Define Amputation
- Amputations may be complete or partial loss of a limb or part thereof. The bleeding from these wounds may be fatal?
What may cause haemorrhage of Amputations to be less severe?
- The haemorrhage in amputations may be less sever in a complete amputation. The arteries constrict and react thus, limiting the blood loss.
Define an Impaled object injury.
- The penetration of a body cavity or region by an elongated object which remains in situ.
- Features of both penetrating and blunt trauma are present.
What are the important steps in managing an impaled object?
- Stabilise the object, as further movement can cause further damage
- Do no remove the object
Define Evisceration
- The removal of internal organs
What are the main causes of evisceration
- Often result from a slashing action from a knife or other sharp object.
What is the treatment of evisceration treatment.
- DO NOT ATTEMPT TO REPLACE THE ORGAN
- Bend the pt knees to relax the abdominal muscle and structure, doing so may cause the organs to retract normally.
- Cover the organ in a sterile dressing keeping the organ moist.
- Keep the PT warm as heat loss from exposed organs can occur.
Describe face and scalp wounds
- These areas are highly vascular and may bleed excessively.
What is the management if brain tissue or bone fragment is visible?
- Do not apply direct pressure and cover the area loosely.
- GCS should be evaluated closesly.
What are good general assessment and management of soft tissue injuries?
- Assess the following
o Size
o Depth
o Location
o Contamination
o Taking a good history; secondary survey is paramount!
IS the weapon / object that cause the injury still present and available to take with for transport
Any other wounds that PT is not aware of due to a distracting injury
What are the general management of the above injuries?
- Irrigate the wound
o Normal saline
o Determine if any debris is left in the wound - Apply appropriate dressing
o West gauze with normal saline to keep the organ moist
o Quick clot dressing, packing wound tightly
o Cat tourniquet
o Cling wrap, loos organs
o Secure with pressure bandages, ring bandage and tape - Splint, immobilise and elevate injury where appropriate to assist with limiting movement and haemorrhage.
- Consider comfort, time to hospital, keep the trauma patient warm and adequate perfusion.
o This may interfere with surgical treatment
What other considerations needs to be considered for this PT?
- Tetanus status o Is the Pt up to date with theirs? - Wound infection o Swelling o Pain o Excessive redness o Discharge from the wound
