Soft-Tissue Injuries Flashcards
Injuries that result from sudden or extreme changes in air pressure
Barotrauma
Death resulting from soft-tissue injury is often related to ___
Hemorrhage or infection
First line of defense against external forces and infection
Skin
Two principle layers of skin
- Epidermis
- Dermis
Tough external layer that forms a watertight covering for the body
Epidermis
Where new skin cells form at the base of the epidermis
Germinal layer
Deeper cells in the germinal layer contain ___
Pigment granules
Inner layer of the skin
Dermis
Lies below the germinal cells of the epidermis
Dermis
Contains the structures that give the skin its characteristic appearance: hair follicles, sweat glands, and sebaceous glands
Dermis
Produce sebum
Sebaceous glands
The oily material that waterproofs the skin and keeps it supple
Sebum
Sebum travels to the skin’s surface along the ___
Shaft of adjacent hair follicles
Small organs that produce hair
Hair follicles
Similar to skin, these membranes provide a protective barrier against bacterial invasion
Mucous membranes
Mucous membranes differ from skin in that they ___
Secrete a watery substance that lubricates the openings
Three types of soft-tissue injuries
- Closed injuries
- Open injuries
- Burns
Soft-tissue damage occurs beneath the skin or mucous membrane but the surface remains intact
Closed injuries
There is a break in the surface of the skin or mucous membrane, exposing deeper tissues to potential contamination
Open injuries
Soft-tissue damage occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation
Burns
Second stage of wound healing
Inflammation
Migrate to the wound area to combat pathogens that have invaded the exposed tissue
White blood cells
A type of white blood cell that destroys bacteria and other pathogens from the wound site
Lymphocytes
Release histamine as part of the body’s early response in the early stages of inflammation
Mast cells
Dilates blood vessels, increasing blood flow to the injured area and resulting in a reddened warm area immediately around the site
Histamine
Histamine makes capillaries more ___
Permeable
Inflammation ultimately leads to the ___
Removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site
The third stage of wound healing
New skin grows in
The fourth stage of wound healing
New blood vessels form
Tough, fibrous protein found in scar tissue, hair, bones, and other connective tissues
Collagen
Last stage of wound healing
Collagen provides stability to the damaged tissue and joins wound borders
Closed soft-tissue injuries are characterized by ___
A history of blunt trauma, pain at the site of injury, swelling beneath the skin, and discoloration
Bruise
Contusion
An injury that causes bleeding beneath the skin but does not break the skin
Contusion
Occurs when a significant force is applied to the body
Crushing injury
Crush syndrome can develop if an area of the body is trapped for longer than ___ and ___
- 4 hours
- Arterial blood flow is compromised
The extent of a crushing injury depends on ___
How much force is applied and for how long
Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods
Crush syndrome
If a patient has been trapped with a crushing object for a prolonged period, ALS providers should ___
Administer IV fluid before freeing the patient
Crush syndrome can lead to ___
Cardiac arrest and renal failure
Develops what edema and swelling result in increased pressure within a closed soft-tissue compartment
Compartment syndrome
The presence of infections organisms or foreign bodies
Contamination
Four types of soft-tissue wounds
- Abrasions
- Lacerations
- Avulsions
- Penetrating wounds
A wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface
Abrasion
A jagged cut in the skin caused by a sharp object or blunt force that tears the tissue
Laceration
A sharp, smooth cut
Incision
Lacerations and incisions may appear ___ or ___
- Linear (regular)
- Stellate (irregular)
An injury that separates various layers of soft tissue so that they become either completely detached or hang as a flap
Avulsion
An avulsion is usually between the ___
Subcutaneous layer and fascia
What to do if an avulsion is hanging like a flap
Replace the flap in its original position as long as it is not visibly contaminated with dirt and/or other foreign materials
What to do if an avulsion has completely separated
Wrap the separated tissue in sterile gauze and take it with you to the ED
An injury in which part of the body is completely severed
Amputation
An injury resulting from a piercing object
Penetrating wound
Objects that penetrate the skin but remain in place
Impaled objects
Treat all penetrating wounds of the neck, chest, back, and upper abdomen with an ___
Occlusive dressing
Anytime you observe bruising, swelling, or deformity, or the patient reports pain, the possibility of a ___ should be considered
Closed injury
Types of patients that need immediate transportation
- Poor initial general impression
- Altered level of consciousness
- Dyspnea
- Abnormal vital signs
- Shock
- Severe pain
Using ___ may provide some background on isolated extremity injuries
OPQRST
Extremities that are painful, swollen, or deformed should be ___
Splinted
If done correctly, splinting can assist with ___
Pain management and bleeding control
Small contusions generally do not require special emergency medical care, but you should ___
Note their presence when trying to determine the true extent of the patient’s injuries
Treat a closed soft-tissue injury by applying the mnemonic ___
RICES
RICES
Rest
Ice
Compression
Elevation
Splinting
All open wounds are assumed to be ___
Contaminated
To prevent an open wound from drying, you may ___
Apply sterile dressings moistened with sterile saline solution and then cover the moist dressing with a dry, sterile dressing
Organs protrude though the wound
Evisceration
How to care for evisceration
Cover the wound with sterile gauze moistened with sterile saline solution and secure it with an occlusive dressing
The only exceptions to the rule of not removing an impaled object
It is through the mouth or cheek and actively obstructs breathing or it is in the chest and directly interferes with performing CPR on a patient who is already in cardiac arrest
If enough air is sucked into a blood vessel, it can block the flow of blood into the lungs and cause cardiac arrest
Air embolism
To control bleeding and prevent the possibility of an air embolism with a neck injury ___
- Cover the wound with an occlusive dressing.
- Apply manual pressure (don’t compress both carotid vessels at the same time).
- Secure a pressure dressing over the wound by wrapping roller gauze loosely around the neck and then firmly through the opposite axilla
Removal of damaged tissue
Debridement
Small animal bites may require ___
- Debridement
- Antibiotics
- Tetanus prophylaxis
How to treat small animal bites
Place a dry, sterile dressing over the wound, and promptly transport to the ED
Emergency treatment of human bites
- Apply a dry, sterile dressing
- Promptly immobilize the area with a splint or bandage
- Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy
A severe burn injury presents several simultaneous life threats, including ___
- Hypovolemic shock
- Sepsis
- Hypothermia
- Respiratory failure
Occurs when the body receives more radiant energy than it can absorb
Burn
Thermal burns can occur when the skin is exposed to temps higher than ___
111°F
In general, the severity of a thermal injury directly correlates with ___
Temperature, concentration, or amount of heat energy possessed by the object and the duration of exposure
Burns to the airway are of great importance because the ___
Loose mucosa in the hypopharynx can swell and result in complete airway obstruction
Circumferential burns of an extremity can ___
Compromise breathing
Circumferential burns of an extremity can lead to ___, resulting in ___
- Compartment syndrome
- Neurovascular compromise and irreversible damage if not appropriately treated
TBSA
Total body surface area
Burns of ___ will likely require IV fluid resuscitation
20% of TBSA or more
Burns of ___ may be fatal without treatment
30% of TBSA or more
Burns of ___ in older adults may be fatal without treatment
Less than 15% of TBSA
Inhalation burn injury can ___ the risk of death from a burn injury
Double
Five factors to determine the severity of a burn
- Depth of the burn
- Extent of the burn
- Any critical areas involved or circumferential burns
- Preexisting medical conditions or other injuries
- Younger than 5 or older than 55
Critical burn areas
- Face
- Upper airway
- Hands
- Feet
- Genitalia
Recommend transfer to a designated burn center for any patient with an acute burn with any of the following ___
- Partial-thickness burns of 20% TBSA or greater in patients 10 to 50 years old
- Partial-thickness burns of 10% TBSA or greater in children younger than 10 or adults older than 50
- Full-thickness burns of 5% TBSA or greater
- Partial or full-thickness burns to the hands, feet, genitalia, face, or major joints
- High-voltage electrical injuries
- Significant chemical burns
- Concomitant traumatic injury
- Inhalation injury
- Significant ongoing medical problems
- Special social/emotional or long-term rehabilitative support
Severe burn in an adult classification criteria
- Full-thickness burns involving the hands, feet, face, genitalia, airway, or circumferential burns
- Full-thickness burns covering more than 5% TBSA in any patient
- Partial-thickness burns covering more than 20% TBSA (10 to 50 y/o) and 10% TBSA (younger than 10 and older than 50)
- Burns with concomitant traumatic injuries
- Burns to patients younger than 5 or older than 50 that would otherwise be classified as moderate
Moderate burn in an adult classification criteria
- Full-thickness burns involving 2% to 10% TBSA (excluding hands, feet, face, genitalia, and upper airway)
- Partial-thickness burns covering 15% to 30% TBSA
- Superficial burns covering more than 50% TBSA
Minor burn in an adult classification criteria
- Full-thickness burns covering less than 2% TBSA
- Partial-thickness burns covering less than 15% TBSA
- Superficial burns covering less than 50% TBSA
When you are treating older adults, pediatric patients, or special needs patients with burns, it is important to be alert for the possibility of ___
Abuse
Signs of abuse include ___
- Evidence of multiple injuries in various stages of healing
- Injuries that do not seem to correspond to the history provided by caregivers
- Burns associated with a suspicious history
Burns that appear in a pattern are suspicious for ___
Intentional injuries
Burns are first classified according to their ___
Depth
Three types of burns
- Superficial (first degree)
- Partial-thickness (second degree)
- Full-thickness (third degree)
Involves only the top layer of skin, the epidermis. The skin turns red but does not blister or burn through this top layer
Superficial burn
Involve the epidermis and some portion of the dermis. Do not destroy the entire thickness of skin, nor is the subcutaneous tissue injured. Typically the skin is moist, mottled, and white to red. Blisters are present
Partial-thickness burn
Extend through all skin layers and may involve the subcutaneous layers, muscle, bone, or internal organs
Full-thickness burn
The burned area is dry and leathery and may appear white, dark brown, or even charred. Some may feel hard to the touch
Full-thickness burn
Significant airway burns may be associated with ___
Singed hair in the nostrils, soot around the nose and mouth, hoarseness, and hypoxia
Rule of palm
The area of the patient’s palm and fingers equals 1% of TBSA
Rule of nines
Divides the body into sections, each of which is about 9% of TBSA
When you calculate the extent of burn injury, include only ___
Partial-thickness and full-thickness burns
Burns in infants and children of a similar size and severity to an adult is more serious because ___
They have more surface area relative to total body mass, which means greater fluid and heat loss. Children also do not tolerate burns as well as an adult does and are more likely to go into shock, experience hypothermia, and have airway difficulties
Severe burn in a child or infant classification criteria
- Any full-thickness burn
- Partial-thickness burns covering more than 20% TBSA
Moderate burn in a child or infant classification criteria
Partial-thickness burns covering 10% to 20% TBSA
Minor burn in a child or infant classification criteria
Partial-thickness burns covering less than 10% TBSA
Specific questions to ask a patient with a burn for the SAMPLE history
- Are you having any difficulty breathing?
- Are you having any difficulty swallowing?
- Are you having any pain?
First responsibility in caring for a patient with a burn
Stop the burning process and prevent additional injury
Do not keep the burned part submersed in water for more than ___
10 Minutes
Large burn
Greater than 10% BSA
Cover larger burns with ___
A dry, sterile, nonadherent dressing
Caused by heat
Thermal burn
Types of thermal burns
- Flame
- Scald
- Contact
- Steam
- Flash
Upper airway damage is often associated with the inhalation of ___
Superheated gases
Lower airway damage is often associated with the inhalation of ___
Chemicals and particulate matter
Apply ___ to help reduce some minor edema in a patient with an inhalation burn
Cool mist, aerosol therapy, or humidified oxygen
The less efficient the combustion process, the more ___ the gases
Toxic
___ intoxication should be considered whenever a group of people in the same place all report a headache or nausea
Carbon monoxide
Carbon monoxide binds to the receptor sites on hemoglobin at least ___ times more easily than oxygen does
250
Most people have ___ carbon monoxide attached to their hemoglobin
2%
Heavy smokers may have ___ carbon monoxide attached to their hemoglobin
4% to 8%
Carbon monoxide levels in the blood at levels of ___ or higher may be fatal
50%
Patients with severe carbon monoxide intoxication usually have an oxygen saturation level that is ___
Normal
Patients who have potentially inhaled toxic gases should receive ___ regardless of ___
- A high concentration of supplemental oxygen
- Pulse oximetry readings
Gaseous form of cyanide
Hydrogen cyanide
Hydrogen cyanide color and smell
- Colorless
- Bitter almonds
Signs and symptoms of hydrogen cyanide poisoning
- Involve the CNS, respiratory, and cardiovascular systems of the body
- Faintness
- Anxiety
- Abnormal vital signs
- Headache
- Seizures
- Paralysis
- Coma
Prehospital diagnosis of hydrogen cyanide poisoning is difficult because ___
Laboratory studies are necessary
In situations in which you have patients who have sustained inhalation injuries, you must first ___
Ensure your own safety and the safety of your coworkers
Prehospital treatment of a patient with suspected hydrogen cyanide poisoning may include ___
Decontamination and supportive care according to signs and symptoms
Most chemical burns are caused by ___
Strong acids or strong alkalis
If the chemical burn exposure occurs at an industrial site, ___
An expert should be on site and able to provide you with information on the chemical
Emergency care of a chemical burn is ___
Basically the same as a thermal burn
The severity of a chemical burn in dependent on ___
- Type of chemical
- Strength
- Duration of exposure
- Area of the body exposed
To stop the burning process from a chemical, ___
Remove any chemical from the patient
Why always brush the dry chemical off before flushing with water?
May be activated with contact with water
Remove a chemical burn patient’s clothing, because there may be ___
Small amounts of chemicals in the creases
For liquid chemicals, immediately ___
Flush the burned area with large amounts of water
When flushing a liquid chemical off of a patient, take care to ___
Not contaminate uninjured areas or make the patient hypothermic. Never direct a forceful stream of water from a hose at the patient
Continue flooding the chemical burn area with gallons of water for ___
15 to 20 minutes after the patient says the burning has stopped
When flushing the chemical from the eyes ___
Hold the eyelid open, without applying pressure over the globe of the eye. Flush from the inside corners to the outside to prevent cross contamination.
If only one eye has chemicals in it ___
Turn the head to that side and flush
If both eyes have chemicals in it ___
Consider hooking up a nasal cannula to a bag of saline and flush both eyes simultaneously. Place the prongs on the bridge of the nose to flush from the inside corners of the eyes to the outside corners
Any substance that prevents the flow of electricity
Insulator
Any substance that allows a current to flow through it
Conductor
A burn injury appears where the electricity ___
Enters and exits
Two dangers specifically associated with electrical burns
- May be large amount of deep tissue injury. Force of the electrical energy can also cause fractures or joint dislocations
- May go into cardiac or respiratory arrest
If neither CPR nor defibrillation is indicated in an electrical burn patient, ___
Gove supplemental oxygen and monitor closely for respiratory or cardiac arrest
Treatment of electrical burn soft tissue injuries includes ___
Placing dry, sterile dressings on a burn wounds, splinting suspected fractures. Provide prompt transport
Taser injuries are generally treated at ___
Impaled objects, the electrodes are removed by a physician
Taser barb length
About .5”
Taser barb wounds are easily treated unless they ___
Penetrate the eye
Characterized by extreme agitation, reduced pain sensitivity, hallucinations, persistent struggling, and elevated temperature
Excited delirium
Excited delirium is commonly associated with ___
Illegal drug ingestion
Excited delirium warrants ___
Assisted ALS response
Be certain you have access to ___ when you respond to calls for patients who have been exposed to Taser shots
An AED
Three types of ionizing radiation
- Alpha
- Beta
- Gamma
___ particles have little penetrating energy and are easily stopped by the skin
Alpha
___ particles have greater penetrating power and can travel much farther in air than alpha particles. Can penetrate skin but can be blocked by simple protective clothing designed for this purpose
Beta
The threat from gamma radiation is ___
Directly proportional to its wavelength
This type of radiation is very penetrating and easily passes through the body and solid materials
Gamma
Radiation is measured in units of ___
Radiation absorbed dose (rad) or radiation equivalent in man (rem): 100 rad = 1 gray (Gy)
Small amounts of everyday background radiation are measured in ___
Rad
The amount of radiation released in a major incident may be measured in ___
Gray
The average human exposure from back ground radiation
0.31 rem per year
Mild radiation sickness can be expected with exposures of ___
1 to 2 Gy (100 to 200 rad)
Moderate radiation sickness can be expected with exposures of ___
2 to 5 Gy
Severe radiation sickness can be expected with exposures of ___
4 to 6 Gy
Exposure to more than ___ may result in death within 2 to 4 weeks (radiation)
10 Gy
Most ionizing radiation accidents involve ___
Gamma radiation or x-rays
Once a radiation explosion victim is decontaminated by the HAZMAT team, begin ___
Treating the XABCs and treat the patient for any burns or trauma
Consider providing basic care to the radiation patient before decontamination if ___
You are wearing protective clothing
How to minimize exposure to radiation
- Limit duration of exposure
- Increase distance from source
- Place shielding between yourself and the source
To treat a contact radiation burn ___
Decontaminate as if it were a chemical burn, then treat it as a burn
Three primary functions of dressings and bandages
- Control bleeding
- Protect the wound from further damage
- Prevent further contamination and infection
Appropriate for smaller wounds
Gauze pads
Adhesive-type dressings are useful for ___
Minor wounds
Made of petroleum jelly-based gauze, aluminum foil, or plastic, prevents air and liquids from entering the wound
Occlusive dressing
These dressings are used to cover sucking chest wounds, abdominal eviscerations, penetrating back wounds, and neck injuries
Occlusive dressing
To keep dressings in place during transport, you can use ___
Soft roller bandages, rolls of gauze, triangular bandages, or adhesive tape
Holds small dressing in place and helps to secure larger dressings
Adhesive tape
Some patients are ___ to adhesive tape
Allergic
If a patient is allergic to adhesive tape, use ___ instead
Paper or plastic tape
Easiest bandage to use
Self-adherent, soft-roller bandages
Do not use ___ to secure dressings. It may become a ___ if the injury swells
- Elastic bandages
- Secure dressings
Always check a limb distal to a bandage for ___
Signs of impaired circulation and sensation
___ are useful in stabilizing broken extremities, and can be used with dressings to help control bleeding from soft-tissue injuries
Air splints and vacuum splints
If a wound continues to bleed despite the use of direct pressure, quickly use a ___
Tourniquet
A tourniquet is most effective as a life-saving measure if ___
Applied prior to the onset of shock from blood loss
