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Soft Tissue Injuries Flashcards

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1
Q

Epidermis

A

Tough, external layer that forms a watertight covering of the body.

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2
Q

How are old epidermis cells replaced?

A

They are replaced by cells that are pushed to the surface when new cells form in the germinal layer at the base of the epidermis.

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3
Q

Dermis

A

Inner layer of skin that lies below the germinal cells of the epidermis.

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4
Q

What does the dermis layer contain?

A

Hair follicles
Sweat glands
Sebaceous glands

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5
Q

Function of sweat glanfs

A

Help cool the body by releasing sweat onto the surface of the skin through small pores that pass through the epidermis.

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6
Q

Function of sebaceous glands

A

Produces sebum which is the oily material that waterproofs the skin and keeps it supple.

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7
Q

Which layer of the skin does the blood vessels provide the skin with nutrients and oxygen?

A

Dermis

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8
Q

Three layers of the skin

A

Epidermis
Dermis
Subcutaneous tissue

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9
Q

What orfices in the body are lined with mucous membranes?

A

Mouth, nose, anus, and vagina

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10
Q

Difference between mucous membranes and skin?

A

Both are a protective barrier, however the mucous membrane secretes a watery substance to lubricate the opening while skin is dry.

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11
Q

The skins many functions :

A

Protects body from pathogens and keeps fluids in.
Nerves in the skin reports to the brain on the environment and many sensations.
Regulating temperature

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12
Q

What is a tension line?

A

Skin is arranged over the body structures in a manner that provides tension.

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13
Q

Lacerations occurring ___ to the skin tension lines may remain ___ with little or no intervention.

A

parallel; closed

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14
Q

Dynamic tension

A

Tension lines found in areas that lie over muscle. Tension varies according to the contraction of the underlying muscle and subsequent movement of the skin.

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15
Q

Why doe injuries to dynamic tension lines interfere with healing?

A

The injury disrupts the clotting process and the tissue repair cycle, resulting in slowed healing and a tendency toward abnormal scar formation.

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16
Q

Closed soft-tissue injuries are characterized by :

A

Hx of blunt trauma
Pain at the injury site
Swelling
Discoloration

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17
Q

What is a contusion?

A

Torn small blood vessels and cellular damage within the dermis.

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18
Q

Ecchymosis

A

Bruising or discoloration associated with bleeding within or under the skin.

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19
Q

Hematoma

A

Large blood vessel is damaged and bleeds rapidly. Usually associated w/ extensive tissue damage.

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20
Q

Crush syndrome

A

Metabolic derangement that can result in renal failure and death. It develops when crushed extremities or other body parts remain trapped for prolonged periods of time.

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21
Q

Pathophysiology of crush syndrome.

A

When tissues are crush, muscle cells die and release harmful substances into surrounding tissues. The oppressing force prevents blood from returning to the injured body part, so the harmful substances are released into the circulation AFTER the limb is freed and blood low is returned.

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22
Q

Compartment syndrome

A

Develops when edema and swelling result in increased pressure within a closed soft-tissue compartment.

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23
Q

What should you assess continuously when a crush injury is suspected? Why?

A

Skin color, temperature, and distal pulses. Looking for signs of compartment syndrome.

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24
Q

Abrasion

A

Wound of the superficial layer of the skin caused by friction when a body rubs or scrapes across a rough or hard surface.

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25
Q

Laceration

A

Jagged cut in the skin caused by a sharp object or blunt force that tears the tissue.

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26
Q

Difference between a laceration and incision?

A

Lacerations is a jagged cut. Laceration is a sharp, smooth cut.

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27
Q

Avulsion

A

Injury that separates layers of soft tissue resulting in complete detachment or hangs as a flap.

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28
Q

What layers of the skin are usually involved in avulsions?

A

Subcutaneous layer and fascia.

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29
Q

Management of complete and incomplete avulsion..

A

Complete : wrap separated tissue in sterile gauze and bring it to the ED.

Incomplete : Replace the flat avulsed flap to its original position as long as it is not visibly contaminated.

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30
Q

Which bacteria account for most bacterial skin infections?

A

Staphylococcus and Streptococcus.

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31
Q

Visible clues of infection include :

A 
Erythema
Pus
Warmth
Edema
Local discomfort
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32
Q

What is lymphangitis? What is a sign of lymphangitis?

A

Inflammation of the lymph channels. Red streaks adjacent to the wound.

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33
Q

Gangrene

A

Dead tissue caused when blood supply to that tissue is interrupted or stopped.

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34
Q

When should you suspect gangrene?

A

Patient has chronic risk factors including DM, smoker, PVD, and there is numbness, coolness, or swelling of an extermity.

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35
Q

What are late signs of gangrene?

A

Discoloration of the limb to black, blue, or red.

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36
Q

Which gangrene bacteria causes a foul-smelling gas?

A

Clostridium perfingens

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37
Q

Tetanus

A

A disease caused by spores that enter the body through a punctured wound contaminated with animal feces, street dust, or soil or that can enter through contaminated street drugs.

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38
Q

What does tetanus do to the body?

A

It causes the body to produce a potent toxin, which results in painful muscle contractions strong enough to fracture bones.

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39
Q

What is the first sign of tetanus?

A

Muscle stiffness in the jaw and neck which then progresses down the remainder of the body.

40
Q

How is necrotizing fasciitis transmission?

A

Vectors such as insect bites or jellyfish stings.

41
Q

s/s of necrotizing fasciitis

A 
Erythema and warmth at the site
Fever
Night sweats
Chills
Vomiting
Diarrhea
42
Q

Which conditions require transport even if the injuries seem minor?

A

Compromise of : nerves, vessels, muscles, tendons or ligaments.
FB or cosmetic complications
Heavy contamination

43
Q

Necrotizing fasciitis

A

Death of tissue from bacterial infection.

44
Q

Primary survey of soft tissue injuries

A

Rapidly determine life threats -XABCD.
Control bleeding quickly.
Address life threats.
Perform manual immobilization if needed.
Check responsiveness w/ AVPU.
Administer high-flow oxygen as needed.
NRB at 15 L/min or BVM if inadequate perfusion or ventilations.
Assess circulatory status for signs of shock.
Perform 60-to-90 second rapid full body scan. Apply c-collar if indicated.
Determine whether patient needs immediate transport or stabilization at scene.

45
Q

History taking of soft tissue injuries

A

SAMPLE
OPQRST
Last tetanus vaccination
Medications and OTC to determine interference with hemostasis.

46
Q

What should be included in your communication and coumentation?

A

Description of MOI
Position in which the patient was found upon arrival
Estimate amount of blood lost
Location and description of any soft-tissue injuries or other wounds

47
Q

Treatment of closed soft-tissue injury

A 
RICES :
Rest
Ice
Compression
Elevation
Splinting
48
Q

What is an occlusive dressing and when should you use one?

A

Dressing made from petroleum gauze, aluminum foil, or plastic that prevents air and liquids from entering or exiting a wound.

Use on open chest wounds, abdominal eviscerations and penetrating wounds above umbilicus, penetrating back wounds, and open neck injuries.

49
Q

What are the primary functions of dressings and bandages?

A

Control bleeding
Protect wound from further damage
Prevent further contamination and infection

50
Q

Management of amputation

A

Complete : control the bleeding. If it involves large area of muscle mass, will most likely require tourniquet and treatment of shock.

Partial : immobilize the part with bulky compression dressings and splint to prevent further injury.

51
Q

Emergency treatment for bites

A

Control bleeding and apply a dry, sterile dressing
Consider irrigation w/ sterile water if grossly contaminated
Immobilize area w/ splint or bandage if extremity
Provide transport to the Ed for surgical cleansing

52
Q

Management of abdominal wounds

A

Cover wound w/ sterile gauze compressed moistened w/ sterile saline solution and secure with an occlusive dressing

53
Q

Management of open neck wounds

A

Cover the wound w/ an occlusive dressing
Apply manual pressure, but do not compress carotid arteries
Secure pressure dressing over the wound w/ roller gauze loosely wrapped around the next and then firmly around opposite axilla.

54
Q

Burn process may results in :

A

Renal failure
Liver failure
Dysrhythmias
Heart failure

55
Q

Which hormones are secreted in response to pain and stress from a burn?

A

Catecholamines - epinephrine and norepinephrine

56
Q

Hypovolemic shock occurs because of the two types of injuries that result from burns :

A

Fluid loos across damaged skin

Volume shifts w/in the rest of the body

57
Q

How does the body respond during shock when the BP decreases?

A

It responds with tachycardia and vasoconstriction, which limits blood flow further and continues the cycle.

58
Q

Complications that can result from a burn injury :

A

Infection
Hypothermia
Hypovolemia
Shock
Loose mucosa in the hypopharynx can swell and rapidly result in complete airway obstruction.
Circumferential burns to chest can compromise breathing.
Circumferential burns of an extremity can result in compartment syndrome.

59
Q

Burns are described in three pathologic progressions, what are they?

A

Zone of coagulation
Zone of stats
Zone of hypothermia

60
Q

Zone of coagulation

A

Central area of skin that suffers the most damage. There is little or no blood flow to the injured tissue.

61
Q

Zone of stasis

A

Peripheral area surrounding the zone of coagulation which has decreased blood flood and inflammation.

62
Q

In which burn zone with necrosis develop in 24 to 48 hours after injury?

A

Zone of stasis

63
Q

Zone of hypothermia

A

Least affected by the thermal injury.

64
Q

Typically how long does it take the cells in the zone of hypothermia to recover?

A

7-10 days

65
Q

What is the main priority of burn treatment?

A

Salvage as much injured as possibly by improving perfusion.

66
Q

When should you suspect substantial airway burns?

A

Signs of singed hair w/in nostrils, soot around the nose and mouth, hoarseness, or hypoxia.

67
Q

Superficial burns

A

Involve epidermis only
Skin turns red but does not blister or burn into next layer
Burn site painful
Ex : sunburn

68
Q

Partial-thickness burns

A 
Epidermis and portion of dermis
No damage to subcutaneous tissue
Skin typically moist, mottled, and white to red
Presence of blisters
Intense pain
69
Q

Full-thickness burns

A

All layers of skin including subcutaneous layers, muscle, bone, or internal organs.
Area is dry and leathery and may appear white, dark brown, or charred.
Some burns feel hard to touch.
Clotted blood vessels or subcutaneous tissue may be visible.
May not have feeling in nerve endings are destroyed.
Less severely burned areas may be extremely painful.

70
Q

Five factors to determine severity of burn?

A

Depth of burn
Extent of burn
Critical areas involved (face, upper airway, hands, feet, genitalia, circumferential burns)
PMH or other injures that can complicate injury
Younger than 5 years or older than 55 years

71
Q

Which two factors in determining severity of a burn is considered the most important?

A

Extent and degree of burn

72
Q

What are burns to the hands, feet, or joints considered serious?

A

Potential for loss of function via scarring.

73
Q

Which areas are considered critical in burn injuries?

A

Face, upper airway, hands, feet, genitalia, and circumferential.

74
Q

Rule of nines for infant

A 
Head : 18
Arms : 9 each
Chest : 18
Back : 18
Genitalia : 1
Legs : 13.5 each
75
Q

Rule of nines for child

A 
Head : 12
Arms : 9 each
Chest : 18
Back: 18
Genitalia : 1
Legs : 16.5 each
76
Q

Rule of nines for adult

A 
Head : 9
Arms : 9 each
Chest : 18
Back : 18
Genitalia : 1
Legs : 18 each
77
Q

Why are burns to children considered more serious than adults?

A

They have more surface area relative to total body mass resulting in greater fluid and heat loss. More likely to experience shock, hypothermia, and airway difficulties because of differences in ages and anatomy.

78
Q

Signs of airway involvement in a burn patient :

A 
Hoarseness
Cough
Stridor
Singed nasal or facial hair
Carbon in the sputum
Hx of fire in an enclosed space
Heavy amounts of secretions and frequent coughing
79
Q

During your secondary assessment, what should you look for specifically in the respiratory system?

A 
Soot around the mouth and nose.
Singed nasal hairs
Breath sounds
RR and quality
DCAP-BTLS
80
Q

During your secondary assessment, what should you look for specifically in the musculoskeletal system?

A

Head : racoon eyes, Battle sign, and/or drainage of blood or fluid from ears or nose; Singes nasal or facial hair, burns or swelling of face or ears, burns or swelling in mouth.
Neck : JVD, tracheal deviation
Chest : check for circumferential burn
Abdomen : palpate all four quadrants for tenderness or rigidity
Extremities : circumferential burns, entry or exit burn wounds of electrical injuries. CMS.
Pelvis : stability

81
Q

What vital signs should you obtain from a burn patient?

A

BP, pulse, and skin to asses perfusion.

O2 and CO monitor to quantify oxygenation and circulatory status.

82
Q

Why should you not immerse burns for longer than 10 minutes?

A

Longer immersion times can increase risk of infection and hypothermia.

83
Q

Emergency care of burns

A

Depending on local protocol, immerse are in cool, sterile water or saline or cover with clean, wet, cool dressings. OR irrigation followed by application of sterile dressing.
High-flow oxygen
Prepare for ventilations and airway adjuncts
Estimate severity of burns. Cover w/ dry, sterile dressing or clean, white sheet if injury is too large.
Establish IV - isotonic crystalloid solution
Keep warm
Positioning
Prompt transport

84
Q

What are the goals in treating patients?

A

Stop the burning process
Assess and treat breathing
Support circulation
Provide rapid transport

85
Q

Consensus formula

A

2-4 mL x Patient’s weight x Percentage of body SA burned = total fluid in 24 hours

86
Q

What amounts and when should the fluid boluses be given according to the Consensus formula>

A

1/2 amount calculated from equation during the first 8 hours.
Other half over the next 16 hours.

87
Q

What happens if you give fluid too early or too fast in a burn patient?

A

Compromise of airway devices, vascular access, and can lead to compartment syndrome.

88
Q

What type of burn is commonly seen in children and handicapped adults?

A

Scald burn

89
Q

Scald burn

A

Contact with hot liquids. Larger surface area as liquids can spread quickly.

90
Q

Contact burn

A

Coming in direct contact with hot objects. Rarely deep.

91
Q

Flash burn

A

Produced by an explosion exposing patient to very intense heat.

92
Q

Most deaths from fires are not caused directly by burns, but rather?

A

Inhalation of toxic gases, upper airway compromise, or pulmonary injury

93
Q

Cause of death if patient survives initial burn injuris?

A

Secondary infection

94
Q

Upper airway damage in fires is usually caused by?

A

Inhalation of superheated gases

95
Q

Lower airway damage in fires is usually caused by?

A

Inhalation of chemicals and particulate matter.

96
Q

Signs and symptoms of hydrogen cyanide poisoning?

A 
CNS, respiratory, and cardiovascular systems.
Faintness
Anxiety
Abnormal vital signs
HA
Seizures
Paralysis 
Coma
97
Q

Severity of chemical burn is related to?

A 
pH level of agent
Concentration of agent
Length of exposure
Volume of agent
Physical form of agent

Advanced EMT (33 decks)

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