Soft-tissue Injury Deck Flashcards
1
Q
What are soft tissues and how are their injuries classified?
A
Soft tissues include all body structures except organs and bones. Injuries to soft tissues can be classified into wounds (open and closed), muscle or tendon strains, ligament sprains, or any combination of these.
2
Q
What is the difference between open and closed wounds?
A
Closed wounds involve injury to underlying structures without a break in the skin, while open wounds involve a break in the skin surface with underlying tissue exposure.
3
Q
What are the main types of closed wounds?
A
The main types of closed wounds are bruises (contusions) and hematomas. Closed wounds result from blunt force or excessive pressure.
4
Q
How are small contusions typically managed?
A
Small contusions usually require no emergency treatment. Cold application and modest pressure during the first 48 hours can limit swelling, decreasing pain and disability.
5
Q
Which closed wounds should be referred for medical aid?
A
Closed wounds around joints, those impairing distal circulation, and those with nerve impairment should be referred for medical aid.
6
Q
What are the types of open wounds?
A
Open wounds include abrasions, lacerations, punctures, avulsions, and amputations. They are characterised by a break in the skin surface, exposing underlying tissue.
7
Q
Describe an abrasion and its common complications.
A
An abrasion is a superficial wound that roughens the skin’s surface, often causing slight bleeding. It may become infected due to dirt or foreign material.
8
Q
What is a laceration, and what are its potential complications?
A
A laceration is a cut with sharp or jagged edges that may involve subcutaneous tissue, muscles, nerves, and blood vessels. Complications include blood loss, infection, and functional impairment.
9
Q
What should be considered with puncture wounds?
A
Puncture wounds vary in size and depth, potentially damaging major blood vessels, organs, muscles, bones, tendons, and nerves. They are prone to infection due to deep foreign material.
10
Q
What defines an avulsion injury, and what are its complications?
A
An avulsion involves the loss or pulling away of the full thickness of skin, exposing deeper tissues. Complications include blood loss, infection, and delayed healing.
11
Q
What is the primary concern with amputations?
A
Amputations, whether partial or complete, expose bone and tissues, posing risks of severe bleeding, shock, infection, and disability.
12
Q
What are dressings and their essential characteristics?
A
Dressings are used to cover open wounds to prevent contamination. They should be larger than the wound, sterile, thick, soft, compressible, and have a lint-free surface.
13
Q
How should a triangular bandage be used and stored?
A
A triangular bandage can hold dressings, apply pressure, and secure splints. It should be folded into a narrow bandage for storage by bringing the point to the base, folding once, and doubling it upon itself.
14
Q
What are the different types of bandages and their primary uses?
A
Bandages include elastic fracture straps, crepe rollers, self-adhering rollers, elastic adhesive-backed rollers, gauze rollers, tubular bandages, and triangular bandages. They secure dressings, apply pressure, and immobilize injuries.
15
Q
Why are square knots recommended for securing triangular bandages?
A
Square knots do not slip once tightened and can be easily untied, making them ideal for securing triangular bandages.
16
Q
What is the role of bulky supports in managing open wounds with foreign bodies?
A
Bulky supports made from triangular bandages or drainage dressings provide pressure to control hemorrhage and prevent further tissue injury in wounds with embedded foreign bodies.
17
Q
What are the principles of bandaging?
A
Principles include:
- Bandage must control hemorrhage and immobilize the wound without constricting circulation.
- Pressure must be evenly distributed over the wound.
- Bandage must cover the entire dressing.
- Fingers and toes should be accessible for checking circulation and neurological function.
- Bandage knots must be accessible and not cause sores.
- Roller bandages must not encircle a limb underneath splints.
18
Q
What is the initial procedure for managing minor wounds?
A
Follow the Priority Action Approach:
- Conduct a scene assessment.
- Complete the primary survey with appropriate modifications.
- Complete the required components of the secondary survey.
19
Q
What is a hematoma?
A
A hematoma is a collection of blood and plasma in a damaged area, causing swelling. It can lead to complications such as circulation deficiencies, loss of feeling, or increasing pain.
19
Q
What is the management protocol for small contusions?
A
Apply cold and modest pressure during the first 48 hours to limit swelling, decrease pain, and reduce disability.
20
Q
When should closed wounds be referred to medical aid?
A
Closed wounds should be referred to medical aid if they:
- Are significant around joints
- Impair distal circulation
- Have nerve impairment
21
Q
When should cold be applied to a wound?
A
Cold should be applied to slow bleeding, limit swelling, and reduce pain. Use caution to avoid hypothermia and ensure good circulation distal to the injury.
21
Q
Cold should be applied to slow bleeding, limit swelling, and reduce pain. Use caution to avoid hypothermia and ensure good circulation distal to the injury.
A
Refer minor wounds to medical aid if they:
- Are longer than 3 cm through the full thickness of the skin.
- Involve joints, tendons, or the palm/back of the hand.
- Require sutures.
- Are dirty or contaminated.
- Are human or animal bites.
- Have embedded foreign materials.
- Are significant second or third-degree burns.
22
Q
How should rings be removed from a swollen finger?
A
Lubricate the finger with soap or petroleum jelly. If this fails, use the string method or remove the ring with diagonal cutters or a special ring cutter.
Wound Cleansing
23
What are the guidelines for wound cleansing?
1. Use warm, clean running tap water for irrigation.
2 Avoid using hydrogen peroxide, alcohol, iodine, zephirin hydrochloride, or mercurochrome in wounds.
3. Use diluted soap or detergent for bite wounds.
4. Cleanse around the wound with sterile gauze, working outward.
5. Use warm running water or sterile saline for inside the wound.
6. Reassess the need for medical aid after cleansing.
24
When should skin closures be used to hold a wound closed?
Skin closures should be used to hold a wound closed only if the patient is returning to work.
24
What are the steps to ensure the adhesion of a skin closure?
1. Dry the wound edges and remove hair.
2. Apply tincture of benzoin sparingly to intact skin around the wound.
3. Use cotton-tipped applicators to apply the compound, ensuring it does not get into the wound.
25
How should skin closures be applied to a wound?
1. Start from the center of the wound and work in both directions.
2. Apply half of the skin closure up to the wound margin and press it firmly into place.
3. Close up the skin edges and press the free half of the closure firmly into place.
4. Apply additional skin closures to complete the closure.
26
What should be done if a skin closure is incorrectly applied?
Lift the edges on the same side of each flap and gently pull the closure off along the long axis of the wound to avoid straining the other skin closures. Reapply as needed.
27
How long should skin closures stay in place?
Skin closures should stay in place for 7 to 10 days.
27
After applying skin closures, what is the next step in dressing a wound?
Apply a sterile dressing large enough to cover the wound and secure it in place with a bandage large enough to cover the entire wound dressing.
28
What should be advised to a patient regarding tetanus immunization?
Ensure the patient’s tetanus immunization is up to date. For clean minor wounds, immunization within the past 10 years is adequate; for all other wounds, it should be within the past 5 years.
29
What instructions should be given to a patient on wound care until follow-up?
1. Keep the dressings clean and dry.
2. Watch for signs of infection.
3. Remove supportive bandages when not actively using the limb (for sprains/strains).
4. Reapply supportive bandages when sleeping (for sprains/strains).
5. Return to first aid for reassessment and redressing.
30
When should a patient report back for reassessment or redressing?
1. If the dressings become wet or soiled.
2. If there is a significant increase in pain in the area.
3. If tingling or a loss of sensation develops in or distal to the area.
4. If the patient notices signs of infection.
31
What should the OFA attendant check during follow-up care after 24 hours?
1. Check the wound for infection.
2. If there is infection, remove all closures so the wound can drain, dress it, and refer the patient to medical treatment.
3. If no infection is found, continue treatment until the wound heals, checking progress every 2 days.
32
What are signs of infection in a wound?
Redness, heat, swelling, increased tenderness, and pus.
33
What are the risks associated with puncture wounds?
Puncture wounds may appear small on the outside but can cause severe internal damage and are prone to infection due to contamination below the surface.
34
What should be considered when assessing a puncture wound?
Consider the mechanism of injury, depth, location, appearance, restriction of movement, and alteration of function.
35
When should a patient with a puncture wound be referred to medical aid?
Refer to medical aid if the wound involves the head, neck, chest, abdomen, groin, or a joint.
36
How should a small wooden sliver be located and removed?
* Cleanse the area with antibacterial detergent solution and dry it with gauze.
* Paint the area with a colored antiseptic solution (e.g., Povidone or iodine).
* Allow the area to remain wet for 15 to 30 seconds, then wipe the color away with gauze.
* If the end of the sliver is close to the surface, it will soak up the colored antiseptic and show up as a dark spot.
* Grasp the end of the sliver with disinfected sliver forceps and withdraw it along the same angle it entered.
37
What is the initial treatment for a patient with a puncture wound who can return to work?
1. Cleanse the wound.
2. Soak the wound in warm potable tap water, normal saline, or a diluted antibacterial detergent solution for 15 to 20 minutes.
3. Dress the wound.
4. Instruct the patient to continue warm saline soaks at home 3 or 4 times a day for 48 hours.
5. Have the patient return for reassessment after 24 hours.
38
What steps should be taken if a puncture wound is caused by an object contaminated with blood or bodily fluids, or an animal bite?
1. Allow the wound to bleed.
2. Wash the area promptly with sterile saline or clean water and mild soap.
3. Dress the wound.
4. Refer the patient to medical aid promptly.
39
How should metal slivers be managed?
If metal slivers can be seen and easily removed, they are managed the same way as wooden slivers, but without using a colored solution, which can make it difficult to locate the sliver.
40
What is the protocol for removing glass slivers?
* Soak the affected area in a warm, diluted antibacterial detergent solution for 20 minutes.
* Attempt to remove the sliver with gentle scrubbing.
* If the sliver can be seen and easily removed, manage it as a wooden sliver, without using a colored solution.
41
What is the procedure for removing a fish hook that is poking through the skin?
* Push the hook further through the skin.
* Cut off the barb.
* Back out the remaining portion of the hook.
Soak the wound in a warm diluted antibacterial detergent solution for 15 to 20 minutes and apply an appropriate dressing.
42
What should be done if the fish hook is pointing towards deeper structures?
Refer the patient to medical aid.
43
What are the signs and symptoms of a pressure injection injury?
* Mechanism of injury involving a pressurized tool.
* Small puncture wound that may ooze grease, paint, or other matter.
* Pain in the affected area, especially on movement.
* Swelling and/or subcutaneous emphysema.
44
What is the recommended action for pressure injection injuries?
Recognize the injury and refer the patient to medical aid immediately.
45
How is a subungual hematoma treated?
* Cleanse the area.
* Release the blood through a small hole in the nail at the center of the blood collection.
* If a nail drill is unavailable, use the red-hot end of an opened paper clip.
* Ensure the patient's hand or foot is on a firm surface during treatment.
* If releasing the blood does not stop the pain, suspect a fracture and refer for medical attention.
46
How should an abscess be managed?
* Apply hot or warm compresses until the abscess bursts naturally, allowing pus to escape.
* Once the core is discharged, apply dry dressings and clean the area with antibacterial detergent solution and gauze swabs as necessary.
* Do not squeeze the abscess.
* Refer to medical treatment if the abscess is large, very painful, or involves the face, neck, groin, or buttocks, or if the patient has a fever or if local measures are ineffective within 1 to 2 days.
47
What are common causes of wound infection?
Infections can be caused by bacteria, viruses, fungi, and parasites, with bacterial infections being the most common in the context of wound infections encountered by OFA attendants.
48
What conditions do bacteria need to survive and grow?
Bacteria need moisture, nutrients, oxygen (though some, like tetanus and gas-gangrene bacteria, live without it), and warmth (normal body temperature, 37°C or 98.6°F).
49
How can bacteria enter the body?
Bacteria can enter the body through broken skin (wounds), inhalation through the nose and mouth, ingestion through the gut, or the genitourinary system.
50
When can bacteria enter a wound?
Bacteria can enter a wound at the time of injury or after the injury through contaminated objects, the patient’s own skin, unsanitary first aid techniques, or improper handling of wound dressings.
50
How can bacteria be spread?
Bacteria can be spread via fingers and hands, to the eyes, nose, mouth, other people, and especially to open wounds.
51
How do different materials affect bacterial contamination in wounds?
Metal fragments are usually free of bacteria, while soil and organic matter are heavily contaminated.
52
What are the signs of wound infection?
Signs of infection include pain and local tenderness, heat around the wound, redness, pus beneath the skin or draining from the wound, swelling of the infected area or proximal lymph nodes, and red streaks extending from the wound.
53
What indicates lymphangitis in a wound infection?
Signs of lymphangitis include fever, swollen and sore lymph nodes, and red streaks extending from the wound. The patient must be examined and treated by a physician immediately.
53
What should be done if a wound infection is suspected?
The patient must be referred to a physician as soon as a wound infection is suspected.
54
What causes tetanus, and where are the bacteria found?
Tetanus is caused by bacteria that inhabit the intestines of domestic animals and are found in soil, dust, and feces. These bacteria grow best in the absence of oxygen.
55
What are the early signs and symptoms of tetanus?
Early signs include irritability, headache, low-grade fever, abdominal muscle cramps, tightness of jaw muscles (lockjaw), fixed half-smile (spasms of face muscles), and difficulty swallowing (spasms of throat muscles).
56
What is the Rapid Transport Category for tetanus?
Patients suspected of having tetanus are in the Rapid Transport Category and require early recognition and rapid transport to a hospital.
56
How is tetanus prevented?
etanus can be prevented by thorough wound cleaning, up-to-date tetanus immunization, and tetanus toxoid injection within 36 hours of injury.
57
Who are at higher risk for necrotizing fasciitis?
Higher risk individuals include the elderly, those with chronic heart or lung diseases, injection drug users, alcoholics, very young children, and people with diabetes, cancer, HIV infection, or AIDS.
57
What are the early signs of gas gangrene?
Early signs include sudden onset of pain and swelling, local tissue discoloration, brownish foul-smelling discharge, low-grade fever, and shock. Crepitus (crackling) beneath the skin is a definitive characteristic.
57
What causes gas gangrene and which wounds are at high risk?
Gas gangrene is caused by bacteria that thrive without oxygen. Wounds involving muscle, especially deep wounds with muscle destruction, poor drainage, and soil contamination, are at high risk.
58
What should be done if gas gangrene is suspected?
If gas gangrene is suspected, the patient is in the Rapid Transport Category. Provide local wound care, supportive care for shock, and administer oxygen.
59
What is necrotizing fasciitis and its common nickname?
Necrotizing fasciitis, also known as "flesh-eating disease," is a rapidly spreading infection that destroys human tissue at a rate of nearly 3 cm per hour.
60
What should be done if necrotizing fasciitis is suspected?
What should be done if necrotizing fasciitis is suspected?
61
What are the general principles for treating major open soft-tissue injuries?
The general principles are to control bleeding, prevent infection, immobilize the affected part, and keep the patient at rest.
61
When should wound cleansing be limited in major wounds?
Wound cleansing should be limited to brushing away gross contaminants and briefly irrigating with sterile saline or tap water. Further cleansing is beyond the scope of first aid and must be left to a physician.
62
What is the general approach for managing major wounds according to the Priority Action Approach?
The Priority Action Approach for managing major wounds includes:
1. Conducting a scene assessment and activating emergency response procedures
2. Assessing consciousness and initiating CPR if needed
3. Positioning the patient supine with cervical spinal motion restriction if necessary
4. Ensuring an open airway
5. Rapidly controlling bleeding before addressing ABCs if bleeding is massive
6. Assessing respiration and intervening as necessary
7. Checking the radial pulse and conducting a rapid body survey
8. Applying dressings and bandages, noting the time of tourniquet application if used
9. Ensuring rapid transport for RTC patients
10. Reassessing ABCs and vitals regularly
11. Avoiding unnecessary movement
12. Conducting a secondary survey
13. Covering open wounds with sterile dressings
14. Stabilizing large embedded foreign bodies
15. Restricting movement of limbs if needed
16. Monitoring ABCs and vitals for signs of deterioration
63
What are the steps for managing severed parts in an amputation?
Steps for managing severed parts include:
1. Finding the severed part
2. Cleaning off gross foreign matter without scrubbing
3. Dressing the part in sterile gauze, clean sheets, or towels
4. Moistening the dressing with sterile saline
5. Placing the dressed part in a sealed waterproof bag or container
6. Placing the bag in another container filled with ice or cold water without allowing it to freeze
7. Transporting the part with the patient, prioritizing life-saving procedures over the management of the severed part
64
What is crush syndrome and how should it be managed?
Crush syndrome is caused by prolonged compression injuries leading to tissue destruction, hypoxia, and acidosis. Symptoms include pain, numbness, swelling, loss of sensation, and shock. Management includes treating for shock, applying cold to decrease tissue breakdown, immobilizing the limb, and ensuring rapid transport to a hospital.
65
What should an OFA attendant do when confronted with a large embedded foreign body?
The OFA attendant should:
1. Not move or alter the position of the foreign body
2. Control bleeding with direct pressure around the wound, using a tourniquet if necessary
3. Stabilize the foreign body and restrict movement
4. Ensure rapid transport for patients with penetrating injuries of the head, neck, chest, abdomen, and groin
66
What are the two ways chemicals can affect the skin?
Chemicals can affect the skin by acting as a direct irritant (primary irritant) or by causing an allergy.
66
What is occupational dermatitis?
Occupational dermatitis is inflammation of the skin caused by exposure to substances in the work environment. It is the most commonly encountered type of occupational disease, often resulting from contact with chemical substances.
67
What percentage of occupational skin diseases is due to primary irritant contact dermatitis?
About 75% of all occupational skin disease is due to primary irritant contact dermatitis.
68
What is a primary irritant?
A primary irritant is any substance that damages the skin by direct contact rather than by causing an allergy.
69
What factors influence whether a substance will act as an irritant?
Factors include the susceptibility of the individual, the concentration of the substance, and the length of time of exposure.
70
What is a sensitizer?
A sensitizer is a substance that does not affect everyone but causes an allergic reaction in susceptible individuals after prior exposure.
71
What are the signs and symptoms of dermatitis?
Symptoms include redness, irritation, swelling, itchiness, pain, blistering, thickening, fissuring, and potential secondary bacterial or fungal infection.
71
How does the body react to sensitizers?
After initial exposure, the body develops an immune response, making the person sensitized. Subsequent exposures can cause allergic reactions, which may occur with progressively smaller amounts of the sensitizer.
72
Which parts of the body are usually affected by occupational dermatitis?
Typically, the hands and forearms are affected, but airborne agents can cause inflammation of the face, neck, and other exposed areas.
73
Why is personal cleanliness important in preventing occupational dermatitis?
Personal cleanliness is vital because it removes dirt and contaminants from the skin, reducing the risk of dermatitis.
74
What measures should workers take for personal cleanliness?
orkers should use provided cleansers or soap, rinse thoroughly with running water, dry completely, use showers when provided, and change clothing at the end of the workday.
75
What should workers avoid using for skin cleaning to prevent dermatitis?
Workers should avoid using solvents like methyl hydrate, kerosene, paint thinners, and acetone, as they remove natural skin oils and can cause dermatitis.
76
What type of protective clothing can help prevent occupational dermatitis?
Protective clothing can include overalls, aprons, gloves, footwear, leggings, and face shields, appropriate to the chemical being handled.
77
What is the purpose of barrier creams in preventing dermatitis?
Barrier creams protect the skin from contact with hazardous substances and make cleansing easier. They should be used where protective clothing cannot be worn.
78
How should barrier creams be used?
Apply the cream to clean, dry skin before exposure, wash off the cream after each work session, and reapply fresh cream to maintain continuous protection.
79
What should be done if dermatitis or skin irritation persists for more than 3-4 days?
Persistent signs of skin irritation should be referred to a physician for early advice and treatment to prevent serious conditions and reduce the likelihood of long-term disability.
79
What are some common chemical causes of occupational dermatitis?
Common causes include mineral oils, solvents, acids, alkalis, oxidizing agents, reducing agents, protein precipitants, and allergens like nickel and chromium.
80
What are the signs and symptoms of hives (urticaria)?
Hives present as raised, reddened, swollen areas with map-like borders, intense itching, and sometimes chest tightness, wheezing, and cardiovascular collapse in severe cases.
81
What treatments are available for hives?
Treatments include cool compresses, antipruritic lotions (e.g., calamine), oral antihistamines, and in severe cases, injections of adrenalin or epinephrine.
82
ow can the workplace be made safer to prevent occupational dermatitis?
Efforts should be made to eliminate harmful materials or switch to safer substances, and provide suitable apparel and cleansing facilities for workers.
83
What is an activity-related soft-tissue disorder (ASTD)?
An ASTD is a soft-tissue injury caused by or aggravated by activity. These disorders affect muscles, tendons, bursae, nerves, and blood vessels, and can be related to work, domestic activities, sports, or hobbies.
84
What are other commonly used terms for ASTDs?
Cumulative trauma disorders and repetitive strain injuries.
85
What are the three main causes of inflammation in soft tissues leading to ASTDs?
Chronic, excessive activity (overuse), infection, and direct trauma.
86
List the risk factors related to activity that can lead to ASTDs.
* Repetition
* Frequency
* Duration
* Force
* Posture
* Static load
* Unaccustomed activity
* Contact stresses
* Impact loading
* Vibration
* Temperature of the ambient environment (particularly cold)
87
List some individual-related risk factors that can influence the development of ASTDs.
Age, sex, smoking, pregnancy, certain medical conditions (e.g., arthritis, diabetes), physical fitness, alcohol and/or drug use.
88
Define tendonitis and tenosynovitis.
Tendonitis is the inflammation of a tendon, and tenosynovitis is the inflammation of the tendon’s synovial sheath. These conditions often occur simultaneously and are commonly referred to together.
89
What is bursitis and where are bursae typically located?
Bursitis is the inflammation of a bursa, a sac-like cavity lined with synovial tissue that reduces friction between tissues. Bursae are located at sites of potential friction between tendons, muscles, and bony prominences.
90
What are the signs and symptoms of tendonitis and bursitis?
Pain (especially with movement), swelling, redness, warmth, crepitus, and tenderness along the affected tendon or bursa.
91
What is a key difference in the symptoms of tendonitis/bursitis and cellulitis?
The presence of fever indicates an infection like cellulitis, which requires early referral to a physician for treatment.
92
Describe the general management approach for tendonitis and bursitis
* Thorough assessment using the Priority Action Approach.
* Rest the affected part.
* Apply cold for up to 20 minutes every 1 to 2 hours.
* Encourage wearing a wrist brace when sleeping.
* Daily reassessment.
* Referral to medical aid if significant pain, restricted range of motion, swelling, or crepitus is present.
92
Under what circumstances should a patient with tendonitis or bursitis be referred to medical aid?
* Significant pain, swelling, crepitus, and limited range of motion.
* Deterioration in condition during daily reassessment.
* No improvement after 3 days of resting the part.
* Suspected infection (increasing pain, spreading redness, fever).
93
What are common symptoms of carpal tunnel syndrome (CTS)?
Numbness, tingling, or burning in parts of the thumb and fingers, pain and occasional muscle weakness of the thumb, pain radiating up the forearm, and pain at night.
94
What are some conditions associated with tendonitis and bursitis in the hand/wrist?
Extensor/flexor tendonitis, de Quervain’s tendonitis, Trigger finger.
95
What are some conditions associated with tendonitis and bursitis in the elbow?
Lateral/medial epicondylitis (tennis/golfer’s elbow), Olecranon bursitis.
96
What are some conditions associated with tendonitis and bursitis in the shoulder?
Various tendons/bursae inflammations, Bicipital tendonitis.
97
What are some conditions associated with tendonitis and bursitis in the hip?
Trochanteric bursitis.
98
What are some conditions associated with tendonitis and bursitis in the knee?
Patellar tendonitis, Prepatellar/suprapatellar bursitis.
99
What is hand-arm vibration syndrome (HAVS) and what causes it?
HAVS is a condition arising from the use of vibrating tools over a period of years, leading to painful blanching of the fingertips due to interference with blood supply. It is also known as vibration white finger or white-finger disease.
99
What are some conditions associated with tendonitis and bursitis in the foot/ankle?
Achilles tendonitis.
100
What are some preventive measures for ASTDs in the workplace?
* Automate repetitive tasks.
* Eliminate unnecessary work steps.
* Provide appropriate tools, equipment, and clothing.
* Use power tools and ergonomic tools.
* Adjust working heights and angles.
* Round and pad work surfaces.
* Use damping materials to reduce vibration.
* Increase or vary work tasks.
* Train workers in safe techniques.
* Encourage rest breaks and micro pauses.
* Minimize overtime.
