Soft tissue trauma Flashcards
Ligaments
- Bone to bone
Tendons
Muscle to bone
Muscle to muscle
Layers of the skin
- Epidermis
- Dermis
- Nerves, hair, capillaries, macrophages, neutrophils
- Subcutaneous
- Fascia
- Superficial
- connective tissue surrounds fat
- Deep
- Thick, fibrous connective tissue
- Final layer of defense b/w infection internal structures
- Superficial
Sprain, treatment
Joint going beyond normal ROM, cause swelling and ecchymosis
Splint, pain management, PMS, elevate
Different types of closed soft tissue injuries
- Contusion
- rupture of small blood vessels and damage to cells in dermis. Ecchymosis
- Hematoma
- Blood tumor
- Large veins or arteries ruptured under skin
- Palpable lump under the skin
- Can bleed up to 1 L
- Sprain
- Forcing joint beyond ROM
- Strain
- Muscles or tendons
- pain, bruising, warm to touch
Different types of open tissue injuries
- Abrasion
- Laceration
- Linear - regular margins
- Stellate - irregular margin
- Incisions
- Avulsions
- Degloving
- Ring
- Amputations
- Complete
- Partial
- Punctures and Penetrations
- Evisceration
- High pressure injection
Amputation treatment
Keep part cool, moist sterile dressing. Apply pressure first, then tourniquet.
Avulsion treatment
Place part back where it belongs, bandage.
Crush injury concerns
- Can cause
- increased risk of infections
- high pressure in muscle compartment preventing capillary filling, causing hypoxia and cell damage
- If damaged muscle cells leak out, can cause rhabdomyolysis
What is rhabdomyolysis in a crush injury?
- Cell contents leaking into the bloodstream due to breakdown of muscle tissue, in this case due to crush injury.
- Hyperkalemia, phosphate, lactic acid, thromboplastin, myoglobin. Myoglobin proteins are nephrotoxic, will cause renal failure
6 P’s of compartment syndrome
Pain
Parasthesia
Paralysis
Pallor
Puffiness
Pulselessness
What is compartment syndrome?
- Elevation of pressure in a muscle compartment above level of capillary perfusion, ceasing blood flow to area.
- Muscle is crushed but compartment remains intact
How does a crush injury lead to rhabdo?
- Crush happens, cuases ischemia of the tissue and hypoxia at cell level.
- Decrease in ATP production due to decrease in aerobic metabolism
- Glycolysis continues (anaerobic), acid builds up
- Less ATP means less sodium and potassium, less NaK pump action
- Sodium and water move freely.
- If blood flow returns, get free radical oxygen called oxygen superoxide.
- attacks cell membranes, influx of Ca+ into cells and mitochondria, leads to mitochondria death and cell breakdown
- Cells broken, influx of Na,Ca, Water.
- Efflux of K, Phospate, Lactic acid, thromboplastin, myoglobin.
- LEADS TO RHABDO
Folliculitis
Bacterial infection of hair follicle
Foruncles
Bacterial, Folliculitis that spreads to surrounding dermis
Carbuncles
Bacterial, Several foruncles that coalesce to form large area of infection
Cellulitis
Bacterial, Local infection of skin that produces swelling, warmth, redness
Gangrene
Bacterial Life threatening, chlostridium infection.
Heavy limb, extreme pain, brawny edema
Herpes simplex virus
Type one - mouth
Type two - genitals
Herpes zoster
Shingles
Herpes varicella
Chickenpox, viral infection of the dermatomes
Tourniquet rules
- At least 1.5” wide
- Challenging to cut flow completely when there are 2 long bones involved (i.e. tib fib)
- Doesn’t occlude? Use second tourniquet
- USE DIRECT PRESSURE FIRST
