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EMT Test 4 > Soft Tissue Trauma > Flashcards

Soft Tissue Trauma Flashcards

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1
Q

What are the Soft Tissues?

A
  • Skin
  • Fatty tissues
  • Muscles
  • Blood vessels
  • Fibrous tissues
  • Membranes
  • Glands
  • Nerves
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2
Q

Functions of Skin?

A
  • Protection
  • Water balance
  • Temperature regulation
  • Excretion
  • Shock absorption
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3
Q

Closed wounds: Contusion

A

Bruise

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4
Q

Closed wounds: Hematoma

A

– Similar to contusion
– More tissue damage
– Involves larger blood vessels

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5
Q

Closed wounds: Crush Injury

A

• Closed crush injury

– Excessive force crushing or rupturing internal (generally solid) organs

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6
Q

Assessment: Closed Wounds

A
  • Bruising may be internal injury or bleeding
  • Consider mechanism of injury
  • Crush injuries are difficult to identify
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7
Q

Treatment: Closed Wounds

A
  • Take appropriate Standard Precautions
  • Manage airway, breathing, and circulation
  • Always manage for internal bleeding and shock if there is a possibility of internal injuries
  • Splint extremities that are painful, swollen, or deformed
  • Stay alert for vomiting
  • Continuously monitor for changes and transport
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8
Q

Types of Open Wounds

A
  • Abrasion
  • Laceration
  • Puncture
  • Avulsion
  • Amputation
  • Crush injury
  • Blast injury
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9
Q

Think about it Open Wound

A
  • Does an open wound necessitate using more than just gloves as standard precautions?
  • Can an open injury affect the patient’s airway or breathing?
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10
Q

Treatment Open Injuries

A
  • Expose wound
  • Clean surface of wound
  • Control bleeding
  • Provide care for shock
  • Prevent further contamination
  • Bandage dressings in place after bleeding is controlled
  • Keep patient still
  • Reassure patient
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11
Q

Treatment: Abrasions & Lacerations

A

• Reduce wound contamination
• Hold direct pressure to control bleeding
• Always check pulse, motor, and sensory
function distal to injury to assure function
• Never open edges of laceration to see inside or further clean wound

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12
Q

Treatment: Puncture Wounds

A

• Use caution—objects may be embedded deeper than they appear
• Check for exit wounds
– May require immediate care
• Bullets can fracture bones as they enter
• Stab wounds are considered serious if in a vital area of body
Reassure patient
• Search for exit wound
• Assess need for shock care
• Follow local protocols regarding
spinal immobilization
• Transport patient

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13
Q

Treatment: Impaled Objects

A
  • Do not remove object; may cause severe bleeding
  • Expose wound area
  • Control profuse bleeding by direct pressure
  • Apply several layers of bulky dressing to “splint” object in place
  • Secure dressings
  • Treat for shock
  • Provide rapid transport
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14
Q

Impaled Object in Cheek

A
  • Take care that object does not enter oral cavity, causing airway obstruction
  • If cheek wall is perforated, profuse bleeding into mouth and throat can cause nausea and vomiting
  • External wound care will not stop the flow of blood into the mouth
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15
Q

Treatment: Impaled Object in Cheek

A
  • Examine wound site, both inside and outside mouth
  • If you find the perforation and can see both ends, remove object
  • If object is impaled into another structure, stabilize in place
  • Position patient to allow for drainage
  • Monitor patient’s airway
  • Dress outside of wound
  • Provide oxygen
  • Provide care for shock
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16
Q

Treatment: Avulsions

A
  • Clean wound surface
  • Fold skin back into normal position
  • Control bleeding and dress with bulky dressings
  • If avulsed parts are completely torn away, save in sterile dressing and keep moist with sterile saline
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17
Q

Treatment: Amputations

A
  • Apply pressure dressing over stump
  • Use pressure points to control bleeding; use tourniquet only if all other methods fail
  • Wrap amputated part in sterile dressing and place in plastic bag; put bag in pan with water and cold packs
  • Do not immerse amputated part directly in icy cold water
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18
Q

Treatment: Genital Injuries

A
  • Control bleeding
  • Preserve avulsed parts
  • Consider if injury suggests another, possibly more serious, injury
  • Calm, professional manner
  • Maintain patient’s dignity
  • Dress and bandage wound
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19
Q

Burns

A

• May involve more than just skin-level structures
• If respiratory structures are affected, swelling may occur, causing life threatening
obstruction
• Don’t let burn distract from spinal damage or fractures

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20
Q

Assessment: Burns

A

• Classifying burns
– Agent and source
– Depth
– Severity

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21
Q

Burns: Depth

• Superficial (1st Degree)

A

– Involves only epidermis
– Reddening with minor swelling

“Sunburn” - damaged outside layer of the skin

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22
Q

Burns: Depth

• Partial Thickness (2nd Degree)

A

– Epidermis burned through, dermis damaged
– Deep, intense pain
– Blisters and mottling

“Blisters Burns”

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23
Q

Burns: Depth

• Full Thickness (3rd Degree)

A

– All layers of skin burned
– Blackened areas surrounded by dry and white patches

black or white waxy appearance

epidermis and dermis are burned - into the subcutaneous layer

more than 15% of body Trauma alert

2nd or 3rd degree burns - only - count

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24
Q

Burns: Severity Rule of Nines

A

– Helps estimate extent of burn area
– Adult body is divided into 11 main areas
– Each represents 9 percent of body surface

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25
Q

Burn Rule of Nines in an Adult

A 
Anterior head= 4.5%
Posterior head= 4.5%
Anterior torso= 18%
Posterior torso= 18%
Anterior leg, each= 9%
Posterior leg, each	= 9%
Anterior arm, each= 4.5%
Posterior arm, each= 4.5%
Genitalia/perineum= 1%
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26
Q

Burn Rule of Nines in an Child - change to the figures in the book

A 
Anterior head	= 9%
Posterior head= 9%
Anterior torso= 18%
Posterior torso= 18%
Anterior leg, each= 6.75%
Posterior leg, each	= 6.75%
Anterior arm, each= 4.5%
Posterior arm, each= 4.5%
Genitalia/perineum= 1%
27
Q

Burn Rule of Nines in an Infant

change to what is in the book

A 
Head and neck= 20%
Anterior torso= 16%
Posterior torso= 16%
Leg, each= 16%
Arm, each =8%
Genitalia/perineum= 1%
28
Q

Burns: Geriatrics and Pediatrics

A

• “Minor” burn area in a young adult can be fatal to a geriatric adult
• Infants and children have a much greater
relationship of body surface area to total
body size, resulting in greater fluid and
heat loss from burned skin

29
Q

Treatment: Thermal Burns

A
  • Use sterile dressings
  • Never apply ointments, sprays, or butters
  • Do not break blisters
30
Q

Treatment: Chemical Burns

A 
• Wash away chemical with
copious amounts of flowing water
• If dry chemical, brush away, then flush with water
• Remove contaminated clothing
• Apply sterile dressings
• Treat for shock
31
Q

Electrical Injuries: Overview

A

• Severe damage through body by
disrupting nerve pathways
• Entry and exit burns are possible
• Respiratory/cardiac arrest are possible
• Bones may fracture from violent muscle contractions

32
Q

Treatment: Electrical Injuries

A
  • Provide airway care
  • Be alert and prepared for cardiac rhythm changes; be ready to defibrillate
  • Treat for shock and provide oxygen
  • Care for spinal and head injuries as well as extremity fractures
  • Evaluate burn sites
  • Cool burning areas and apply sterile dressings
33
Q

Dressing

A

any material applied to wound to control bleeding and prevent contamination

34
Q

Pressure Dressing

A

.

35
Q

Occlusive Dressing

A

.

36
Q

Bandage

A

any material used to hold dressing in place

37
Q

Dressing Open Wounds

A
  • Expose wound
  • Completely cover wound area
  • Dressings should not be removed unless bulky dressing is blood soaked and new one must be applied to maintain direct pressure
  • Control bleeding by direct pressure or pressure dressings
38
Q

Bandaging Open Wounds

A

• Do not bandage too tightly or too loosely
• Do not leave loose ends
• Do not cover tips of fingers or toes—must observe distal skin
color changes
• Cover all edges of dressings

39
Q

Chapter Review: Soft Tissue Trauma

A
  • Soft-tissue injuries may be closed or open.
  • Closed injuries include contusions, hematomas, and crush injuries.
  • Open wounds include abrasions, lacerations, avulsions, amputations, and crush injuries.
40
Q

Chapter Review: Soft Tissue Trauma

A
  • For open wounds, expose the wound, control bleeding, and prevent further contamination.
  • For both open and closed injuries, take appropriate Standard Precautions.
41
Q

Chapter Review: Soft Tissue Trauma

A

• Burn severity is determined by considering the source, the region affected, depth of
burn, extent of burn, age of the patient, and other patient illnesses or injuries.

42
Q

Chapter Review: Soft Tissue Trauma

A

• Care for burns includes stopping the burning, covering a thermal burn with a dry sterile dressing, flushing a chemical burn with sterile water, protection of the airway, administration of oxygen, treatment for shock, and transport.

43
Q

Chapter Review: Soft Tissue Trauma

A

• For treatment of electrical injuries, be sure that you and the patient are in a safe zone
away from possible contact with electrical sources. Protect airway, breathing, and circulation. Be prepared to care for respiratory or cardiac arrest. Treat for shock, care for burns, and transport.

44
Q

Remember: Soft Tissue Trauma

A
  • The soft tissue of the body is made up of skin, fatty tissues, muscles, blood vessels, fibrous tissues, membranes, glands, and nerves.
  • The skin provides protection, water balance, temperature regulation, excretion, and shock absorption.
45
Q

Remember: Soft Tissue Trauma

A
  • Open or closed in reference to a soft tissue injury is dictated by whether or not the skin is still intact.
  • Closed injuries must be evaluated with consideration to underlying anatomy and mechanism of injury.
46
Q

Remember: Soft Tissue Trauma

A
  • Open injuries typically are easier to visualize, but they often can mask underlying injuries.
  • Burns involve immediate destruction of tissue but also can have a long-term effect, both physically and emotionally.
47
Q

Remember: Soft Tissue Trauma

A
  • Safety must be a key concern when treating a patient with a burn or an electrical injury.
  • The goal of dressing and bandaging wounds is to control bleeding and to prevent infection.
48
Q

Questions to consider: Soft Tissue Trauma

A
  • Does the patient have a patent airway and is breathing adequate?
  • If the wound is penetrating, is there an exit wound?
  • What is the best way to immobilize an impaled object?
49
Q

Questions to consider: Soft Tissue Trauma

A
  • Is there respiratory involvement with the burn?
  • Have we irrigated the chemical burn sufficiently?
  • Does the electrical burn have an exit wound?
  • Is the bandage securely fastened to hold the dressing?
50
Q

Critical Thinking: Soft Tissue Trauma
A 21-year-old male lacerated his anterior elbow when he fell through a window. There is a lot of blood around the patient. Bystanders have applied numerous towels and washcloths over the wound (at least 3 inches thick).

A

• There are so many dressings on the wound that you can’t tell if it is still bleeding. The patient is alert, but pale and anxious. The radial pulse on his uninjured arm is weak and rapid. How much assessment of the wound should you do and how do you do it without making things worse?

51
Q

where do the structures in the skin originate from

4 layers of epidermis
outside - epidermis
dermis

A

.

52
Q

skin is the largest organ in the body that weighs approx 8 pounds

A

.

53
Q

know contusion, hematoma, 645

A

.

54
Q

know all the open wounds

A

.

55
Q 
abrasion - road rush
laceration - cut 
punture
avulsion - flap of skin
......
A

.

56
Q

dont remove impaled object unless they go through the check and are threatening the airway

A

.

57
Q

burn victims - can see the external - get them to open the mouth - inhaled soot, singed nose hair - airway will start to swell - will be an ALS pt - paralyze and intubate

A

.

58
Q

size of the patients hand is approximately 1%

A

….

59
Q

calculate rule of 9’s on the test

whole arm - circumferential arm is burned -

pulls off cap of radiator

A

.

60
Q

chemical burns - take off the clothing - gross decontamination remove 90% of the source wash or whatever for the remaining 10 %

A

.

61
Q

electrical injury make sure the power is off

A

.

62
Q

electrical injury burn from the inside out like a microwave

A

.

63
Q

dressing and bandage

A

.

64
Q

wrap in the direction of venous blood flow distal to proximal

pms - wound care - pas
document

A

.

EMT Test 4 (11 decks)

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