Soft-Tissue Trauma Flashcards
What is the first tissue of the human body to experience the effects of trauma?
Integumentary system
____ are blunt, no penetrating injuries that crush and damage small blood vessels.
Contusions
What is the term given to general reddening of the skin due to dilation of the superficial capillaries?
Erythema
The skin is comprised of _____ percent of total body weight.
16
Risk factors for soft-tissue wounds include?
Age, alcohol or drug abuse, and occupation
______ is blue-black discoloration of the skin due to leakage of blood into the tissues.
Ecchymosis
Contusions are more pronounced in areas where?
The mechanism causing injury and skeletal structure trap the skin
Define hematoma
Collection of blood beneath the skin or trapped within a body compartment
A hematoma in the thigh can contain over ______ of blood before swelling becomes noticeable.
A liter
What is the most minor of injuries that violate the skin?
Abrasions
A ____ is an open wound that penetrates more deeply into the dermis than an abrasion.
Laceration
The orientation of tension in the skin is revealed in characteristic patterns called?
Tension lines.
Lacerations cutting across the tension lines have a tendency to be?
Pulled apart
Static tension is noted in areas with _____ movement of this and structures beneath. (Anterior ______ or ______).
Limited
Anterior abdomen or between joints in extremities
Dramatic tension lines occur where?
Elbow, wrist, knee
If orientation parallels tension lines, wound may _____.
Remain closed
If orientation is perpendicular to tension lines, wound may ________.
Gape open
An ____ is a surgically smooth laceration which bleeds ____.
Incision
Freely
A ______ involves a small entrance wound with damage that extends into the bodies interior.
Puncture
What occurs when a flap of skin, although cut or torn, is not torn completely loose from the body.
An avulsion
What type of injury is frequently seen with blunt trauma to the skull where the scalp is torn and folds back?
Avulsion
What is homeostasis?
The body’s natural ability to stop bleeding; the ability to clot blood
_____ cannot contract and thus continue to bleed.
Capillaries
____ begin the clotting process.
Platelets
What are the chemicals released by white blood cells that attract more white blood cells to an area of inflammation?
Chemotactic factors
_____ are white blood cells charged with the primary purpose of neutralizing foreign bacteria.
Granulocytes
Which cell is the immune system cell that has the ability to recognize and ingest foreign pathogens?
Macrophage
______ attack invading pathogens directly or through an antibody response.
Lymphocytes
What does histamine do inside the body?
It dilates pre-capillary blood vessels, increases capillary permeability, and increases blood flow into and through the injured or infected tissue
What is another word for swollen?
Edematous
What results from inflammation?
The clearing away of dead and dying tissue, removal of bacteria and other foreign substances, and the preparation of the damaged area for rebuilding.
What is the epithelialization stage of healing?
It is the stage in which epithelial cells migrate over the surface of the wound
In clean, surgically prepared surgical wounds, complete epithelialization may take place in as little as ________.
48 hours
What is neovascularization?
New growth of capillaries in response to healing
What is collagen?
It is the body’s main structural protein
A strong, tough fiber forming part of hair, bones, and connective tissue
What are fibroblasts?
Specialized cells that form collagen
_____ involves reorganizing collagen fibers into near, parallel bands.
Remodeling
What are the most common causes of skin and soft tissue infections?
Staph and strep
Which bacteria colonized on the surface of normal skin?
Staph
Infections usually appear within ___ to ____ days and present with?
2-3 days
Pain, tenderness, erythema, warmth
What are the risk factors for infection?
Hosts health
Type and location of wound
Associated contamination
Treatment
Which type of patients have a greater risk of infection?
Diabetics
Elderly
Infirm
COPD
What types of drugs reduce the body’s inflammation response?
Nonsteroidal anti-inflammatory drugs NSAIDS
For example - Colchicine (med for gout)
_____ agents, which are used to combat rapidly reproducing cells in cancer patients, also disrupt cell regeneration at an injury site.
Neoplastic
Well-vasculated areas are _____ to infection.
Resistant
Distal extremities are _______ for infection.
Greater risk
When are antibiotics most helpful for deep wounds?
Within the first hour
Antibiotics for the treatment of gram positive infections include?
Anti-staph penicillins, cephalosporins
Tetanus is caused by?
Bacterium
And is anaerobic
Tetanus presents with?
Few signs or symptoms at the local wound site and widespread, painfully involuntary muscle contractions.
Lock jaw is usually seen with?
Tetanus
______ is a powerful inhibitor of platelet aggregation.
Aspirin
What are some examples of anticoagulants?
Warfarin
Heparin
TPA
Streptokinase
______ interfere with or break down the protein fibers that form clots and we used to prevent or destroy obstructions at critical locations.
Anticoagulants
______ fluid is a cellular component of blood, similar to plasma.
Serous
In ________, an extremity injury causes significant edema and swelling in the deep tissue.
Compartment syndrome
When pressure rises above _____ to _____, the blood flow to that muscle group or compartment is compromised and ischemia ensues.
45-60mmHg
Volkmans contracture occurs when?
Scar tissue shortens the length of the muscle strand
Which extremities are more susceptible to compartment syndrome?
Lower extremities
A ______ is a formation resulting from overproduction of scar tissue.
Keloid
Keloids are more common in?
Darkly pigmented individuals and develops on sternum, lower abdomen, upper extremities, and ears
What is hypertrophic scar formation?
An excessive accumulation of scar tissue, usually within the injury border, that is often associated with dynamic skin tension lines, like at flexion joints
Why is hemorrhage with crush injuries difficult to control?
- the actual source of bleeding may be hard to ID
- several large vessels may be damaged
- general condition of limb may not support application of direct pressure
When does crush syndrome occur?
When body parts are entrapped for 4 hours or longer
What is rhabdomylosis?
Skeletal muscle disintegration)
High levels of myoglobin can?
Lodge in filtering tubules of the kidney, leading to renal failure
What is the leading cause of delayed death in crush syndromes?
Renal failure
Rising phosphate levels can lead to?
Abnormal calcifications in the vasculature and nervous system
____ dressings are cotton or fiber like fiber pads that have been specially prepared to be without miccroorganisms.
Sterile
_____ dressings are clean but are not free of miccroorganisms.
Non-sterile
Nonsterile dressings are not intended for?
Application directly to a wound
They are meant to be placed over a sterile dressing to add bulk or absorptive power
What types of dressings are helpful in parenting air aspiration into chest and open neck wounds?
Occlusive/nonocclusive dressings
_____ dressings are untreated cotton or other fiber pads that will stick to drying blood and fluid that has leaked from open wounds.
Adherent
_____ dressings are specially treated with chemicals such as polymers to prevent the wound fluids and clotting materials from adhering to the dressing.
Nonadherent
_____ dressings are dressings impregnated with agents that potentiate the clotting mechanisms, causing more rapid and aggressive clotting.
Hemostatic
What is the most common and convenient bandage material?
Soft, self-adherent, roller bandage
____ bandages are soft, self-adherent bandages which are a convenient material for securing dressings.
Gauze
____ bandages are strong, plastic, paper, or fabric material with adhesive on one side.
Adhesive
A rapid secondary assessment is done for?
Significant mechanisms of injury
Focused secondary assessments are done for?
No significant mechanism of injury
What is the primary method of controlling hemorrhage?
Direct pressure
What are the three objectives of bandaging to control hemorrhaging?
Keep wound clean
Immobilize the wound site
To halt hemorrhage, apply firm pressure to site for at least ____ minutes.
10
_____ can correct acidosis, help prevent renal failure, and correct hyperkalemia.
Alkalinition
What is the care for crush syndromes?
sodium bicarbonate 1mEq/kg initially then 0.25mEq/kg/hr
In crush injuries, consider _____mg calcium chloride IVP to counteract dysrhythmias induced by hyperkalemia.
500
What is the most prominent symptoms of compartment syndrome?
Six Ps Pain Paresthesia Paresis Pressure Passive stretching pain Pulselessness
Care at the hospital for crush injury is aggressive and may use techniques such as ___ and _____.
Debridement
Hypebaric
________ a Xanthine oxidise inhibitor, interferes with the production of uric acid and may help reperfusion of both the kidneys and the skeletal muscles.
Allopurinol
Compartment syndrome rarely occurs within the first _____ hours after an acute injury.
4
What is the single most effective prehospital treatment for compartment syndrome?
Elevation
What does elevation do for a crush syndrome?
Reduces edema, increases venous return, lowers compartment pressure, helps prevent ischemia
Trauma to the thorax area is likely to injure both the ____ and the ____.
Plura
Lungs
Dress all open thoracic wounds with ________ dressings.
Sterile
When should a tetanus booster be obtained by the patient?
If time since immunization has been longer than 5 years
How does the integumentary system prevent pathogens from attacking the body?
The skin provides a protective barrier against pathogens
Of the open wounds presenting to emergency departments, up to _____ percent will eventually become infected, resulting in significant morbidity.
6.5
When an artery is ruptured but the skin is not broken, blood can separate the tissues and pool in a pocket. This pocket of blood is known as a?
Hematoma
The anaerobic bacterium clostridium perfingens causes a deep space infection called:
Gangrene
In a soft tissue injury, what may cause a bandage to fit properly at first but later become too tight and reduce circulation?
Damaged tissue swelling
When bandaging the foot and ankle to create pressure and control bleeding, wrap in a:
Distal-to-proximal fashion to avoid forming a venous tourniquet
