The Integumentary System

Question 1

What are we looking for when visually assessing the skin?

Answer 1

looking for Contusion, lacerations, abrasions, penetrations, swelling or deformity (CLAPSD), as well as redness, swelling (edema), rash, discoloration or other abnormal findings

Question 2

What are we physically touching and assessing for on the skin?

Answer 2

We are using our hands on assessment to look for tenderness, instability or crepitus (TIC) and temperature (to touch), skin turgor and pain

Question 3

With traumatic injuries of the integumentary system what treatments should we prioritize?

Answer 3

controlling major hemorrhage, stabilizing impaled objects and restoring any loss of neuromuscular status

Question 4

How should we treat an amputation/avulsion?

Answer 4

-Most likely a load and go situation
-High concentration O2 should be used for major
hemorrhage
-Hemorrhage control is key and biggest life threat
-Try to determine blood loss, if objects are still impaled, foreign bodies and status of CSM.
-Once bleeding controlled cover stump with moist dressing and wrap any amputated body parts/tissue in bag with ice.
-Amputation of thumb or penis is a resulting code 4 however amputation of less than 3 fingers or an avulsion is a code 3

Question 5

What should be considered while assessing a soft tissue injury?

Answer 5

-Remember underlying structures.
-If frothy or pink blood noted, consider lung or esophageal involvement.
-If required cut clothes, jewelry or otherwise and assess CSM.
-Any impaled objects are stabilized in place unless impaled in cheek or causing a/w issues. Eviscerated guts covered w moist, sterile bulky dressing

Question 6

In the rule of 9s burn assessment, what % is the trunk?

Answer 6

A burn covering the anterior or posterior side of the trunk is 18%, together it would be 36%.

Question 7

In the rule of 9s burn assessment, what % is the face?

Answer 7

The face is 4.5%, the entire head and neck would be 9%.

Question 8

In the rule of 9s burn assessment, what % is the arm?

Answer 8

The anterior or posterior surface of the arm would be 4.5% (the upper arm is 2% and the lower arm is 1.5%), the entire arm would be 9%

Question 9

In the rule of 9s burn assessment, what % is the leg?

Answer 9

The anterior or posterior surface of the leg would be 9%, the entire leg would be 18%

Question 10

In the rule of 9s burn assessment, what % is the groin or palms?

Answer 10

Both the palm or the groin would be 1%

Question 11

What life threats from burns are we looking for?

Answer 11

-smoke inhalation
-severe burns
-a/w burns
-CO poisoning
-associated trauma

Question 12

What are the indications of smoke inhalation?

Answer 12

-smoky breath
-singed hairs/lips/mouth
-soot
-cough/drooling/stridor and a/e with associated resp effort

Question 13

How do we treat a 1st degree burn or a 2nd degree burn < 10-15%?

Answer 13

use wet dressings with dry dressing or sheet on
top

Question 14

How do we treat a 2nd degree burns > 10-15% or a 3rd degree burn?

Answer 14

use dry dressing

Question 15

What are conditions are burn patients susceptible to?

Answer 15

sepsis, hypovolemia (3rd space shifting) or
hypothermia

Question 16

How long should you irrigate a chemical burn if the chemical is alkaline?

Answer 16

20 mins

Question 17

How long should you irrigate a chemical burn if the chemical is acidic?

Answer 17

10 mins

Question 18

How long should you irrigate a chemical burn if the chemical is unknown?

Answer 18

20 mins

Question 19

What life threats should be considered with blunt or penetrating trauma?

Answer 19

-tension pneumothorax
-tamponade
-major hemorrhage
-flail chest
-myocardial contusion
-spinal cord injury
-pulmonary or vascular compromise with chest trauma

Question 20

How should you manage a bite?

Answer 20

-irrigation for approx. 5mins
-possibly immobilization of affected area
-never ice packs or cold compress

Question 21

What are bed/pressure sores?

Answer 21

-Resulting from long time pressure between the bone and a surface w/ skin in-between
breaking down over time
-Generally over heels, hips or tailbone
-Wheelchair or bed ridden pts are high risk
-Healing takes time with high rate of infection
-These patients need to be assessed for sepsis

Question 22

What is cellulitis?

Answer 22

-Bacterial infection of the dermis and sub-Q layers
-Generally found occurring on legs and face but can be anywhere
-Will be swollen, red, tender and hot to the touch
-May see line drawn around perimeter to monitor growth. Generally treated w/ abx but takes time to heal
-Susceptible to sepsis

Question 23

What is chicken pox?

Answer 23

-Viral infection (varicella zoster)
-Will usually start on torso and/or face but can appear or spread anywhere
-Will usually last 5-7days
-Can lead to complications such as pneumonia, brain edema or bacterial skin infection
-Can be much more serious in adults and that’s why we vaccinate against it

Question 24

What is shingles?

Answer 24

-Also caused by the VZV.
-Presents usually on torso in a wide band/strip
-Can be quite painful but heals in 2- 4 weeks however may cause permanent nerve damage (Rx gabapentin)
-The varicella vaccine reduces chance of getting shingles by up to 90%

Question 25

What is diaper rash?

Answer 25

-Resulting from the diaper trapping “things” or causing irritation itself -Usually starts in the areas with skin folds or concave areas -Can be red/tender and possibly weeping and may lead to bacterial/fungal infections -Usually treated topically with associated limited diaper usage

Question 26

What is necrotizing fasciitis?

Answer 26

-Aka flesh eating disease, caused by bacterial infection generally strep A or MRSA -Generally found on the limbs or perineum -Rapid onset and spread. May start from a small scratch and within days pt becomes septic and quite ill -Left untreated can be fatal

Question 27

What is Fournier's gangrene?

Answer 27

-A type of nec fash affecting the external genitalia or perineum -Can be isolated or septic (80% mortality rate in the presence of fever) -Will require abx treatment and even debridement -Prehospital we will treat symptoms, i.e.. sepsis and pain

Question 28

What is cyanosis?

Answer 28

-sign of a lack of perfusion, generally first seen in the nail beds or lips/face -can have underlying causes of peripheral vaso-c (shock), poor oxygenation or poor cardiac output or any combo of the 3 -need to quickly identify the underlying cause and correct it as cyanosis can be a sign of a true life threat

Question 29

What is lividity?

Answer 29

-Lividity results from a body lying in one position for a period of time without circulation. The blood/fluid will pool in dependent areas (gravity) -Lividity should not be seen in a living patient and is part of our obviously dead patient criteria (deceased patient standard)

Question 30

What is urticaria?

Answer 30

-A blotchy type rash otherwise known as hives. -An inflammatory reaction caused by capillary leakage generally found on torso -Urticaria has a few different causes but should be considered to be related to allergic reaction until proven otherwise -May be painful/itchy. -Will remain until underlying cause is treated/ reversed and fluid can be reabsorbed

Question 31

What are potential life threats for patients experiencing anaphylaxis?

Answer 31

-A/e obstruction -Bronchoconstriction -Hypotension -Cardiac arrest

Question 32

What is petechia?

Answer 32

-A rash characterized by small red “dots” caused by minor bleeding from ruptured capillaries. -Generally found on skin, conjunctiva or on soft palate -Has several different causes including trauma, strep infection (soft palate), clotting disorders or any number of other disease processes -Generally pain free, our goal is to try and ascertain the root cause

Question 33

What is Raynauds?

Answer 33

-A white appearance in the periphery as result of exposure to cold causing constriction of small arteries -Generally easily reversible by warming up the affected part of the body -May cause some pain/numbness as rewarming occurs and sensation/circulation is restore

Question 34

According to the BLS Amputation and Avulsion Standard, what are some life/limb/function threats from amputations?

Answer 34

-hemorrhagic shock -loss of limb -loss of function

Question 35

According to the BLS Blunt/Penetrating Injury Standard, what are some potential life/limb/function threats in abdominal/pelvic injury?

Answer 35

-rupture, perforation, laceration, or hemorrhage of organs and/or vessels in the abdomen and potentially in the thorax or pelvis -spinal cord injury

Question 36

According to the BLS Blunt/Penetrating Injury Standard, how should you treat a patient with a pelvic fracture?

Answer 36

-attempt to stabilize the unstable pelvis with a circumferential sheet wrap or a commercial device, -secure the patient to a spinal board or adjustable break-away stretcher, -avoid placing spinal immobilization or stretcher straps directly over the pelvic area -secure and immobilize lower limbs to prevent additional pelvic injury

Question 37

According to the BLS, how do you treat an open or sucking chest wound?

Answer 37

-seal wound with a commercial occlusive dressing with one way valve; if not possible, utilize an occlusive dressing taped on three sides only -apply dressing large enough to cover entire wound and several centimeters beyond the edges of the wound -monitor for development of tension pneumothorax -if tension pneumothorax becomes obvious or suspected release occlusive dressing and/or replace

Question 38

According to the BLS, what are the life/limb/function threats of a head injury?

Answer 38

-intracranial and/or intracerebral hemorrhage -neck/spine injuries -facial/skull fractures -concussion

Question 39

According to the BLS Burn Standard, what are the life/limb/function threats from a burn?

Answer 39

-airway burns -asphyxia (smoke inhalation) -carbon monoxide/cyanide poisoning -shock

Question 40

According to the BLS Soft Tissue Injuries Standard, how should a wound hemorrhage be controlled on the extremities (most to least invasive)?

Answer 40

-apply well-aimed, direct digital pressure at the site of bleeding, -apply a tourniquet, if tourniquet fails to stop bleeding completely or cannot be used for any reason then apply a second tourniquet -pack the wound with hemostatic dressing if appropriate and available or standard gauze if contraindicated or unavailable, maintain pressure and secure with a pressure dressing;