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PC1-2 > Vol.4-Ch.4 "Soft Tissue Trauma" > Flashcards

Vol.4-Ch.4 "Soft Tissue Trauma" Flashcards

1
Q

How much body weight is accounted for from skin (integumentrary system)? (%)

A

16%

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2
Q

What is by far the most common form of trauma?

A

Soft tissue injuries

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3
Q

What are some risk factors for soft tissue trauma? (3)

A
  • age
  • alcohol/drugs
  • occupation
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4
Q

Epidermis:

Is vasculature present?

As cells are pushed up to surface they flatten and interlock forming a firm barrier called ____?

What is secreted here to keep the skin lubricated, flexible, and water resistant?

What does the epidermis block/absorb?

A

Epidermis:

  • No vasculature is present
  • Outer layer is called the Stratum Corneum
  • Sebum is a waxy substance that lubricates
  • Responsible for producing pigmentation that protects against ultraviolet radiation

(Takes 2 weeks for cells to go from dermis to epi, anoher 2-4 weeks to be abraded away)

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5
Q

What is the dermis primarily made of and what is it’s main functions?

A

Connective tissue (mostly made from collagen) that helps contain the body and support the functions of the epidermis.

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6
Q

What is the upper layer of the dermis called? What is it made of? What is it’s main function?

A

The Papillary Layer is made of Loose connective tissue, capillaries, and nerves supplying the epidermis

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7
Q

What is the deeper layer of the dermis called? What is it made of? What is it’s main function?

A

The Reticular Layer is made up of Strong connective tissue that firmly secures it to the subcutaneous layer

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8
Q

The dermis contains _____ x4?

A
  • blood vessels
  • nerve ending
  • glands
  • other structures (such as hair follicles)
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9
Q

What are 3 functions of hair/hair follicles?

Which layer are they found in?

A

to produce hair that helps:

  • reduce surface abrasion
  • reduce surface friction
  • to conserve heat

*found in the dermis

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10
Q

What is the function of sebaceous glands?

Where are they found?

A

They produce sebum and secrete it directly onto the skin’s surface or into hair follicles

It is found in the dermis

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11
Q

What is the function of sudoriferous glands?

Where are they found?

A

They secrete sweat to transfer heat away from the body through evaporation

It is found in the dermis

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12
Q

Function of macrophages and lymphocytes?

A

Begin the inflammatory response by killing invading bodies and triggering a call for other similar cells

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13
Q

Function of mast cells?

A

Control the microcirculation to tissues and respond to the initial invasion, increasing capillary flow and permeability

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14
Q

Function of fibroblasts?

A

Lay down and repair protein strands (mostly collagen) to strengthen the wound site and begin restoring the skin’s integrity

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15
Q

What is the subcutaneous layer made of?

What are it’s 2 great functions?

A

Mostly made of fat/adipose tissue making it great at conserving heat and absorbing trauma

(heat moves 3x mores slowly through this layer)

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16
Q

Where does the lymphatic system reintroduce it’s fluids to the venous system?

A

Just above the superior vena cave

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17
Q

What connects the muscles to the skeleton system and what are those bonds made of?

A

Tendons are made of almost pure collagen fibers running parallel

(ligaments = bone to bone)

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18
Q

Lacerations cut ACROSS tension lines of the skin tend to gape or open _____?

Lacerations cut ALONG tension lines of the skin tend to gape or open _____?

A

Lacerations ACROSS tension lines gape MORE

Lacerations ALONG tension lines gape LESS

(For example think of cuts along or across the forehead)

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19
Q

Tension lines in the skin can be either _____ or _____. Explain the differences between the two and how it can effect healing.

A

Static tension - is in areas that move less and therefore have less obstructed healing processes

Dynamic tension - is in areas that move a lot and therefore have their healing process interrupted often by movement

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20
Q

What are the 3 types of closed wounds?

A
  • Contusions
  • Hematomas
  • Crush Injuries
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21
Q

What is a contusion? How does it develope?

A

Contusion - a blunt, non-penetrating injury that crushes and damaged small blood vessels.

Because of this the escaping blood and fluids fill the inflamed tissue (causing erythema or reddening) and interstitial spaces that ultimately results in ecchymosis or black-and-blue discoloration from the hemoglobin losing its oxygen and darkening.

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22
Q

What is a hematoma?

A

A hematoma is a collection of blood (often from an artery) that has separated tissue and pooled.

This can include enough blood to be a factor of hypovolemia, especially when in the thighs or upper arms.

Sometimes are hard to tell when they are deep but easy to see when on the head b/c of the skull.

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23
Q

What is a crush injury vs crush syndrom?

A

A crush injury involves a body part that is compressed and sustains deep injury to the muscles, blood vessels, bones, or other internal structures.

Crush syndrome is when that pressure is applied for a long time, the cells damaged beneath can lease large amounts of myoglobin, potassium, lactic acid, and other toxins that when the pressure is released then escape and spread in the body. This results in severe acidosis, and can be very dangerous to the heart and kidneys.

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24
Q

What are the 7 types of open wounds?

A
  • Abrasions
  • Lacerations
  • Incisions
  • Punctures
  • Impaled
  • Avulsions
  • Amputations
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25
Q

What is an abrasion?

A

Usually only minor wounds caused by a scraping or abrasive action damaging the epidermis and top of dermis where there is only minor vessels; persistent bleeding but only minor volumes

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26
Q

What is a laceration?

A

It is a deeper wound than abrasion that penetrates deeply into the dermis and can damage arteries, veins, nerves, muscles, tendon/ligaments, and maybe organs.

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27
Q

What is an incision?

A

More or less a laceration caused by a surgically sharp object like a scalpel or glass; it tends to bleed freely

28
Q

What is a puncture?

A

Punctures wounds are another type of laceration but often with a small entrance going deep into the body, this would can sort of cover itself up though as it usually seals itself after, masking any serious bleeding and the extent of the damage inside

29
Q

What is an impaled object?

A

A type of puncture or laceration where the object is still present in the body; it is in itself a complication as the object can be entangled with vessels or organs inside and removal can cause more damage or it can be actively holding pressure or blocking bleeding which removal could then cause uncontrollable bleeding

30
Q

What is an avulsion? What a special type of avulsion?

A

An avulsion is when a flap of skin is torn or cut but not completely removed from the body. This is often seen in the head where the scalp is torn and then pushed back.

A type of this is Degloving or Ring injury where a ring or machinery tears the skin off the underlying muscle, connective tissue, vessels, and bone.

31
Q

What is an amputation?

A

When a digit or limb is completely removed ; a clean cut may bleed LESS than if it is a jagged or crushed cut.

32
Q

What are the 5 stages of the healing process?

A
  • hemostasis
  • inflammation
  • epithelialization
  • neovascularization
  • collagen synthesis
33
Q

What are the 3 stages of hemostasis? Briefly explain each one.

A
  • Vascular Phase: right after the cut the vessel will contract, reducing its lumen size, thicken its walls, and shrinking back into the wound, reducing blood flow.
  • Platelet Phase: the vessel walls and platelets become sticky and form an unstable grouping of platelets to help reduce blood leaving the vessels
  • Coagulation Phase: the tunica intima exposes collagen and other proteins to help produce fibrin strands that help catch platelets and erythrocytes to form a more stable gelatinous mass to stop bleeding.
34
Q

Describe the process of inflammation. (6)

A

1) Damaged cells or invading pathogens release proteins and chemicals called Chemotactic Factors the recruit other cells for help.
2) First to arrive is the Granulocytes and Macrophages (both Phagocytes) that engulf bacteria, debris, and foreign material and then release the byproducts (process = Phagocytosis)
3) Lymphocytes (WBCs) and Immunoglobulins (immune proteins) attack invading pathogens directly or w/ antibodies.
4) (occurs with step 3) As the byproducts from the phagocytes engulfing and destroying are released; Mast Cells release Histamines that dilate the precapillary blood vessels and makes them more permeable, ultimately increasing blood flow. Is is called Hyperemia and is responsible for erythema (reddening)
5) Now that the area has increased flow and permeability Edema or in this case Hyperemia is caused from the accumulation of fluids and causes swelling. This increase in fluids brings more oxygen, phagocytes, and draws away the byproducts of the destruction and repair
6) Increased blood flow and local tissue metabolism increases temperature which can also help denature pathogen proteins

35
Q

What are the ultimate signs/symptoms of inflammation? (3)

A
  • swollen
  • red
  • warm/hot
36
Q

What is the function of granulocytes and macrophages in the inflammation process?

A

Granulocytes are the first to the scene ; both are phagocytes so they engulf and destroy bacteria, debris, and foreign material through phagocytosis

37
Q

What is the function of lymphocytes (WBCs) and immunoglobulins in the inflammation process?

A

Attack invading pathogens directly or with antibodies

38
Q

What is the function of mast cells in the inflammation process?

A

To release histamines that dilate the blood vessels and increase their permeability to increase blood flow

39
Q

What is epithelialization?

A

The Stratum Germinativum cells rapidly divide and regenerate, forming a uniform layer of skin cells. In large wounds, the cells may not be complete and collagen will show through as a shiny, pink line called a SCAR

40
Q

What is neovascularization?

A

The process of creating new blood vessels for the increased demand for oxygen and nutrients at the damaged site. These vessels bud from undamaged capillaries near by and grow into the healing tissue. This can take weeks or months and the new tissue is fragile and BLEEDS EASY.

41
Q

What is collagen synthesis?

How strong is the new tissue at 4 months when a scar if fully mature?

A

Fibroblasts are brought to a wound area to synthesize collagen which then binds wound margins together and strengthens the wound site. This only gives the new tissue about 60 PERCENT the original strength however at 4 months when the scar is fully mature

42
Q

What is the bodies main structural protein?

A

Collagen; a strong tough fiber forming part of hair, bones, and connective tissue. Scars, cartilage, and tendons are almost entirely made of collagen.

43
Q

What is the most common complication of an open wound?

A

An infection; this delays healing

44
Q

What are the 2 most common causes of skin and soft tissue infections?

A

Staphylococcus and Strepococcus bacterial families;
they are Gram-positive, aerobic, and very common in the environment.
Staphylococcus frequently colonizes on the surface of the skin.

(Methicillin-resistance Staphylococcus (MRSA) and Vancomycin-resistant Staphylococcus (VRSA) are types of Staph resistant to the typically used drugs to fight it)

45
Q

What is the Gram’s Method of staining?

A

A procedure to identify different types of bacteria

46
Q

How long does it take for an infection to be noticeable and what does it usually present with?

What is lymphangitis?

A

2-3 days after injury and presents with pain, tenderness, erythma, and warmth.

(Often puss, a collection of WBCs, cell debris, and dead bacteria, may be present)

Lymphangitis is inflammation of the lymphatic vessels caused by the infection and is seen as red streaks heading proximal

47
Q

What 4 things do the risk factors for infection come down to?

A
  • Pts health
  • wound type/location
  • associated contamination
  • treatment provided
48
Q

What is gangrene? Besides one of the rarest and most feared wound complications

A

A deep space infection caused by the anaerobic bacterium Clostridium Perfringens. Usually comes from loss of blood supply, crush injury, or infection. It produces a gas deep in the wound causing subcutaneous emphysema the smells foul when gas is released. Unchecked, it leads to sepsis and death.

49
Q

What is tetanus?

How many shots and boosters to prevent?

A

“Lockjaw”; caused by bacteria Clostridium Tetani and is aerobic, that produces widespread, painful, involuntary muscle contraction.

There is an antidote but it only neutralizes circulating toxins. There is also immunization that you can receive as 3 shots in childhood and boosters every 10 years

50
Q

What are 3 conditions that can reduce the healing process?

A
  • impaired hemostasis
  • re-bleeding
  • delayed healing
51
Q

At what pressure within a fascia does it begin to restrict capillary blood flow to muscles and nerves?

After how long is the ischemic damage irreversible?

What is especially at risk of compartment sydrome?

A

30mmHg

10hours

Lower extremities especially calfs

52
Q

What is a keloid?

A

Excessive scar tissue the extends beyond the boundaries of the wound

53
Q

What is a pressure injury?

A

It is like a minor crush injury where the bodies weight against the ground or hard surface causes hypoxia for the tissues between the two (like if on a spine board or ground too long)

54
Q

How long does it take for crush syndrome to set it?

What is necrosis and rhabdomyolysis?

What are the chief things created by necrosis and rhabdomyolysis? (3) what will an increase level of these cause?

A

4 hours or longer

Necrosis = cellular changes with resultant release of metabolic byproducts

Rhabdomyolysis = skeletal muscle destruction

1) Myoglobin - if large amounts accumulate in kidney tubules will cause kidney failure (leading cause of death)
2) phosphate & potassium - hyperkalemia (high potassium) reduces the hearts ability to respond to electrical stimuli causing arrhythmias
3) lactic acid

55
Q

What is injection injury?

A

when a high pressure line injects fluid through a Pts skin and into subcutaneous layers

56
Q

What are the 6 types of dressings used for soft tissue injuries?

A
  • Sterile/Nonsterile:
    (sterile is prepackaged pads that are sterile till bag is opened and go straight onto wound; nonsterile is “clean” but not of microbes and goes over a sterile but not directly on wound)
  • Occlusive/Nonocclusive:
    designed to prevent fluid and air movement through
  • Adherent/Nonadherent:
    adherent can be painful or tear clot when removed but promotes clotting as they stick to drying blood and fluid. NonA have chems on them that prevent wound fluids and clot materials from sticking to dressing (nonA is preferred)
  • Absorbent/Nonabsorbent
  • Wet/Dry
  • Hemostatic
57
Q

What are 4 types of hemostatic agents and describe them?

A

1) Celox - main ingredient is Chitosan (from crustaceans) that when mixed with blood becomes extrememly adherent and is antibacterial and hypoallergenic. Lasts for 3 years
2) Hemcon - used a lot on the battlefield, they are chitosan infused bandages
3) QuickClot - agent made of ziolite (volcanic rock) that absorbs water, increasing clot formation. older formulas have caused burn injuries from exothermic reaction. Lasts for 3 years.
4) TraumaDEX - starch based powder from plants. supplied in bellows and applied directly to wound, it also absorbs water promoting clot formation.

58
Q

What are the 5 types of bandages?

A
  • Self-Adherent Roller Bandage (most common; Kling or Kerlix)
  • Gauze Bandage
  • Adhesive Bandage
  • Elastic (ACE) Bandage
  • Triangular Bandage
59
Q

What are the 3 basic objectives of dressing and bandaging a wound?

A

1) Control all Hemorrhaging
2) Keep wound as clean as possible
3) Immobilize the wound

60
Q

What are 2 ways to reduce edema and pain in soft tissue injuries?

A

A cold pack wrapped in a dry towel or gentle pressure

do not apply cold pack directly to wounded area

61
Q

What does RICE stand for and for what injuries is it used?

A

Rest
Ice
Compression
Elevate

Used for blunt muscle injuries

62
Q

What is the “position of function” for injuries with joints?

A

A position halfway between extension and flexion

63
Q

What is a common complication with bandaging?

A

Wrapping to tight on an injury that is continuing to swell so as the edema progresses it can turn the bandage into a functioning tourniquet

A good way to prevent this is only tighten to where you can slip a finger under and monitor by making sure you can still slip the finger under, otherwise it may be getting tighter from swelling.

64
Q

How do you treat an amputation?

A

Apply direct pressure and bulky dressing to the wound if possible with next step after failure being a tourniquet.

DO NOT delay transport to look for amputated part

For transport of amputated body part place it in a plastic bag wrapped in moistened gauze and immersed in cool water with just a few ice cubes (NOT JUST A TUB OF ICE)

65
Q

What is the focus of the prehospital care of a crush injury?

A
  • Rapid transport
  • Adequate fluid resuscitation
  • Diuresis
  • Systematic alkalization with sodium bicarbonate via IV to take preventative measures against acidosis from crush syndrome

(also think about applying a tourniquet proximal to injury before removing crushing weight to help prevent the reabsorption of the toxins)

66
Q

At what degree of injury should you automatically assume you are going to want to transport the patient?

A

Any wound affecting anything beneath the skin or a heavily contaminated wound

PC1-2 (23 decks)

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