soft-tissue injuries - shenandoah county · 2011-10-13 · chapter 27 soft-tissue injuries limmer...

CHAPTER 27

Soft-Tissue Injuries

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Injuries

Soft Tissue Soft Tissue Anatomy & Anatomy & PhysiologyPhysiology

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Open andOpen andClosed WoundsClosed Wounds

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Closed WoundsClosed Wounds

Closed Wound

Key Term

Internal injury with no open pathway

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Internal injury with no open pathway

from the outside to the injured site

Types of Closed Wounds

Contusion

Hematoma

Crush Injury

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Crush Injury

Closed Wound Closed Wound –– ContusionContusion

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Emergency Care ofClosed Wounds

Take appropriate BSI precautions.

Manage airway; apply oxygen.

If shock is suspected, treat it.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

If shock is suspected, treat it.

Splint painful, swollen, or deformed

extremities.

Transport.

Open Wound

Key Term

An injury in which the skin is

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

An injury in which the skin is

interrupted, or broken, exposing

the tissue underneath

Types of Open Wounds

Abrasions & Lacerations

Avulsions

Punctures

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Amputation

Crush

Open Wounds Open Wounds –– Abrasions & LacerationsAbrasions & Lacerations

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Open Wound Open Wound –– LacerationLaceration(Smooth Edges)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Open Wound Open Wound ––Laceration Laceration (Jagged Edges)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Open Wound Open Wound –– AvulsionAvulsion

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Open Wound Open Wound –– PuncturePuncture

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Entrance and Exit WoundsEntrance and Exit Wounds

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Open Wound Open Wound –– AmputationAmputation

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Crush injuries may cause both open and Crush injuries may cause both open and closed wounds.closed wounds.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Emergency Care ofOpen Wounds

Take BSI precautions.

Manage airway; apply oxygen.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Expose the wound.

Control bleeding.

Continued…

Emergency Care ofOpen Wounds

Bandage & prevent contamination.

Keep patient calm, quiet.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Treat for shock; transport;

reevaluate.

Specific Injuries

Amputations

Neck Wounds

Impaled Objects

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Chest Wounds

Abdominal Wounds

Amputations

Monitor airway; administer oxygen.

Control bleeding.

Do not complete partial

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Do not complete partial

amputations.

Treat for shock.

Continued…

Amputations

Wrap the amputated part in sterile

dressing.

Wrap part in plastic. Keep cool.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Transport with patient if possible.

Open Neck Wound

May cause air embolism.

Cover with occlusive dressing.

Do not compress both carotids at

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Do not compress both carotids at

same time.

Cover wound with gloved hand.Cover wound with gloved hand.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Place occlusive dressing over wound.Place occlusive dressing over wound.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Place dressing over occlusive dressing.Place dressing over occlusive dressing.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Bandage. Do not compress both carotids Bandage. Do not compress both carotids or restrict breathing.or restrict breathing.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Impaled Object

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Impaled Object

Do not remove object unless:

Through the cheek

Interferes with chest compression

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Interferes with chest compression

Interferes with transport (relative)

Emergency Care of an Impaled Object

Manually stabilize object.

Expose area.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Control bleeding.

Stabilize with bulky dressing.

Bandage.

Impaled Object Impaled Object –– CheekCheek

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Impaled Object in the EyeImpaled Object in the Eye

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Signs of Chest Wounds

Wound or trauma to the chest.

Sucking sound.

Patient may be short of breath or

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Patient may be short of breath or

gasping for air.

Chest wounds may cause damage to lungs.Chest wounds may cause damage to lungs.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Lung Lung

Chest Wall

Emergency Care of Chest Wounds

Manage airway.

Expose area.

If open wound, apply occlusive

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

If open wound, apply occlusive

dressing.

Administer oxygen.

Place in position of comfort (if no

spine injury suspected).

Occlusive DressingOcclusive Dressing

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Flutter Valve Flutter Valve –– InspirationInspiration

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Flutter Valve Flutter Valve –– ExhalationExhalation

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Manual StabilizationManual Stabilization

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Use bulky dressings and bandage toUse bulky dressings and bandage tostabilize.stabilize.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Closed Abdominal Wounds

Monitor airway; administer oxygen.

Be alert for vomiting.

Flexing patient’s knees may reduce

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Flexing patient’s knees may reduce

pain.

Treat for shock.

Transport.

Monitor airway; administer oxygen.

Do not touch or try to replace

exposed organs.

Abdominal Evisceration(Open Abdominal Wounds)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

exposed organs.

Cover exposed organs & wound

with dressing moistened with sterile

saline.Continued…

Treat for shock; maintain warmth.

Transport.

Abdominal Evisceration(Open Abdominal Wounds)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Transport.

Abdominal EviscerationAbdominal Evisceration

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Expose the wound.Expose the wound.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cover with sterile dressing.Cover with sterile dressing.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

BurnsBurns

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

BurnsBurns

Source

Depth

Conditions That May Affect Burn Severity

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Extent and regions burned

Age of patient

Preexisting medical conditions

Sources of Burns

Thermal

Chemical

Electrical

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Electrical

Light

Radiation

Layers of the SkinLayers of the Skin

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Reddened skin

Pain at burn site

Superficial Burn(1st Degree Burn)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Involves only epidermis

Partial-Thickness Burn(2nd Degree Burn)

Intense pain

White to red skin

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Blisters

Involves epidermis and dermis

Full-Thickness Burn(3rd Degree Burn)

Dry, leathery skin (white, dark

brown, or charred)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Loss of sensation (little pain)

All dermal layers may be involved

Classifying Classifying BurnsBurnsby Depthby Depth

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Classifying Burns by DepthClassifying Burns by Depth

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Full-Thickness

Partial-Thickness

Superficial

Body Surface Area

A burn equivalent to the size of the patient’s hand is equal to 1% body

surface area (BSA).

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Rule of Nines Rule of Nines ––AdultAdult

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Rule of NinesRule of Nines––Child and InfantChild and Infant

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Burns with respiratory injury

Full-thickness burns > 10% BSA

Determining Burn Severity:Critical BurnsCritical Burns

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Partial-thickness burns > 30% BSA

Burns with painful, swollen, or

deformed extremity

Moderate burns in young or elderly

Burns to face, hands, or feet

Determining Burn Severity:Critical BurnsCritical Burns

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Burns to genitalia

Burns encircling any body part (arm,

chest, etc.)

Determining Burn Severity:Moderate BurnsModerate Burns

Full-thickness burns 2-10% BSA

Superficial burns > 50% BSA

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Superficial burns > 50% BSA

Determining Burn Severity:Minor BurnsMinor Burns

Full-thickness burns < 2% BSA

Partial-thickness burns < 15% BSA

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Greater surface area relative to

total size

Greater fluid and heat loss

Burns in Infants and Children

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Higher risk for shock

May be a result of abuse

Infants and Children

Burn Severity

Critical Any full-thickness burns

Partial thickness >20% BSA or involving hands, feet, face,

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

involving hands, feet, face, genitalia

Moderate Partial-thickness, 10-20% BSA

Minor Partial-thickness, <10% BSA

Emergency Care of Burns

Body substance isolation,

protective gear.

Stop the burning process with

water or saline.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

water or saline.

Remove smoldering clothing and

jewelry.

Prevent further contamination.

Continued…

Emergency Care of Burns

Monitor the airway for closure.

Cover burn area with dry, sterile

dressing.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Do not use ointments/lotions.

Do not break blisters.

Transport following local protocols.

Chemical Burns

Protect yourself from exposure.

Wear appropriate protective gear.

Activate Hazmat team if necessary.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Activate Hazmat team if necessary.

Emergency Care ofChemical Burns

Brush dry powders off the skin

before flushing.

Flush with large amounts of water.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Flush with large amounts of water.

Do not contaminate uninjured

areas while flushing.

Continue flushing during transport.

Electrical Burns

Do not touch a patient who is in

contact with an electrical source.

Contact trained personnel for rescue.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Emergency Care ofElectrical Burns

Administer oxygen.

Watch for cardiac or respiratory

arrest.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

arrest.

Internal injuries often more severe

than external ones.

Treat soft-tissue injuries.

Electrical burns may have entry and exit Electrical burns may have entry and exit wounds.wounds.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Dressings andDressings andBandagesBandages

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

BandagesBandages

Purpose

Stop the bleeding

Protect wound from further damage

Prevent contamination and

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

infection

Dressings

Sterile, directly cover wound

Gauze pads

Universal (trauma dressing)

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Occlusive

Bandages

Hold dressings in place

Roller gauze

Triangular bandage

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Triangular bandage

Tape, air splints

Dressings and BandagesDressings and Bandages

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Dressing/Bandage: ForeheadDressing/Bandage: Forehead

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Dressing/Bandage: ElbowDressing/Bandage: Elbow

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Dressing/Bandage: HandDressing/Bandage: Hand

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Dressing/Bandage: ShoulderDressing/Bandage: Shoulder

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Bandaging & DressingTechnique

Use BSI precautions.

Expose area.

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Cover wound; control bleeding.

Bandage securely.

Reevaluate.

1. Distinguish between open and

closed wounds

2. Describe the emergency care for:

Review Questions

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

2. Describe the emergency care for:

Open chest wound

Impaled object

Amputation

3. List and differentiate between the

3 depths of burns.

4. Describe the emergency care for

Review Questions

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

4. Describe the emergency care for

chemical, electrical burns.

5. What is the difference between a

dressing and a bandage?

What is your general impression

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

of the patient?

What priority would you assign to

her?

What interventions are appropriate at

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

What interventions are appropriate at

this time?

Would you change the priority of

transport of this patient based on what

you now know? Why or why not?

What interventions are appropriate

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

What interventions are appropriate

for this patient?

Sample Documentation

Limmer et al., Emergency Care Update, 10th Edition

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ