Download Introduction to Emergency Medical Care

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Chapter 26
Soft Tissue Injuries
Slide 1
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Case History
You are on the scene of a jetliner crash. You
are directed to care for a male whose injuries
include an avulsion of the scalp and
lacerations to the chest. Both are actively
bleeding. There are also partial- and fullthickness burns to his entire back and burns
to the anterior surface of both arms and both
legs.
Slide 2
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Skin — Functions
• Protects body from environment
• Barrier to infection and loss of fluids
• Regulates temperature
• Sensory organ for touch, pain, temperature,
and pressure perception
Slide 3
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Structure of Skin
Slide 4
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Wounds
DCAP-BTLS
•
•
•
•
•
•
•
•
Deformities
Contusions
Abrasions
Punctures
Burns
Tenderness
Lacerations
Swelling
Slide 5
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Wounds
• Closed wounds
 Blunt or compression forces
applied to skin
 Vessels may leak or rupture,
causing swelling.
» Contusions
• Open wounds
 Any wound that results in a
break in the skin
 Abrasions, lacerations,
avulsions, amputations,
punctures, crush injuries
Slide 6
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Severity and Complications –
Soft Tissue Injuries
• Factors affecting severity




Mechanism of injury
Site of injury
Extent of injury
Introduction of foreign
bodies and contaminations
• Common complications
 Bleeding
 Infection
 Damage to underlying
structures
Slide 7
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Wound Management
• Control bleeding.
• Prevent further contamination.
• Immobilize affected part.
• Preserve avulsed or amputated parts.
• Stabilize impaled objects.
Slide 8
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Emergency Medical Care
• Take personal protection measures.
 Gloves
 Hand washing
• Ensure patent airway/artificial ventilation/oxygenation
• Treat for shock (hypoperfusion).
• Splint fractures.
• Transport.
Slide 9
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Emergency Medical Care —
Body Substance Isolation
• Gloves
• Gown
• Eye protection
• Hand washing
Slide 10
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Amputations
• Amputated part may remain viable for
up to 18 hours.
• Rinse off gross contamination.
• Cover part with sterile dressing.
• Place in watertight plastic bag.
• Place bag in another container with
ice.
Slide 11
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Avulsions
• Irrigate gross debris.
• Avulsed part may be
returned to normal
anatomic position.
• Bandage.
Slide 12
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Impalement Injury
• Object may stop blood flow
from a severed vessel.
• Removal of object may
cause active bleeding.
• Stabilize object in place with
bulky dressing unless in
cheek.
• Large objects may be cut to
facilitate transport.
Slide 13
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Neck Wounds
• May lead to air embolism
 Air may be sucked into
large veins during
inspiration.
 Trapped air can obstruct
blood flow.
• Treatment
 Cover with occlusive
airtight dressing.
 Transport in supine or
head-down position.
Slide 14
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Dressings
• Any sterile material
used to cover a wound
• Types of dressings
 Multi-trauma
 4 x 4 gauze
 Occlusive
 Vaseline
 Prepackaged adhesive
Slide 15
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Bandages
• Attaches dressing to
wound
• Provides continued
pressure
• Types
 Self-adherent
 Triangular
 Elastic
 Gauze
 Adhesive tape
Slide 16
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Facial Injuries
• Airway management is first concern.
• Bleeding, foreign bodies, and
vomitus can obstruct airway.
• Swelling and hematomas can cause
airway compromise.
• Airway control
 Manually extract foreign bodies.
 Suction.
 Position patient to permit drainage.
Slide 17
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Facial Injuries –
Impaled Objects
• Object may cause bleeding
and obstruction of airway.
• Object should be removed if
possible.
• Control bleeding using direct
pressure.
• Position patient to allow for
drainage.
• Suction as needed.
Slide 18
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Anatomy of the Eye
Slide 19
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Foreign Bodies in Eye
• Very irritating
• Cause considerable pain
• Location
 Eyeball, lower or upper eyelid
 Foreign body on lid may be felt during
blinking.
• Superficial or deeply embedded
• May require eye surgery
Slide 20
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Corneal Abrasions
• Cornea is particularly
sensitive.
• Scratches are very
painful.
• Feeling may persist
after a foreign body is
removed.
• Patching the eye may
give some pain relief.
Slide 21
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Traumatic Iritis
• Trauma to eye can cause
 Spasm of iris
 Inflammation of the conjunctiva
• Pupil
 May appear fixed in midposition or slightly dilated
 May be unresponsive to light
 May be confused with CNS injury
Slide 22
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Extruded Eyeball
• Extruding from the
socket
• Moistened sterile
dressing
• Cover with a cup
Slide 23
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Anatomy of the Ear
Slide 24
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Injuries to Ear
• Blunt trauma
 Contusions and hematoma
of the auricle
 May damage eardrum with
resulting pain and/or
bleeding
• If blood or fluid is present,
consider possible skull
fracture.
 Apply loose sterile dressing.
Slide 25
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Foreign Bodies in Ear
• If Object is lodged in auditory canal, it should
be removed in emergency department.
• Eardrum is sensitive.
 May be painful, if punctured
 Penetration may cause bleeding.
• Be careful not to obstruct flow from auditory
canal.
Slide 26
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Barotrauma
• Caused by changing environmental
pressures (flying or diving)
• Middle ear maintains equal pressure through
eustachian tubes.
• Changes in pressure before equalization
cause distortion and rupture of eardrum.
Slide 27
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Mechanisms of Barotrauma
Slide 28
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Mechanisms of Barotrauma
Slide 29
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Barotrauma
• Pain and/or hearing loss
• Upper respiratory tract infections may
predispose patients to barotrauma
• No prehospital treatment for barotrauma
of the ear
Slide 30
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Depth or Degree of the Burn
• Superficial
• Partial-thickness
• Full-thickness
Slide 31
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Burns — Classification
• Superficial
 Involves only the epidermis
 Reddened skin and pain at the
site
• Partial-thickness
 The epidermis and dermis
 White to red skin that is moist
and mottled
 Blisters and intense pain
Slide 32
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Burns – Classification
• Full-thickness
 Extend through all dermal
layers
 Skin dry and leathery or
white, dark brown, or
charred
 Little or no pain
 Hard to the touch
Slide 33
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Rule of Nines
• Calculate extent of burns using rule of nines
• Describe depth, extent, and location of burned areas
Slide 34
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Complicating Factors
• Age of the patient
 <5 years of age
 >55 years of age
Slide 35
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Complicating Factors
• Inhalation injuries
 Most common cause of
death in fires
 Physical signs that should
raise suspicion
» Singed nasal hairs
» Carbonaceous sputum
» Burns around nose and
mouth
» Hoarseness
» Respiratory distress
Slide 36
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Burn Severity
• Critical burns requiring transport to a burn center
Slide 37
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Moderate Burns
• Full-thickness burns of
2% to 10% of the body
 Excluding hands, feet,
face, genitalia, and upper
airway
• Partial-thickness burns
of 15% to 30% of BSA
• Superficial burns to
>50% BSA
Slide 38
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Minor Burns
• Full-thickness burns of
<2% of BSA
• Partial-thickness burns of
<15% of BSA
Slide 39
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Emergency Medical Care
• Take personal protection measures.
• Stop the burning process, initially with water or saline.
• Remove smoldering clothing and jewelry.
• Continually monitor the airway for evidence of closure.
• Maintain body temperature.
Slide 40
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Emergency Medical Care Prevent Further Contamination
• Cover the burned area with a
dry, sterile dressing.
• Do not use any type of
ointment, lotion, or
antiseptic.
• Do not break blisters.
• Know local protocols for
transport to appropriate local
facility.
Slide 41
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Infants and Children
• Greater surface area in relationship to body
size
 Results in greater fluid and heat loss
• Full-thickness burn or partial-thickness burn
 Critical burn
» >20% of BSA
» Burn involving the hands, feet, face, airway, or genitalia
Slide 42
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Infants and Children
• Partial-thickness burn of 10% to 20%
 Moderate burn in a child
• Partial-thickness burn <10%
 Minor burn
• Higher risk for
 Shock (hypoperfusion)
 Airway problem
 Hypothermia
• Consider possibility of child abuse
Slide 43
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Chemical Burns –
Emergency Medical Care
• Dry powders should be brushed off before
flushing.
• Immediately begin to flush with large amounts
of water.
 Do not contaminate uninjured areas when
flushing.
• Continue flushing the contaminated area
while en route to receiving facility.
Slide 44
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Electrical Burns
• Scene safety is paramount.
• Do not attempt to remove
patient from the electrical
source, unless trained to do
so.
• If the patient is still in contact
with the electrical source, do
not touch the patient.
Slide 45
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Electrical Burns –
Emergency Medical Care
•
•
•
•
Manage life threats with appropriate spinal precautions.
Splint fractures.
Administer oxygen.
Monitor the patient for respiratory and cardiac arrest.
 Consider need for AED.
• Look for entrance and exit wounds.
• Injuries are often more severe than external indications.
• Treat soft tissue injuries.
Slide 46
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Lightning Injuries
Slide 47
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