Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Copyright © 2004, Mosby Inc. All rights reserved. Chapter 26 Soft Tissue Injuries Slide 1 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Structure of Skin Slide 4 Copyright © 2004, Mosby Inc. All rights reserved. Wounds DCAP-BTLS • • • • • • • • Deformities Contusions Abrasions Punctures Burns Tenderness Lacerations Swelling Slide 5 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Wound Management • Control bleeding. • Prevent further contamination. • Immobilize affected part. • Preserve avulsed or amputated parts. • Stabilize impaled objects. Slide 8 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Emergency Medical Care — Body Substance Isolation • Gloves • Gown • Eye protection • Hand washing Slide 10 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Avulsions • Irrigate gross debris. • Avulsed part may be returned to normal anatomic position. • Bandage. Slide 12 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Dressings • Any sterile material used to cover a wound • Types of dressings Multi-trauma 4 x 4 gauze Occlusive Vaseline Prepackaged adhesive Slide 15 Copyright © 2004, Mosby Inc. All rights reserved. Bandages • Attaches dressing to wound • Provides continued pressure • Types Self-adherent Triangular Elastic Gauze Adhesive tape Slide 16 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Anatomy of the Eye Slide 19 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Extruded Eyeball • Extruding from the socket • Moistened sterile dressing • Cover with a cup Slide 23 Copyright © 2004, Mosby Inc. All rights reserved. Anatomy of the Ear Slide 24 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Mechanisms of Barotrauma Slide 28 Copyright © 2004, Mosby Inc. All rights reserved. Mechanisms of Barotrauma Slide 29 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Depth or Degree of the Burn • Superficial • Partial-thickness • Full-thickness Slide 31 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Rule of Nines • Calculate extent of burns using rule of nines • Describe depth, extent, and location of burned areas Slide 34 Copyright © 2004, Mosby Inc. All rights reserved. Complicating Factors • Age of the patient <5 years of age >55 years of age Slide 35 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Burn Severity • Critical burns requiring transport to a burn center Slide 37 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Minor Burns • Full-thickness burns of <2% of BSA • Partial-thickness burns of <15% of BSA Slide 39 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. 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 Copyright © 2004, Mosby Inc. All rights reserved. Lightning Injuries Slide 47 Copyright © 2004, Mosby Inc. All rights reserved.