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
Soft Tissue Injury The Skin External Bleeding • BSI-always!!!! • Severity of blood loss: – Amount – Rate – Other injuries or existing conditions – Existing medical conditions – Patients age Estimated Blood Volume • Normal adult-70 ml/kg • Infants & children-80 ml/kg • A 200 ml blood loss in adult only is a 4% loss, but in an infant would be 25%. Remember –severity of blood loss is a percentage of how much blood is estimated to be lost, but don’t get focused on how much rather than what signs & symptoms your patient is showing. • Need to control bleeding, but do not get tunnel vision. Remember the basics first – Scene Size-up – Primary – Secondary • Airway & Breathing take priority Types of Bleeding Controlling Bleeding • Direct Pressure – Bandages – Fingertip pressure – If foreign object seen, secure in place and place dressing around area. DO NOT remove unless affecting airway • Tourniquets Scene Size-up, Primary Assessment, and Rapid Secondary Assessment • • • • • • • • Standard Precautions Scene safety General impression Control significant bleeding ABCs Apply O2 Rapid secondary assessment Obtain vital signs Factors that increase bleeding • • • • • Movement Low body temperature Medications Intravenous fluids Removal of dressings & bandages PASG pneumatic antishock garment Indications • Suspected pelvic fracture with hypotension <90 mmHg • Suspected intraperitoneal hemorrhage <90 mmHg Contraindications • Penetrating thoracic trauma • Splinting of lower extremity fractures • Eviscerated abdominal organs • Impaled object in abdomen • Pregnancy • Cardiopulmonary arrest • CHF • Pulmonary Edema Once placed, do not remove with medical control authorization • Wound-injury to the skin and underlying tissues • Wounds categories – Closed – Open – Single – multiple Closed Injuries • Hematoma • Contusion • Ecchymosis Open Injuries Abrasions • Caused by scraping, rubbing, or shearing • Considered to be superficial • Very painful • Can be life threatening • Not necessarily to injury but potential for infection, contamination, & potential for other life threatening injuries Lacerations • Break in skin • May be linear or stellate (irregular) • Linear • Knife • Razor • Broken glass • Edges smooth • Stellate • Blunt objects • Edges are jagged Avulsions • Loose flap of skin & underlying tissue that is torn loose or pulled completely off • Bleeding may be severe • Healing prolonged • Extensive scarring Amputations • Disruption of the continuity of an extremity or other body part • Ripping or tearing • Incomplete amputation will bleed more than a complete • Always consider shock Punctures & Penetrations • • • • Result of sharp, pointy object May be little, but underlying damage may be worst Stab wounds • May be small & undetectable • Remember underlying internal damage Gunshot wounds • Entrance and exit sites • Entrance will be smaller • Exit larger and will be bleed profusely • Assess for more than one wound and remember underlying internal damage Crush Injuries • Caused by blunt trauma or crushing forces • May not appear serious • May be swollen, painful, & deformity • External bleeding minimal or even absent • Always suspect internal bleeding • Walking wounded Bites • Dog bites most common • Complications • Infection • Cellulitis • Septicemia • Rabies • Tetanus • Combination of crush and penetration injury Clamping injury • Body part that is caught in machinery • Time is key Assessment • Scene size up & primary assessment • Secondary assessment • Emergency medical care • Reassessment Special Considerations – – – – – Chest injuries Abdominal injuries Impaled objects Amputations Large open injuries Dressings & Bandages • Dressings – – – – Gauze pad Self adhering dressing Universal or multitrauma dressing Occlusive dressing • Bandages – – – – Self adhering Gauze rolls Triangular bandage Air splint • Pressure dressings General principles of dressing & bandages • No hard or fast rules • Must adapt to what is available • Conditions – – – – – – – Clean Do not tape in place until bleeding controlled Must cover wound Attempt to remove all jewelry Do not leave too loose Do not wrap too tightly If covering small wound on extremity, wrap larger area – Once positioned, leave where it is – Tourniquet if unable to control bleeding