1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bleeding, Shock, and Soft Tissue Wounds

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Dressings and Bandages Bleeding Shock Soft Tissue Injuries Burns

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Dressings An absorbent pad placed over wound –Stops bleeding –Protects wound from further injury –Prevents contamination and infection

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Types of Dressings Universal dressing 4 x 4 gauze Adhesive type bandages Occlusive bandages

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bandages Hold dressings in place Can provide pressure over wound

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Types of Bandages Self-adherent roller bandage Gauze rolls Triangular bandages Adhesive tape

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bleeding Called hemorrhage Can be internal or external Normal response to injured blood vessel is to constrict cut ends and form blood clots If wounds too severe or ability to clot blood decreased, body can’t stop bleeding Significant hemorrhage can lead to shock and death

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Types of Bleeding

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Control of Bleeding Direct pressure Elevation Pressure points Tourniquet

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Direct Pressure First action Usually effective Once applied do not release until bleeding controlled Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Tourniquet Should be placed as close as possible to the point of injury and tightened only until blood loss is reduced to a controllable state with application of dressings Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Internal Bleeding Can be extensive Chest, abdominal and pelvic cavities can hold a significant amount of blood Isn’t visible Maintain high level of suspicion –MOI –Shock

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Internal Bleeding Signs & Symptoms Discolored, tender, swollen or hard tissue Rapid pulse and respirations Pale, cool, sweaty skin Nausea/vomiting Extreme thirst Changes in mental status

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bleeding Management Control of external bleeding Support airway, breathing, and circulation Reassure patient Keep patient warm Keep patient in position of comfort –Supine is fine

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is Shock? A state of hypoperfusion of the body’s tissues Not enough oxygen getting to the cells of the body

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Cells of body don’t receive enough O 2 Often due to blood loss –O 2 carried by RBC –RBC lost with bleeding → not enough O 2 carried to meet body needs Lack of O 2 → Cell damage & death

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Progresses Hypoperfusion Cellular hypoxia Cell death Organ failure Patient death

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Causes of Shock Problem with –Pump –Fluid –Pipes

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Signs and Symptoms Changes in mental status –Restlessness –Anxiety Rapid shallow respirations Pale, cool, moist skin

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Shock Management Control of external bleeding Support airway, breathing, and circulation Reassure patient Keep patient warm Keep patient in position of comfort –Supine is fine

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Soft Tissue Injuries Can be very dramatic Shotgun Blast at close range (exit)

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Abrasions Scraping away of outer skin layer Painful Usually minor Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Lacerations Tear, break or cut in skin Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Soft Tissue Management Expose the wound Control the bleeding Prevent further contamination

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Punctures May have entrance and exit wound Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Punctures Object may remain impaled Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Puncture Management Usually not removed prehospital Stabilized in place with bulky dressings Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Puncture Management Remove object only if –It obstructs the airway –It interferes with chest compressions

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chest Injuries May lead to collapsed lung May allow air to enter and exit chest cavity Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Open Chest Wounds Cover with an occlusive dressing to prevent air from entering chest Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Occlusive Dressings Tape securely on 3 sides Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Eviscerations An open injury through which internal organs are protruding Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Evisceration Management Never attempt to replace organs Cover with sterile, moist dressing Cover with dry dressing to prevent heat loss Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

34. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Amputations Usually involve extremities but can involve ear or nose Small amount to massive bleeding Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

35. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Amputation Management If available, someone should find body part Place part in plastic bag and seal it Place bag into container filled with ice and water Never use ice without water Never use dry ice

36. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Burns Heat (thermal) Chemical Electrical

37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Burn Classification According to depth –Superficial –Partial thickness –Full thickness

38. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Superficial Burns AKA: first-degree burns Involve outermost layer of skin –Redness and swelling –Sunburn Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

39. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Partial-Thickness Burns AKA: second- degree burns Involve outer and middle layers of skin –Causes intense pain –Redness and blisters Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Full Thickness Burns AKA: third-degree burn Involves all layers of skin –No pain in area of full-thickness burn –Pain in surrounding area of lesser burns –Charred or white tissue –Dry and leathery Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Rule of Nines Extent of burns can’t be assessed immediately Rule of Nines gives an estimate 9% 18% 9% 18% 1% 18% 9% 18% 1% 13.5%

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Infants and Children Large surface area for body size At risk for hypothermia and fluid loss Keep environment warm

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Child Abuse and Burns History doesn’t account for injury Clean line of demarcation between burned and non-burned area Particular pattern to burn

44. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Burn Management Stop the burning! –Water or saline –Remove smoldering clothes –If clothing adheres to skin, do not pull it away, cut away as much as possible with scissors

45. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Burn Management Support airway, breathing, and circulation Assess for other injuries Remove patient jewelry Cover burns with dry, sterile dressing

46. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CAUTION! Do not break blisters Do not apply any type of ointment, lotion or antiseptic

47. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chemical Burns Avoid contact with substance Use personal protection Flush exposed area with copious amounts of water –Remove clothing as they may retain chemical Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

48. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chemical Burns Brush away any dry powder before flushing –Water may react with chemical to produce heat → further injury Eye Injuries –Flush eyes continuously until EMS arrives

49. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Electrical Burns Ensure patient is no longer in contact with electricity Consider more than one MOI May be minor damage externally but extensive damage internally Entry Exit

50. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Electrical Burns Usually have entrance and exit wound If decreased LOC, expose patient to check for further injury Immediate life-threatening problems are respiratory and cardiac arrest

51. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Critical Burns Any burns involving respiratory system Partial-thickness burns over > 10% of body Full-thickness burns Burns that involve face, hands, feet, genitalia or major joints Electrical burns Chemical burns

52. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary Soft tissue injuries may appear dramatic, –Be alert to signs of internal bleeding and shock, which may quickly lead to death

53. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions?