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Presentation on theme: "LESSON 17 SOFT-TISSUE INJURIES."— Presentation transcript:


2 Introduction Wounds common with trauma and burns
In open wounds, skin is torn or cut and often bleeding Muscle and soft tissue may be injured Open wounds have risk of infection

3 Types of Soft-Tissue Injuries
Type and amount of bleeding depend on wound type, location, depth

4 Closed Wounds No break in skin
Discoloration and swelling from internal bleeding Musculoskeletal injuries may be present

5 Abrasions Superficial skin layers scraped off Often painful
Underlying tissues not usually injured Capillary bleeding stops itself Foreign material can cause infection

6 Lacerations May damage underlying tissue May cause severe bleeding
Laceration through artery may be life-threatening

7 Punctures, Penetrating Wounds
Caused by object penetrating skin and deeper tissues Little or no external bleeding Severe internal bleeding May be both entrance and exit wounds Likely to trap foreign material Increased infection risk

8 Avulsions Skin and soft tissue torn partially from body

9 Traumatic Amputations
Complete cutting or tearing off of all or part of extremity Part may be surgically reattached

10 Burns Damage caused to skin and other tissue by heat, chemicals or electricity

11 General Principles of Wound Care
Control serious bleeding after primary assessment With less serious bleeding, complete assessment and standard patient care first

12 Always Perform Standard Assessment
Size up scene Complete primary assessment Take history Perform secondary assessment and physical examination as appropriate Complete reassessments

13 Always Perform Standard Patient Care
Ensure EMS has been activated Use body substance isolation Maintain patient’s airway Provide artificial ventilation if needed Comfort, calm and reassure patient

14 Additional Care for Soft-Tissue Injuries
Use needed BSI precautions Control bleeding Cover wound with sterile gauze Apply direct pressure

15 Additional Care for Soft-Tissue Injuries (continued)
With minor wounds: Irrigate with large amounts of running water Irrigate wound to remove foreign matter from wound Pat area dry, apply sterile dressing, bandage Prevent contamination with dressing and bandage If stitches needed or patient’s tetanus vaccination not current, ensure patient receives medical attention

16 Wound Cleaning Alert! Do not use alcohol, hydrogen peroxide or iodine on wound Avoid breathing or blowing on wound Do not attempt to remove clothing stuck to wound; cut around clothing and leave in place Do not scrub wound

17 Purpose of Dressings Helps control bleeding Prevents infection
Absorbs drainage Protects wound while healing

18 Types of Dressings Sterile gauze pads Roller gauze
Non-stick gauze pads Adhesive strips Bulky Occlusive Improvised

19 Improvising Dressings
If sterile dressing not available, use clean cloth Non-fluffy cloth less likely to stick Use clean towel, handkerchief, other material Avoid cotton balls or cotton cloth For bulky dressings, use sanitary pads, towels, baby diapers or many layers of gauze

20 Ring Dressing Don’t put direct pressure over:
Skull fracture Fractured bone protruding from a wound Object impaled in wound Control bleeding with pressure around object or fracture

21 Guidelines for Using Dressings
Wash hands and wear medical examination gloves Choose dressing larger than wound Do not touch part of dressing that will touch wound Lay dressing on wound, cover whole wound

22 Guidelines for Using Dressings (continued)
If blood seeps through, do not remove dressing but add more on top Use direct pressure to control bleeding if needed Apply bandage to hold dressing in place

23 Purpose of Bandages Cover a dressing Keep dressing in place on wound
Maintain pressure to control bleeding Support or immobilize musculoskeletal injury

24 Types of Bandages Adhesive compresses Adhesive tape rolls Tubular
Elastic roller Self-adhering Gauze roller Triangular Improvised

25 Guidelines for Bandaging
Should be clean, not necessarily sterile Apply bandage firmly but don’t cut off circulation Never encircle neck Don’t cover fingers or toes Check fingers or toes for color, warmth, sensation

26 Guidelines for Bandaging (continued)
If reduced circulation, unwrap bandage and reapply Keep checking tightness of bandage Be sure bandage is secure Anchor first end and tie, tape, pin or clip ending section Use elastic roller bandage to make pressure bandage around a limb to control bleeding

27 Guidelines for Bandaging (continued)
Elastic roller bandages support joints and prevent swelling Wrap from bottom of limb upward Bandage joint in position it will be kept Use wide bandage with evenly distributed pressure for extremities

28 Puncture Wounds

29 Puncture Wounds May involve unseen deeper injuries
Check for exit wound Carry great risk of infection Internal bleeding may be significant

30 Care for Puncture Wounds
Follow general principles of wound care Remove small objects and dirt but not large impaled objects Irrigate the wound with large amounts of water With small punctures, gently press wound edges Don’t put medication inside or over puncture wound Dry the area and apply dressing and bandage Seek medical attention if appropriate

31 Impaled Objects Object often seals wound or damaged blood vessels

32 Impaled Object (continued)
Removing object could cause more injury and bleeding Leave it in place and dress wound around it Control bleeding by applying direct pressure at sides of object

33 Impaled Object (continued)
Dress wound around object Use bulky dressings to stabilize object Support object while bandaging dressings in place Seek medical attention

34 Avulsion With skin flap, try to move skin or tissue into normal position (unless contaminated) Control bleeding Provide wound care If avulsed body part completely separated – care for it like an amputation

35 Amputation Control bleeding and care for wound first, then recover and care for amputated part

36 Care for Amputated Part
Wrap severed part in dry sterile dressing or clean cloth; do not wash Place part in plastic bag and seal Place sealed bag in another bag or container with ice and water  part should not touch water or ice directly or be surrounded by ice Do not let part become saturated with water Give part to responding EMS

37 Animal Bites

38 Seriousness of Animal Bites
Bleeding and tissue damage can be severe Increased risk of infection All bites carry rabies risk

39 Care of Animal Bites Follow general principles of wound care
Clean with large amounts of water with or without soap (except when bleeding severely) Control bleeding Dress and bandage

40 Care of Animal Bites (continued)
Ensure patient sees health care provider as soon as possible Do not try to catch animal  but note its appearance Report bite to animal control or law enforcement

41 Chest Injuries

42 Care for Impaled Object in Chest
Follow general principles of wound care Keep patient still, seated or lying down Do not remove object unless it interferes with chest compressions when CPR is needed

43 Care for Impaled Object in Chest (continued)
Manually secure object while exposing wound area and controlling bleeding Stabilize impaled object with bulky dressings Bandage area around object Monitor breathing and vital signs Treat for shock

44 Sucking Chest Wound Open wound in chest caused by penetrating injury
Wound lets air move in and out of chest during breathing Can be life-threatening Use special dressing to allow air to escape through the wound but prevent air from being sucked in

45 Care for Sucking Chest Wound

46 Closed Chest Injury Organ damage or internal bleeding can be serious
Consider possibility of pneumothorax or hemothorax with any trauma to chest

47 Pneumothorax Air escapes from injured lung into thoracic cavity causing collapse of some or all of lung Results in respiratory distress

48 Hemothorax Blood from injury accumulates in thoracic cavity, compressing the lung Causes respiratory distress and possibly shock

49 Signs and Symptoms of Pneumothorax or Hemothorax
Little or no external evidence of injury Signs and symptoms of shock Respiratory distress

50 Care for Chest Injuries
Perform standard patient care Help responsive patient to position of easiest breathing Treat for respiratory distress Follow local protocol for oxygen

51 Abdominal Injuries

52 Open Abdominal Wound Usually injures internal organs (intestines, liver, kidneys or stomach) Large wound may cause evisceration Abdominal organs protrude through wound Serious emergency

53 Care for Open Abdominal Wounds
Follow general principles of wound care Position patient on back Loosen tight clothing Cover wound and organs with thick moist dressing

54 Care for Open Abdominal Wounds (continued)
Cover dressing with large, occlusive dressing Cover area with blanket or towel Monitor vital signs, and treat for shock

55 Genital Injuries

56 Genital Injuries Rare because of protected location
Occur from blunt trauma, an impact or sexual abuse Provide privacy

57 Care for Genital Injuries
Injured testicles – support with towel between legs Vaginal bleeding – have woman press sanitary pad or clean folded towel to area

58 Head and Face Injuries

59 Head and Face Injuries Consider possible neck or spinal injury
Do not move patient’s head while giving emergency care

60 Scalp Wound Before controlling bleeding, confirm no signs of skull fracture: Deformed area of skull A depressed or spongy area in skull Blood or fluid from ears or nose Eyelids swollen shut or bruising Raccoon eyes Battle’s sign Unequal pupils Object impaled in skull

61 Care for Scalp Wound With no signs of skull fracture:
Apply dressing Use direct pressure to control bleeding Follow general principles of wound care Never wrap bandage around neck

62 Scalp Wound Without Suspected Skull Fracture
Replace skin flaps and cover wound with sterile dressing Control bleeding with direct pressure Secure dressing with roller bandage or triangular bandage

63 Neck Injuries Bruising, swelling, difficulty speaking, airway obstruction may result Treat minor wounds like other wounds Significant open wounds are medical emergencies  bleeding can be profuse

64 Care for Neck Injuries Follow general principles of wound care
Control bleeding with direct pressure Place occlusive dressing over wound and tape on all sides Apply pressure on dressing to control bleeding When bleeding is controlled, apply pressure dressing over occlusive dressing Do not obstruct airway or compress other blood vessels in neck

65 Eye Injuries Serious because vision may be affected
Avoid putting pressure on eyeball Movement of eye will worsen injury Keep unaffected eye covered

66 For a Blow to the Eye Follow general principles of wound care
If eye is bleeding or leaking fluid, patient needs emergency medical care immediately Put cold pack over eye with a barrier, but do not put pressure on eye Do not try to remove a contact lens Cover both eyes

67 Care for a Large Object Embedded in the Eye
Follow general principles of wound care Do not remove object Stabilize with dressings or bulky cloth (paper cup for large object) Cover both eyes

68 Dirt or Small Particle In Eye
Do not let patient rub eyes Wait to see if patient’s tears flush out object Gently pull upper eyelid out and down over lower eyelid to catch particle on lashes If particle remains and is visible, try to brush it out If particle still remains or patient has any vision problems or pain, cover both eyes and seek medical care

69 For Chemical or Substance Splashed in Eye
Follow general principles of wound care Have patient lie flat with head tilted to affected side Hold eyelid open with gloved hand Flush eye with running water or saline until additional EMS providers arrive  use specialized solution if available Follow local protocol to consult PCC

70 Ear Injuries Bleeding or cerebrospinal fluid from ear is sign of serious head injury Do not use direct pressure to stop fluid coming out of ear Do not remove any foreign object If insect in ear, gently pour lukewarm water into ear to float it out

71 Care for External Ear Injuries
Control bleeding with direct pressure Dress wound

72 Care for Internal Ear Injuries
Follow general principles of wound care Help patient sit up Tilt affected ear lower than unaffected ear Cover ear with loose sterile dressing Don’t apply pressure or plug ear closed

73 Nose Injuries Nose trauma can cause heavy bleeding
Bleeding from back of nose down throat needs immediate medical attention Allow blood to drain from mouth

74 Care for Nose Injuries Follow general principles of wound care
Patient sits with head slightly forward with mouth open Don’t remove objects from nose Don’t tilt patient’s head backward Pinch nostrils just below bridge of nose for 10 minutes

75 Care for Nose Injuries (continued)
Place cold compress on nose After 10 minutes release pressure slowly If bleeding continues, pinch nostrils for another 10 minutes Put unresponsive patient on side and pinch nostrils Don’t pack nostrils with dressing

76 Cheek Injuries Object impaled in cheek (possible airway obstruction)
Remove it only if airway cannot be controlled Place dressing inside mouth between wound and teeth Place another dressing on outside of wound Apply pressure as needed Position unresponsive patient with head turned to side

77 Teeth and Mouth Injuries
Control bleeding with direct pressure on dressing Priorities: Ensure airway is open Ensure blood drains from mouth

78 Bleeding in Mouth Have patient sit with head tilted forward to let blood drain out Wound penetrating lip: Put rolled dressing between lip and gum Second dressing against outside lip Bleeding tongue: Put dressing on wound and apply pressure Do not repeatedly rinse mouth or let patient swallow blood

79 Tooth Knocked Out Control bleeding with rolled gauze over socket
Save tooth May be reimplanted if patient sees dentist Touch only tooth’s crown Do not clean or scrub tooth Place in container of milk or clean water Get patient and tooth to dentist

80 Burns

81 Burns Major cause of death and injury
Caused by sun, heat, chemicals, electricity

82 Assessing a Heat Burn Perform the standard assessment Consider:
Burn depth Burn size or extent Respiratory involvement Specific body areas burned Patient’s age and health status

83 Classification of Burns
Superficial Partial-thickness Full-thickness

84 Superficial Burns Also called first-degree burns
Damage only outer layer (epidermis) Skin is red, dry, painful Some swelling may occur Usually minor except for extensive area

85 Partial-Thickness Burns
Also called second-degree burns Damage skin’s deeper layer (dermis)

86 Partial-Thickness Burns (continued)
Skin is red, mottled, very painful Blisters and weeping clear fluid may be present Often need medical attention

87 Full-Thickness Burns Also called third-degree burns
Damage through subcutaneous layer and may include muscle and other tissues

88 Full-Thickness Burns (continued)
Skin is charred and blackened or white, yellow, tab Burn feels leathery Pain is not present but likely in adjacent areas Medical emergency

89 Assessing Burn Size and Severity
Rule of Nines

90 Emergency Burns by Size
Burn size influences whether shock and complications develop Emergencies: Any full-thickness burn >50-cent piece Partial-thickness burn >10% of adult body (5% of child or older adult) Superficial burn over >50% of body

91 Assess Burn Location Partial- or full-thickness burns on face, genitals, hands or feet need immediate medical care Circumferential burns should receive immediate medical attention Burns around nose and mouth may affect breathing and are medical emergencies

92 Assess Burned Patient’s Age and Health
Burns in those <5 or >55 are more serious Chronic health disorders make burns more serious

93 Principles of Care for Heat Burns
Cool with cold water except for burn over 20% of body or 10% in child Cool as long patient feels pain Continually add fresh water Protect burned area from additional trauma and pathogens Provide supportive care

94 Emergency Care for Heat Burns
Perform standard patient care Follow general principles of wound care Remove the heat source and smoldering clothing Cool burn with sterile or clean room-temperature water or cold running tap water (except large, full-thickness burns)

95 Emergency Care for Heat Burns (continued)
Remove constricting clothing and jewelry If clothing sticks cut around it Treat for shock Cover burn with non-stick dressing  use sheet over large area Follow local protocol for oxygen Don’t apply cream or ointment Don’t break blisters

96 Emergency Care for Heat Burns (continued)
Don’t give patient anything to drink Monitor breathing and give BLS if needed For large burns in children: Keep environment warm With suspicious pattern of burn marks, consider possibility of child abuse

97 Smoke Inhalation

98 Smoke Inhalation Airway may swell and make breathing difficult
Damage to alveoli may affect ability to receive oxygen Carbon monoxide poisoning may also have occurred

99 Signs and Symptoms of Smoke Inhalation
Coughing, wheezing, hoarse voice Possible burned area Blackening on face or chest Difficulty breathing

100 Care for Smoke Inhalation
Perform standard patient care Get patient to fresh air, or fresh air to patient Follow local protocol for oxygen Help position into easy breathing Put unresponsive patient in recovery position Monitor breathing Be ready to give BLS if needed

101 Chemical Burns

102 Chemical Burns Strong chemicals can burn skin on contact
Sometimes burns develop slowly Acids, alkalis, liquids and solids can cause burns Flush substance off skin with water as soon as possible Check Material Safety data Sheet in work settings

103 Signs and Symptoms of Chemical Burns
Pain or burning sensation Chemical on patient’s skin or clothing Spilled substance on or around unresponsive patient Smell of fumes

104 Emergency Care for Chemical Burns
Perform standard patient care Send someone for the Material Safety Data Sheet Wear gloves and eye protection Move patient or ventilate area With dry chemicals, brush off skin

105 Emergency Care for Chemical Burns (continued)
Flush area as soon as possible with copious running water until additional EMS personnel arrive

106 Emergency Care for Chemical Burns (continued)
Don’t try to neutralize an acid with an alkaline or vice versa Remove clothing and jewelry while flushing With a splash injury, consider possibility of an eye burn With chemical in the eye, flush with running water until additional EMS personnel arrive

107 Electrical Burns and Shocks

108 Electrical Burns and Shocks
Occur when body contacts electricity Typical injuries occur with faulty appliances or power cords or appliance in contact with water

109 Injuries From Electricity
External burns caused by heat of electricity Electrical injuries caused by electricity flowing inside body High-voltage electricity in body can cause heart rhythm irregularities that threaten circulation or cause heart to stop Patient may be in cardiac arrest on your arrival

110 Signs and Symptoms of Electrical Injury
Source of electricity nearby External entrance and exit wounds Unresponsiveness, seizures, changing levels of responsiveness Breathing abnormalities Weak or irregular pulse Can cause unseen severe internal injuries

111 Emergency Care for Electrical Burns
Perform standard patient care Don’t touch patient until area is safe Stop burning and cool area Remove clothing and jewelry Cover burn with a sterile dressing Treat for shock Maintain normal body temperature

112 Emergency Care for Electrical Burns (continued)
Keep unresponsive patient in recovery position Monitor breathing and vital signs Assume patient with lightning strike or high-voltage shock has spinal injury  stabilize head and neck Care for shock and give BLS as needed


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