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© 2011 National Safety Council 17-1 SOFT-TISSUE INJURIES LESSON 17
© 2011 National Safety Council 17-2 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
© 2011 National Safety Council 17-3 Types of Soft-Tissue Injuries Type and amount of bleeding depend on wound type, location, depth
© 2011 National Safety Council 17-4 Closed Wounds No break in skin Discoloration and swelling from internal bleeding Musculoskeletal injuries may be present
© 2011 National Safety Council 17-5 Abrasions Superficial skin layers scraped off Often painful Underlying tissues not usually injured Capillary bleeding stops itself Foreign material can cause infection
© 2011 National Safety Council 17-6 Lacerations May damage underlying tissue May cause severe bleeding Laceration through artery may be life- threatening
© 2011 National Safety Council 17-7 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
© 2011 National Safety Council 17-8 Avulsions Skin and soft tissue torn partially from body
© 2011 National Safety Council 17-9 Traumatic Amputations Complete cutting or tearing off of all or part of extremity Part may be surgically reattached
© 2011 National Safety Council Burns Damage caused to skin and other tissue by heat, chemicals or electricity
© 2011 National Safety Council General Principles of Wound Care Control serious bleeding after primary assessment With less serious bleeding, complete assessment and standard patient care first
© 2011 National Safety Council Always Perform Standard Assessment Size up scene Complete primary assessment Take history Perform secondary assessment and physical examination as appropriate Complete reassessments
© 2011 National Safety Council 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
© 2011 National Safety Council Additional Care for Soft-Tissue Injuries Use needed BSI precautions Control bleeding Cover wound with sterile gauze Apply direct pressure
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Purpose of Dressings Helps control bleeding Prevents infection Absorbs drainage Protects wound while healing
© 2011 National Safety Council Types of Dressings Sterile gauze pads Roller gauze Non-stick gauze pads Adhesive strips Bulky Occlusive Improvised
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Purpose of Bandages Cover a dressing Keep dressing in place on wound Maintain pressure to control bleeding Support or immobilize musculoskeletal injury
© 2011 National Safety Council Types of Bandages Adhesive compresses Adhesive tape rolls Tubular Elastic roller Self-adhering Gauze roller Triangular Improvised
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Puncture Wounds
© 2011 National Safety Council Puncture Wounds May involve unseen deeper injuries Check for exit wound Carry great risk of infection Internal bleeding may be significant
© 2011 National Safety Council 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
© 2011 National Safety Council Impaled Objects Object often seals wound or damaged blood vessels
© 2011 National Safety Council 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
© 2011 National Safety Council Impaled Object (continued) Dress wound around object Use bulky dressings to stabilize object Support object while bandaging dressings in place Seek medical attention
© 2011 National Safety Council 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
© 2011 National Safety Council Amputation Control bleeding and care for wound first, then recover and care for amputated part
© 2011 National Safety Council 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
© 2011 National Safety Council Animal Bites
© 2011 National Safety Council Seriousness of Animal Bites Bleeding and tissue damage can be severe Increased risk of infection All bites carry rabies risk
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Chest Injuries
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Care for Sucking Chest Wound
© 2011 National Safety Council Closed Chest Injury Organ damage or internal bleeding can be serious Consider possibility of pneumothorax or hemothorax with any trauma to chest
© 2011 National Safety Council Pneumothorax Air escapes from injured lung into thoracic cavity causing collapse of some or all of lung Results in respiratory distress
© 2011 National Safety Council Hemothorax Blood from injury accumulates in thoracic cavity, compressing the lung Causes respiratory distress and possibly shock
© 2011 National Safety Council Signs and Symptoms of Pneumothorax or Hemothorax Little or no external evidence of injury Signs and symptoms of shock Respiratory distress
© 2011 National Safety Council 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
© 2011 National Safety Council Abdominal Injuries
© 2011 National Safety Council Open Abdominal Wound Usually injures internal organs (intestines, liver, kidneys or stomach) Large wound may cause evisceration Abdominal organs protrude through wound Serious emergency
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Genital Injuries
© 2011 National Safety Council Genital Injuries Rare because of protected location Occur from blunt trauma, an impact or sexual abuse Provide privacy
© 2011 National Safety Council Care for Genital Injuries Injured testicles – support with towel between legs Vaginal bleeding – have woman press sanitary pad or clean folded towel to area
© 2011 National Safety Council Head and Face Injuries
© 2011 National Safety Council Head and Face Injuries Consider possible neck or spinal injury Do not move patient’s head while giving emergency care
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Eye Injuries Serious because vision may be affected Avoid putting pressure on eyeball Movement of eye will worsen injury Keep unaffected eye covered
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Care for External Ear Injuries Control bleeding with direct pressure Dress wound
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Teeth and Mouth Injuries Control bleeding with direct pressure on dressing Priorities: Ensure airway is open Ensure blood drains from mouth
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Burns
© 2011 National Safety Council Burns Major cause of death and injury Caused by sun, heat, chemicals, electricity
© 2011 National Safety Council 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
© 2011 National Safety Council Classification of Burns Superficial Partial-thickness Full-thickness
© 2011 National Safety Council 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
© 2011 National Safety Council Partial-Thickness Burns Also called second-degree burns Damage skin’s deeper layer (dermis)
© 2011 National Safety Council Partial-Thickness Burns (continued) Skin is red, mottled, very painful Blisters and weeping clear fluid may be present Often need medical attention
© 2011 National Safety Council Full-Thickness Burns Also called third-degree burns Damage through subcutaneous layer and may include muscle and other tissues
© 2011 National Safety Council 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
© 2011 National Safety Council Assessing Burn Size and Severity Rule of Nines
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Assess Burned Patient’s Age and Health Burns in those 55 are more serious Chronic health disorders make burns more serious
© 2011 National Safety Council 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
© 2011 National Safety Council 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)
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Smoke Inhalation
© 2011 National Safety Council 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
© 2011 National Safety Council Signs and Symptoms of Smoke Inhalation Coughing, wheezing, hoarse voice Possible burned area Blackening on face or chest Difficulty breathing
© 2011 National Safety Council 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
© 2011 National Safety Council Chemical Burns
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council Emergency Care for Chemical Burns (continued) Flush area as soon as possible with copious running water until additional EMS personnel arrive
© 2011 National Safety Council 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
© 2011 National Safety Council Electrical Burns and Shocks
© 2011 National Safety Council Electrical Burns and Shocks Occur when body contacts electricity Typical injuries occur with faulty appliances or power cords or appliance in contact with water
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council 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
© 2011 National Safety Council WOUNDS AND SOFT TISSUE INJURIES LESSON
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