National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 18 Soft-Tissue Injuries

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 18.1 List four functions of the skin List the layers of the skin List and describe three types of closed soft-tissue injuries List and describe nine types of open soft-tissue injuries. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 18.5 Describe the emergency care for the following injuries: a.closed soft-tissue injury b.amputation c.open soft-tissue injury d.impaled object 18.6 Describe and demonstrate three methods for controlling external bleeding. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 18.7 Compare and contrast a dressing and a bandage Demonstrate the proper procedure for applying each of the following: a.dressing b.compression dressing c.bandage d.tourniquet

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology of Skin Physiology of Bleeding and Clotting Types of Soft-Tissue Injuries Assessment Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation During a bike race, a rider loses control and falls on a gravel road. His left arm and leg are covered in blood, with a significant laceration in his left bicep. He is wearing a helmet, is responsive and alert, and has no neck or back pain. He is in obvious pain from the laceration and from multiple abrasions on his arms and legs.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology of the Skin Largest organ of the body Multi purpose Two layers ◦ Epidermis ◦ Dermis

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology of the Skin

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Physiology of Bleeding and Clotting Bleeding is a leak in a blood vessel ◦ Artery ◦ Vein ◦ Capillary Clotting /coagulation naturally close wounds so skin repair can begin ◦ Multiple body systems are involved ◦ Medications may alter the normal clotting process

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Physiology of Bleeding and Clotting

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Soft-Tissue Injuries Closed Injury: Skin remains intact ◦ Contusion ◦ Hematoma ◦ Crush injuries ◦ Compartment syndrome continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Soft-Tissue Injuries continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Soft-Tissue Injuries Open Injury: Skin is disrupted ◦ Abrasion ◦ Incision ◦ Laceration ◦ Avulsion ◦ Amputation ◦ Puncture ◦ Open crush injury ◦ High pressure injection ◦ Mechanical tattooing continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Soft-Tissue Injuries continued Copyright E. M. Singletary, MD

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Types of Soft-Tissue Injuries Burns Injury: Exposure to excessive energy ◦ Thermal ◦ Friction ◦ Chemicals ◦ Electricity ◦ Nuclear radiation continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update What actions does the patroller take? What injuries are found? Are there any complications?

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Use PPE / Standard Precautions Standard assessment procedures – ABCDs, SAMPLE, and vitals Be aware of other potential injuries Check for shock Check CMS Document findings

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Direct Pressure Pressure Bandage Hemostatic Bandage Tourniquet

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries Contusions (closed injuries) ◦ Cold therapy ◦ R. I. C. E. S Open Injuries ◦ Control bleeding ◦ Provide wound care ◦ Cover wound with a dressing ◦ Bandage ◦ Splint extremity wounds continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries Complex Injuries: ◦ Avulsion Clean, replace flap, bandage ◦ Amputation Preserve part, keep moist and cool, send with patient Splint injured area continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries Complex Injuries: ◦ Impaled object Stabilize in place; rarely needs to be removed Airway obstructions may need to be removed continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Treating for Specific Injuries continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Dressing and Bandaging Multiple materials may be used as dressings: ◦ Sterile ◦ Non-sterile ◦ Pressure ◦ Occlusive ◦ Stabilizing ◦ Hemostatic

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Dressings and Bandages Different locations/injuries need different types of bandages: ◦ Joints ◦ Conical regions ◦ Head ◦ Hands and fingers Check CMS before and after bandaging

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition How were the patient’s wounds treated? Were any other forms of treatment given? What transportation decision was made?

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The skin is the largest organ in the body, and it serves three purposes: it provides a protective barrier, it functions in the control of body temperature, and it acts as a sensory organ. The three types of soft-tissue injuries are closed injuries, open injuries, and burns. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary External bleeding is controlled using direct pressure, a pressure dressing, or rarely a tourniquet. When applying a dressing to control bleeding, do not remove it because doing so can disrupt clots and cause more bleeding. Instead, add additional dressings. Hemostatic bandages contain a substance that helps stop external bleeding. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Do not use elastic bandages to secure dressings. Splinting a soft-tissue injury helps decrease bleeding and reduces pain. Applying an effective field dressing and bandage is an important skill for OEC Technicians.