Chapter 26 Soft-Tissue Injuries Chapter 26: Soft-Tissue Injuries.

Chapter 26 Soft-Tissue Injuries Chapter 26: Soft-Tissue Injuries

National EMS Education Standard Competencies (1 of 4)
Trauma Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient. National EMS Education Standard Competencies Trauma Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient.

Soft Tissue Trauma Recognition and management of Wounds Burns Electrical Chemical Thermal Chemicals in the eye and on the skin National EMS Education Standard Competencies Soft-Tissue Trauma Recognition and management of • Wounds • Burns • Electrical • Chemical • Thermal • Chemicals in the eye and on the skin

Pathophysiology, assessment, and management Wounds Avulsions Bite wounds Lacerations Puncture wounds Incisions National EMS Education Standard Competencies Pathophysiology, assessment, and management of • Wounds • Avulsions • Bite wounds • Lacerations • Puncture wounds • Incisions

Pathophysiology, assessment, and management (cont’d) Burns Electrical Chemical Thermal Radiation Crush syndrome National EMS Education Standard Competencies • Burns • Electrical • Chemical • Thermal • Radiation • Crush syndrome

Introduction (1 of 3) Soft-tissue injuries are common.
Simple as a cut or scrape Serious as a life-threatening internal injury Do not become distracted by dramatic open wounds. Do not neglect airway obstruction. Lecture Outline I. Introduction A. Soft-tissue injuries are common. 1. They can be as simple as a cut or scrape. 2. They can be as serious as a life-threatening internal injury. 3. Do not become distracted by dramatic open wounds. a. Do not make the critical mistake of neglecting other life-threatening conditions such as airway obstruction.

Introduction (2 of 3) Soft tissues of the body can be injured through a variety of mechanisms: Blunt injury Penetrating injury Barotrauma Burns Lecture Outline B. The soft tissues of the body can be injured through a variety of mechanisms. 1. A blunt injury occurs when the energy exchange between the patient and an object is more than the tissues can tolerate. 2. A penetrating injury occurs when an object breaks through the skin and enters the body. 3. Barotrauma, commonly seen in blast injury victims, refers to injuries that result from sudden or extreme changes in air pressure. 4. Burns may also result in soft-tissue injuries.

Introduction (3 of 3) Soft-tissue trauma is a common form of injury.
Death is often related to hemorrhage or infection. Soft-tissue injuries can often be prevented by simple protective actions. Lecture Outline C. Soft-tissue trauma is a common form of injury. 1. Open wounds accounted for approximately 4.1 million emergency department (ED) visits in 2011. 2. Wound care is one of the most frequently performed procedures in EDs across the United States. 3. Most of these injuries require basic interventions: a. Wound irrigation b. Dressing c. Bandaging d. Limited suturing D. Death is often related to hemorrhage or infection. 1. Uncontrolled hemorrhage can lead to shock and death. 2. When the skin barrier is breached, invading pathogens can cause local or systemic infection. 3. Infection can be life or limb threatening, especially in children, older adults, and people with diabetes or other conditions that may compromise the immune system. E. Soft-tissue injuries and their complications can often be prevented by using simple protective actions. 1. Effective strategies to reduce injury and death from burns: a. Smoke alarms b. Controlling the temperature of hot water heaters c. Enforcing building codes that regulate electrical and construction practices

The Anatomy and Physiology of the Skin (1 of 10)
The skin is the body’s first line of defense against: External forces Infection The skin is relatively tough, but still susceptible to injury. Range from simple bruises and abrasions to serious lacerations and amputations Lecture Outline II. The Anatomy and Physiology of the Skin A. The skin is the body’s first line of defense against external forces and infection. 1. It is the largest organ in the body. 2. It is relatively tough, but still susceptible to injury. a. Injuries range from simple bruises and abrasions to serious lacerations and amputations. b. Injuries may expose blood vessels, nerves, and bones.

In all instances, the EMT must: Control bleeding. Prevent further contamination to decrease the risk of infection. Protect wounds from further damage. Apply dressings and bandages to various parts of the patient’s body. Lecture Outline B. In all instances, the EMT must: 1. Control bleeding 2. Prevent further contamination to decrease the risk of infection 3. Protect wounds from further damage 4. Apply dressings and bandages to various parts of the patient’s body

Skin varies in thickness. Thinner in the very young and very old Thinner on the eyelids, lips, and ears than on the scalp, back, soles of feet Thin skin is more easily damaged than thick skin. Lecture Outline C. Skin varies in thickness, depending on the person’s age and the skin’s location. 1. Skin is thinner in the very young and the very old. 2. Skin is thinner on the eyelids, lips, and ears than on the scalp, back, and soles of the feet. 3. Thin skin is more easily damaged than thick skin.

The skin has two principal layers: the epidermis and the dermis. Epidermis: tough, external layer Dermis: inner layer Lecture Outline D. Anatomy 1. The skin has two principal layers: the epidermis and the dermis. a. The epidermis is the tough, external layer that forms a watertight covering for the body. i. The epidermis is composed of several layers. b. The dermis is the inner layer of the skin. i. It contains hair follicles, sweat glands, and sebaceous glands. ii. Blood vessels in the dermis provide the skin with nutrients and oxygen.

The illustration on this slide shows the structure of the skin. © Jones & Bartlett Learning.

Skin covers all the external surfaces of the body. Bodily openings are lined with mucous membranes. Provide a barrier against bacterial invasion Secrete a watery substance that lubricates the openings Lecture Outline 2. Skin covers all the external surfaces of the body. a. The various openings in the body are lined with mucous membranes. i. Mucous membranes provide a protective barrier against bacterial invasion. ii. They secrete a watery substance that lubricates the openings. iii. They are moist, whereas skin is generally dry.

Skin serves many functions. Keeps pathogens out Keeps fluids in Helps body regulate temperature Nerves in the skin report to the brain on the environment and sensations. Lecture Outline E. Physiology 1. Skin serves many functions. a. Keeps pathogens out b. Keeps fluids in c. Helps to regulate body temperature d. The nerves in the skin report to the brain on the environment and many sensations. e. This nerve pathway connection allows the body to adapt to the environment through responses in the skin and surrounding tissues.

Any break in the skin may allow bacteria to enter and increases the possibilities of: Infection Fluid loss Loss of temperature control Lecture Outline 2. Any break in the skin may allow bacteria to enter and increases the possibility of infection, fluid loss, and loss of temperature control. a. Any one of these conditions can cause serious illness and even death.

Three types of soft-tissue injuries: Closed injuries Damage is beneath skin or mucous membrane. Surface is intact. Open injuries Break in surface of skin or mucous membrane Exposes deeper tissues to contamination Lecture Outline 3. Three types of soft-tissue injuries: a. Closed injuries i. Damage occurs beneath the skin or mucous membrane. ii. The surface of the skin or mucous membrane remains intact. b. Open injuries i. There is a break in the surface of the skin or mucous membrane. ii. Exposes deeper tissues to contamination

Three types of soft-tissue injuries (cont’d): Burns Damage results from thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation Lecture Outline c. Burns i. Damage results from: (a) Thermal heat (b) Frictional heat (c) Toxic chemicals (d) Electricity (e) Nuclear radiation

Pathophysiology of Closed and Open Injuries (1 of 2)
Cessation of bleeding is the primary concern. The next wound healing stage is inflammation. A new layer of cells is then moved into the damaged area. Lecture Outline III. Pathophysiology of Closed and Open Injuries A. Pathophysiology 1. Healing of wounds is a natural process that involves several overlapping stages, all directed toward the larger goal of maintaining homeostasis (balance). 2. Cessation of bleeding is the primary concern. a. Loss of blood hinders the provision of vital nutrients and oxygen to the affected area. b. It also impairs the tissue’s ability to eliminate wastes. c. The end result is abnormal or absent function, which interferes with homeostasis. 3. The next wound healing stage is inflammation. a. Additional cells move into the damaged area to begin repair. b. White blood cells migrate to the area to combat pathogens that have invaded the exposed tissue. c. Lymphocytes destroy bacteria and other pathogens. d. Mast cells release histamine. e. Inflammation ultimately leads to removal of: i. Foreign material ii. Damaged cellular parts iii. Invading microorganisms 4. To replace the area damaged in a soft-tissue injury, a new layer of cells must be moved into this region. a. Cells quickly multiply and redevelop across the edges of the wound. b. Except in cases of clean incisions, the appearance of the restructured area seldom returns to the preinjury state. c. Despite the changed appearance, the function of the area may be restored to near normal.

Pathophysiology of Closed and Open Injuries (2 of 2)
Pathophysiology (cont’d) New blood vessels form. Collagen provides stability to the damaged tissue and joins wound borders. Lecture Outline 5. New blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue. a. New capillaries bud from intact capillaries that lie adjacent to the damaged skin. b. These vessels provide a channel for oxygen and nutrients and serve as a pathway for waste removal. 6. In the last stage of wound healing, collagen provides stability to the damaged tissue and joins wound borders, thereby closing the open tissue. a. Collagen is a tough, fibrous protein found in scar tissue, hair, bones, and connective tissue. b. Collagen cannot restore the damaged tissue to its original strength.

Closed Injuries (1 of 4) Characteristics of closed injuries:
History of blunt trauma Pain at the site of injury Swelling beneath the skin Discoloration Lecture Outline B. Closed injuries 1. Closed soft-tissue injuries are characterized by: a. History of blunt trauma b. Pain at the site of injury c. Swelling beneath the skin d. Discoloration

Closed Injuries (2 of 4) A contusion (bruise) causes bleeding beneath the skin but does not break the skin. Caused by blunt forces Buildup of blood produces blue or black ecchymosis. A hematoma is blood collected within damaged tissue or in a body cavity. Lecture Outline 2. A contusion (bruise) is an injury that causes bleeding beneath the skin but does not break the skin. a. Contusions result from blunt forces striking the body. b. The epidermis remains intact, but cells within the dermis are damaged, and small blood vessels are usually torn. c. The buildup of blood produces a characteristic blue or black discoloration called ecchymosis. 3. A hematoma is blood that is collected within damaged tissue or in a body cavity. a. It occurs whenever a large blood vessel is damaged and bleeds rapidly. b. It is usually associated with extensive tissue damage.

Closed Injuries (3 of 4) A crushing injury occurs when a significant amount of force is applied to the body. Extent of damage depends on: Amount of force Length of time force is applied When an area of the body is trapped for longer than 4 hours, crush syndrome can develop. Lecture Outline 4. A crushing injury occurs when significant force is applied to the body. a. The extent of the damage depends on: i. How much force is applied ii. The amount of time that the force is applied b. Continued compression of the soft tissues will cut off circulation, producing further tissue destruction. 5. When an area of the body is trapped for longer than 4 hours and arterial blood flow is compromised, crush syndrome can develop. 6. When a patient’s tissues are crushed beyond repair, muscle cells die and release harmful substances into the surrounding tissues. a. Harmful substances are released into the body’s circulation after the limb is freed and blood flow is returned. b. Advanced life support (ALS) providers should administer IV fluid before the crushing object is lifted off the body. c. Freeing the body part from entrapment also creates the potential for cardiac arrest and renal failure. d. Consider requesting ALS assistance for situations of prolonged entrapment prior to extrication.

Closed Injuries (4 of 4) Compartment syndrome results from the swelling that occurs whenever tissues are injured. Severe closed injuries can also damage internal organs. Assess all patients with closed injuries for more serious hidden injuries. Lecture Outline 7. Compartment syndrome develops when edema and swelling result in increased pressure within a closed soft-tissue compartment. a. Pressure increases within the compartment, which interferes with circulation. b. Delivery of nutrients and oxygen is impaired and by-products of normal metabolism accumulate. c. There is pain, especially on passive movement. d. The longer this situation persists, the greater the chance for tissue death. e. EMTs must continually reassess skin color, temperature, and pulses distal to the injury site if crush injury is suspected. 8. Severe closed injuries can damage internal organs. a. The greater the amount of energy absorbed from the blunt force, the greater the risk of injury to deeper structures. b. You must assess all patients with closed injuries for more serious hidden injuries.

Open Injuries (1 of 7) In an open injury the protective layer of the skin is damaged. The wound is contaminated and may become infected. Four types: Abrasions Lacerations Avulsions Penetrating wounds Lecture Outline C. Open injuries 1. Open injuries differ from closed injuries in that the protective layer of the skin is damaged. a. Can produce extensive bleeding 2. A break in the protective skin layer or mucous membrane means that the wound is contaminated and may become infected. a. Contamination: the presence of infectious organisms or foreign bodies, such as dirt, gravel, or metal, in the wound b. Address both excessive bleeding and contamination in your treatment of open soft-tissue wounds. c. Four types of open soft-tissue wounds: i. Abrasions ii. Lacerations iii. Avulsions iv. Penetrating wounds

Open Injuries (2 of 7) An abrasion is a wound of the superficial layer of the skin. Caused by friction when a body part rubs or scrapes across a rough or hard surface Lecture Outline 3. An abrasion is a wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface. a. An abrasion usually does not penetrate completely through the dermis, but blood may ooze from the injured capillaries in the dermis. i. Examples: road rash, road burn, strawberry, rug burn b. Abrasions can be extremely painful because the nerve endings are located in this area. © American Academy of Orthopaedic Surgeons. © Jones & Bartlett Learning.

Open Injuries (3 of 7) A laceration is a jagged cut.
Caused by a sharp object or blunt force that tears the tissue An incision is a sharp, smooth cut. Lecture Outline 4. A laceration is a jagged cut caused by a sharp object or a blunt force that tears the tissue. a. An incision is a sharp, smooth cut. b. The depth of the injury can vary. c. Lacerations and incisions may appear linear (regular) or stellate (irregular). d. Lacerations or incisions that involve arteries or large veins may result in severe bleeding. © English/Custom Medical Stock Photo © Jones & Bartlett Learning.

Open Injuries (4 of 7) An avulsion separates various layers of soft tissue so that they become either completely detached or hang as a flap. Often there is significant bleeding. Lecture Outline 5. An avulsion separates various layers of soft tissue (usually between the subcutaneous layer and fascia) so that they become either completely detached or hang as a flap. a. Often there is significant bleeding. b. Never remove an avulsion skin flap, regardless of its size. © Jones & Bartlett Learning. © Jones & Bartlett Learning.

Open Injuries (5 of 7) An amputation is an injury in which part of the body is completely severed. A penetrating wound is an injury resulting from a piercing object. Can damage structures deep within the body Lecture Outline c. An amputation is an injury in which part of the body is completely severed. i. You can easily control the bleeding from some amputations, such as the fingers, with direct pressure and pressure dressings. ii. If there is massive bleeding, you should stop the bleeding, which often requires a tourniquet, and treat the patient for hypovolemic shock. 6. A penetrating wound is an injury resulting from a piercing object, such as a knife, ice pick, splinter, or bullet. a. These objects can damage structures deep within the body and cause unseen bleeding. b. If the wound is to the chest or abdomen, the injury can cause rapid, fatal bleeding. 7. Impaled objects are objects that penetrate the skin but remain in place. a. Concerns with this type of injury: i. Damage to structures deep inside the body ii. Presence of foreign materials inside the tissue that can lead to infection

Open Injuries (6 of 7) Stabbings and shootings often result in multiple penetrating injuries. Assess the patient carefully to identify all wounds. Count the number of penetrating injuries. Determine the type of gun when possible, but do not delay transport. You may have to testify in court. Lecture Outline 8. Stabbings and shootings often result in multiple penetrating injuries. a. Assess the patient carefully to identify all wounds. b. Count the number of penetrating injuries, especially with gunshot wounds. i. Leave the distinction between entrance and exit to the physician. c. In a shooting, determine the type of gun when possible, but do not let this delay patient transport. d. Sometimes patients or bystanders can tell you how many rounds were fired, but given the stress of the environment, their information may be unreliable. e. You may have to testify in court. i. Carefully document the circumstances surrounding the gunshot injury, the patient’s condition, and the treatment you give.

Open Injuries (7 of 7) Blast injuries
Primary blast injury: damage caused by the blast wave and sudden pressure changes Secondary blast injury: damage results from flying debris Tertiary blast injury: victim is thrown by explosion, perhaps into an object Lecture Outline 9. Blast injuries often result in multiple penetrating injuries. 10. The mechanism of injury from a blast injury is generally due to three factors: a. Primary blast injury: Damage is caused by the blast wave itself and the sudden pressure changes of the explosion. b. Secondary blast injury: Damage results from flying debris that causes multiple penetrating wounds. c. Tertiary blast injury: The victim is thrown by the explosion, perhaps into an object.

Patient Assessment of Closed and Open Injuries
More difficult to assess a closed injury than an open injury You can see an open injury. Consider the possibility of a closed injury when you observe: Bruising Swelling Deformity The patient reporting pain Lecture Outline IV. Patient Assessment of Closed and Open Injuries A. It is more difficult to assess a closed injury than to assess an open injury. 1. Anytime you observe bruising, swelling, or deformity, or if the patient is reporting pain, the possibility of a closed injury should be considered. 2. An open injury is easier to assess because you can see the injury.

Scene Size-up (1 of 2) Scene safety
Observe the scene for hazards to your crew, bystanders, and the patient. Consider the need for additional resources. Take the necessary standard precautions. Be careful where you put you hands, place your equipment, and how you package patient. Focus on controlling the bleeding. Lecture Outline B. Scene size-up 1. Scene safety a. Observe the scene for hazards to your crew, bystanders, and the patient. b. Ensure that the scene is safe and consider the need for additional resources. c. Take the necessary standard precautions before approaching the scene—a minimum of gloves and eye protection. d. Open soft-tissue injuries can be messy but should not take priority over more serious life-threatening injuries. e. Be careful where you put your hands, place your equipment, and how you package the patient for transport. f. Focus on controlling the bleeding.

Scene Size-up (2 of 2) Mechanism of injury
Look for indicators of the MOI as you assess the scene. The MOI may provide information about potential safety threats. Evaluate scene safety and consider additional resources. Lecture Outline 2. Mechanism of injury (MOI) a. Look for indicators of the MOI as you assess the scene. i. They can help you develop an early index of suspicion for underlying injuries. ii. Interactions with the patient and your assessment will provide you with additional information about the extent of the injuries. b. The MOI may provide information about potential safety threats. c. Use all available information to evaluate scene safety and consider whether additional resources may be necessary.

Primary Assessment (1 of 4)
Identify life threats and transport priority. Form a general impression. Look for indicators of the patient’s condition. Check for more serious hidden injuries. Check for responsiveness. Lecture Outline C. Primary assessment 1. Focus on identifying and managing life-threatening concerns and identifying transport priority. 2. Form a general impression. a. Important indicators will alert you to the seriousness of the patient’s condition. i. Is the patient awake and interacting with his or her surroundings, or is the patient lying still, making no sounds? ii. Is the patient responding to you appropriately or inappropriately? iii. Is the patient’s breathing pattern rapid or slow, deep or shallow? iv. What is the color and condition of the patient’s skin? v. Does the patient have any apparent life threats? b. Closed soft-tissue injuries may appear to be minor, but could indicate serious internal injuries. i. Do not be distracted from looking for more serious hidden injuries. c. Check for responsiveness. i. If the patient is alert, ask about the chief complaint. ii. Administer high-flow oxygen via a nonrebreathing mask to patients whose level of consciousness is less than alert, treat for potential shock, and provide immediate transport. iii. If the patient has significant trauma, perform a rapid exam, look for life threats, and treat them as you find them. iv. If the patient has obvious life-threatening external bleeding, control the bleeding first (even before airway and breathing), then assess and treat the ABCs, and provide treatment for shock.

Airway and breathing Provide high-flow oxygen. Ensure that the patient has a clear and patent airway. Protect the patient from further spinal injury. Assess the patient for adequate breathing. Inspect and palpate the chest for DCAP-BTLS. Lecture Outline 3. Airway and breathing a. Providing high-flow oxygen may help reduce the effects of shock and assist in perfusion of damaged tissues, particularly in crush injuries. b. Ensure that the patient has a clear and patent airway. c. Protect the patient from further spinal injury by preventing the head and torso from moving. d. Assess the patient for adequate breathing. e. Inspect and palpate the chest wall for DCAP-BTLS. f. Open soft-tissue injuries of the face and neck have a potential to interfere with the effectiveness of the airway and breathing. i. Evaluate the patient’s voice and speaking ability. ii. If an open injury is found on the chest, evaluate for air movement through the wound that indicate a deep penetrating injury. iii. Assess the patient’s back for injuries that might need treatment.

Circulation Assess the patient’s pulse rate and quality. Determine the skin condition, color, and temperature. Check the capillary refill time. You may need to treat the patient for shock. Lecture Outline 4. Circulation a. Quickly assess the patient’s pulse rate, rhythm, and quality. b. Determine the skin condition, color, and temperature. c. Check the capillary refill time. d. Your assessment of the pulse and skin will give you an indication as to how aggressively you need to treat the patient for shock.

Transport decision Immediately transport in these cases: Poor initial general impression Altered level of consciousness Dyspnea Abnormal vital signs Shock Severe pain Lecture Outline 5. Transport decision a. Consider whether transport to the closest hospital is appropriate or whether the patient would be better served by transport to a trauma center. b. Types of patients who need immediate transportation: i. Poor initial general impression ii. Altered level of consciousness iii. Dyspnea iv. Abnormal vital signs v. Shock vi. Severe pain c. Patients who have visible significant bleeding or signs of significant internal bleeding may quickly become unstable.

History Taking (1 of 2) Investigate the chief complaint.
Obtain a medical history. Obtain a SAMPLE history. Using OPQRST may provide some background on isolated extremity injuries. Try to use SAMPLE, OPQRST, and DCAP-BTLS together. If the patient is unresponsive, attempt to obtain the history from other sources. Lecture Outline D. History taking 1. Investigate the chief complaint. a. Obtain a medical history and be alert for injury-specific signs and symptoms and any pertinent negatives. b. Obtain a SAMPLE history from your patient. i. Using OPQRST may provide some background on isolated extremity injuries. ii. When you use SAMPLE, OPQRST, and DCAP-BTLS together, your assessment will provide significant insight into the patient’s condition. iii. Any information you receive will be very valuable if the patient loses consciousness. c. If the patient is unresponsive, attempt to obtain the history from other sources: i. Friends or family members ii. Bystanders iii. Medical identification jewelry iv. Cards in wallets

History Taking (2 of 2) Typical signs of an open injury: Bleeding
Break(s) in the skin Shock Hemorrhage Disfigurement or loss of a body part Lecture Outline d. Typical signs of an open injury: i. Bleeding ii. Break(s) in the skin iii. Shock iv. Hemorrhage v. Disfigurement or loss of a body part e. Chronic medical conditions such as anemia and hemophilia as well as a host of other medical conditions can complicate open soft-tissue injuries.

Secondary Assessment (1 of 5)
After you evaluate ABCs and treat immediate life threats, a more detailed assessment should follow. Secondary assessment: Is a more systematic full-body scan Typically occurs en route to the emergency department Lecture Outline E. Secondary assessment 1. After you evaluate ABCs and identify and treat immediate life threats, a more detailed assessment should follow. 2. The secondary assessment is a more systematic full-body scan or focused examination of the patient. 3. The secondary assessment, which includes assessing interventions and repeating vital signs, typically occurs en route to the ED.

Physical examination Listen to breath sounds. Determine the respiratory rate. Note the pattern and quality of respiratory effort. Assess for asymmetric chest wall movement. Lecture Outline 4. Physical examination a. Listen to breath sounds with a stethoscope. b. Determine the patient’s respiratory rate. c. Note the pattern and quality of respiratory effort. d. Assess for asymmetric chest wall movement.

Physical examination (cont’d) Assess the neurologic system. Assess the musculoskeletal system with a detailed exam of entire body. Assess all anatomic regions. Lecture Outline e. Assess the neurologic system: i. Level of consciousness ii. Pupil size and reactivity iii. Motor response iv. Sensory response f. Assess the musculoskeletal system by performing a detailed exam of the entire body. i. Look for DCAP-BTLS. ii. Assess the chest, abdomen, and extremities for hidden bleeding and injuries. iii. Log roll the patient, and assess the posterior torso for injuries. iv. Once the back has been assessed, perform a complete spinal immobilization if indicated. g. Assess all anatomic regions: i. Check for jugular vein distention and tracheal deviation. ii. Check the pelvis for stability. iii. Check the abdomen. iv. Check the extremities, and record pulse, motor, and sensory function.

Vital signs Reassess the vital signs to identify how quickly the patient’s condition is changing. Signs that indicate hypoperfusion and the need for rapid transport: Tachycardia Tachypnea Low blood pressure Lecture Outline 5. Vital signs a. Reassess the vital signs to identify how quickly the patient’s condition is changing. b. Signs that indicate hypoperfusion and indicate the need for rapid transport: i. Tachycardia ii. Tachypnea iii. Low blood pressure

Vital signs (cont’d) Weak pulse Cool, moist, and pale skin Reassessment indicates how well the patient is tolerating the injury and the effectiveness of your interventions. Lecture Outline iv. Weak pulse v. Cool, moist, and pale skin c. Reassessment of the patient’s vital signs will indicate how well the patient is tolerating the injury and the effectiveness of your interventions.

Reassessment (1 of 5) Repeat the primary assessment.
Assess the effectiveness of prior treatments. Reassess vital signs and the chief complaint. Lecture Outline F. Reassessment 1. Reassessment should be conducted regularly during transport. 2. Repeat the primary assessment and pay extra attention to areas of concern identified in the initial assessment. 3. Assess the effectiveness of prior treatments. 4. Reassess vital signs and the chief complaint.

Reassessment (2 of 5) Recheck patient interventions.
Reassess bandaging. Identify and treat changes in the patient’s condition. Lecture Outline 5. Recheck patient interventions. 6. Reassess the effectiveness of the bandaging. 7. Identify and treat changes in the patient’s condition.

Reassessment (3 of 5) Interventions
Assess and manage all threats to the patient’s airway, breathing, and circulation. Give oxygen to patients with traumatic injuries that impact the airway or ventilation or those with a potential for shock. Expose all wounds, control bleeding, and be prepared to treat for shock. Lecture Outline 8. Interventions a. Assess and manage all threats to the patient’s airway, breathing, and circulation. b. Give supplemental oxygen via a nonrebreathing mask to all patients with traumatic injuries impacting the airway or ventilation or those with a potential for shock. c. Expose all wounds, control bleeding, and be prepared to treat the patient for shock.

Reassessment (4 of 5) Interventions (cont’d)
Flush small wound surfaces with sterile saline prior to applying a dressing. Do not remove any material stuck in the wound. Splint extremities that are painful, swollen, or deformed. Lecture Outline d. Consider flushing small wound surfaces without significant bleeding with sterile saline prior to applying a dressing. e. If any material is “stuck” in the wound, do not remove it, as this may worsen bleeding and shock. f. Splint extremities that are painful, swollen, or deformed.

Reassessment (5 of 5) Communication and documentation
Description of the MOI Position in which you found the patient Amount of blood loss Location and description of any soft-tissue injuries or other wounds Size and depth of the injury How you treated the injuries Lecture Outline 9. Communication and documentation a. Your communication and documentation must include a description of the MOI and the position in which you found the patient when you arrived on scene. b. Attempt to report blood loss using terms that you are comfortable with and that will be easily understood by other personnel. c. Include the location and description of any soft-tissue injuries or other wounds you have located and treated. d. Describe the size and depth of the injury. e. Provide an accurate account of how you treated these injuries.

Emergency Medical Care for Closed Injuries (1 of 3)
No special emergency care for small contusions Extensive injuries could lead to hypovolemic shock. Closely watch any area of injury, no matter how minor. Lecture Outline V. Emergency Medical Care for Closed Injuries A. Small contusions generally require no special emergency medical care, but you should note their presence to determine the extent of the patient’s injuries. B. More extensive closed injuries may involve significant swelling and bleeding beneath the skin, which could lead to hypovolemic shock. C. The injuries might not have had time to cause swelling or bruising. D. Closely watch any area of injury throughout the time you are caring for the patient, no matter how minor it may look upon initial assessment.

Treat closed soft-tissue injury using the RICES mnemonic: Rest Ice Compression Elevation Splinting Lecture Outline E. Treat a closed soft-tissue injury using the RICES mnemonic: 1. Rest 2. Ice 3. Compression 4. Elevation 5. Splinting

Signs of developing shock: Anxiety or agitation Changes in mental status Increased heart rate Increased respiratory rate Diaphoresis Cool or clammy skin Decreased blood pressure Lecture Outline F. Be alert for signs of developing shock: 1. Anxiety or agitation 2. Changes in mental status 3. Increased heart rate 4. Increased respiratory rate 5. Diaphoresis 6. Cool or clammy skin 7. Decreased blood pressure G. If the patient exhibits signs and symptoms of shock, treat accordingly and aggressively.

Emergency Medical Care for Open Injuries (1 of 11)
Before caring for the patient, follow standard precautions. If life-threatening bleeding is observed, assign a team member to apply direct pressure. Cover wounds of the chest, upper abdomen, or upper back with an occlusive dressing. Lecture Outline A. Before you begin to care for a patient with an open wound, follow standard precautions. 1. If life-threatening bleeding is observed, assign a team member to apply direct pressure over the wound to control the bleeding. 2. If the wound is in the chest, upper abdomen, or upper back, cover it with an occlusive dressing.

Control bleeding using: Direct, even pressure and elevation Pressure dressings and/or splints Tourniquets Lecture Outline 3. Control bleeding using: a. Direct, even pressure and elevation b. Pressure dressings and/or splints c. Tourniquets

All open wounds are assumed to be contaminated and present a risk of infection. Control bleeding by splinting the extremity, even if there is no fracture. Lecture Outline B. All open wounds are assumed to be contaminated and present a risk of infection. 1. Applying a sterile dressing reduces the risk of further contamination. 2. Do not remove material from an open wound, no matter how dirty the wound is. 3. Small wound surfaces without significant bleeding can be flushed with sterile saline prior to applying a dressing. 4. In most circumstances, hospital personnel, rather than EMTs, will clean open wounds. C. In some cases, you can better control bleeding from open soft-tissue wounds by splinting the extremity, even if there is no fracture.

Abdominal wounds An open wound in the abdominal cavity may expose internal organs. In an evisceration, the organs protrude through the wound. Lecture Outline D. Abdominal wounds 1. An open wound in the abdominal cavity may expose internal organs. 2. In an evisceration, the organs protrude through the wound. © Dr. M.A. Ansary/Photo Researchers, Inc.

Abdominal wounds (cont’d) Cover the wound with sterile gauze. Secure the gauze with an occlusive dressing. Keep the organs moist and warm. Lecture Outline a. Cover the wound with sterile gauze moistened with sterile saline solution. b. Secure the gauze with an occlusive dressing. c. Keep the organs moist and warm. 3. Most patients with abdominal wounds require immediate transport to a trauma center. © Jones & Bartlett Learning. © Jones & Bartlett Learning.

Impaled objects Remove an impaled object only when: The object is in the cheek or mouth and obstructs the airway. The object is in the chest and interferes with CPR. Lecture Outline E. Impaled objects 1. Occasionally, a patient will have an object, such as a knife, fishhook, wood splinter, or piece of glass, impaled in his or her body. 2. To treat this injury, follow the steps in Skill Drill 26-1. 3. Remove an impaled object only in two circumstances: a. The object is in the cheek or mouth and obstructs the airway. b. The object is in the chest and directly interferes with CPR. 4. If the object is very long, secure and then shorten it. 5. Provide rapid transport.

Neck injuries Open neck injuries can be life threatening. Open veins may suck in air and cause cardiac arrest. Cover the wound with an occlusive dressing. Apply manual pressure but do not compress both carotid arteries at the same time. Lecture Outline F. Neck injuries 1. Open neck injuries can be life threatening. 2. If the veins of the neck are open to the environment, they may suck in air. a. If enough air is sucked into a blood vessel, it can block the flow of blood in the lungs, and cause cardiac arrest. b. This condition is called air embolism. 3. Cover the wound with an occlusive dressing. 4. Apply manual pressure but do not compress both carotid arteries at the same time. a. This could impair circulation to the brain and cause a stroke. 5. Use caution with patients suffering from a neck injury depending on the MOI involved. a. Immobilize the C-spine if indicated, including placing a cervical collar.

Small-animal bites A small animal’s mouth is heavily contaminated with virulent bacteria. Wounds may require: Debridement Antibiotics Tetanus prophylaxis Surgical repair Bites should be evaluated by a physician. Lecture Outline G. Bites 1. Small-animal bites and rabies a. Consider the scene and crew safety prior to entering the environment. b. A small animal’s mouth is heavily contaminated with virulent bacteria. c. Consider all small-animal bites to be contaminated and potentially infected wounds. d. Treatment may require: i. Debridement (removal of damaged tissue) ii. Antibiotics iii. Tetanus prophylaxis iv. Surgical repair e. All small-animal bites should be evaluated by a physician.

A major concern is the spread of rabies. Acute, potentially fatal viral infection of the central nervous system Can affect all warm-blooded animals Transmitted through biting or licking an open wound Prevented only by a series of special vaccine injections Lecture Outline f. A major concern is the spread of rabies, an acute, potentially fatal viral infection of the central nervous system that can affect all warm-blooded animals. i. The virus is in the saliva of a rabid, or infected, animal and is transmitted through biting or licking an open wound. ii. Infection can be prevented only by a series of special vaccine injections. g. Children, particularly young ones, may be seriously injured or even killed by dogs. i. The animal may turn and attack you as well. ii. Do not enter the scene until the animal has been secured by the police or an animal control officer.

Human bites The human mouth contains an exceptionally wide range of bacteria and viruses. Regard any human bite that has penetrated the skin as a very serious injury. Can result in a serious, spreading infection Lecture Outline 2. Human bites a. The human mouth, more so than even the small animal’s mouth, contains an exceptionally wide range of bacteria and viruses. b. Regard any human bite that has penetrated the skin as a very serious injury. c. Any laceration caused by a human tooth can result in a serious, spreading infection.

Emergency treatment: Apply a dry, sterile dressing. Promptly immobilize the area with a splint or bandage. Provide transport to the ED. Lecture Outline d. Emergency treatment consists of the following steps: i. Apply a dry, sterile dressing. ii. Promptly immobilize the area with a splint or bandage. iii. Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy. © American Academy of Orthopaedic Surgeons.

Burns (1 of 2) Account for approximately 3,400 deaths per year
Among the most serious and painful of all injuries A burn occurs when the body receives more radiant energy than it can absorb. Sources of this energy may include heat, toxic chemicals, and electricity. Lecture Outline VII. Burns A. Burns account for approximately 3,400 deaths per year. B. Burns are among the most serious and painful of all injuries. 1. A burn occurs when the body, or a body part, receives more radiant energy than it can absorb, resulting in an injury. a. Potential sources of this energy: i. Heat ii. Toxic chemicals iii. Electricity

Burns (2 of 2) Always perform a complete assessment to determine whether other serious injuries are present. Children, older patients, and patients with chronic illnesses are more likely to experience shock from burn injuries. Lecture Outline 2. Although a burn may be the patient’s most obvious injury, you should always perform a complete assessment to determine whether other serious injuries are present. 3. Children, older patients, and patients with chronic illnesses are more likely to experience shock from burn injuries.

Pathophysiology of Burns (1 of 3)
Burns are soft-tissue injuries that are created by the transfer of radiation, thermal, or electrical energy. Thermal burns occur when the skin is exposed to temperatures higher than 111ºF. Lecture Outline C. Pathophysiology of burns 1. Burns are soft-tissue injuries that are spread out over a large area and are created by the transfer of radiation, thermal, or electrical energy. a. Thermal burns can occur when skin is exposed to temperatures higher than 111°F (44°C).

Pathophysiology (cont’d) Severity of a thermal injury correlates directly with: Temperature Concentration Amount of heat energy possessed by the object or substance Duration of exposure Lecture Outline b. The severity of a thermal injury correlates directly with: i. Temperature ii. Concentration iii. Amount of heat energy possessed by the object or substance iv. Duration of exposure

Pathophysiology (cont’d) The greater the heat energy, the deeper the wound. People reflexively limit heat energy and exposure time. They cannot do so if unconscious or trapped. Lecture Outline c. Burn injuries are progressive—the greater the heat energy, the deeper the wound. 2. People naturally limit the amount of time they are exposed to such heat. a. If clothing is on fire or the person is trapped or unconscious, exposure time can be extended.

Complications of Burns (1 of 2)
When a person is burned, the skin that acts as a barrier is destroyed. Burns create a high risk for: Infection Hypothermia Hypovolemia Shock Lecture Outline D. Complications of burns 1. The skin serves as a barrier between the environment and the body. a. When a person is burned, this barrier is destroyed. b. Burns create a high risk for: i. Infection ii. Hypothermia iii. Hypovolemia iv. Shock

Complications of Burns (2 of 2)
Burns to the airway are of significant importance. Circumferential burns of the chest can compromise breathing. Circumferential burns of an extremity can lead to neurovascular compromise and irreversible damage. Lecture Outline 2. Burns to the airway are of significant importance because the loose mucosa in the hypopharynx can swell and lead to complete airway obstruction. 3. Circumferential burns of the chest can compromise breathing. 4. Circumferential burns of an extremity can lead to compartment syndrome, resulting in neurovascular compromise and irreversible damage if not appropriately treated. 5. If you suspect any complications, call for ALS backup.

Burn Severity (1 of 5) Burn severity depends on: Depth of burn
Extent of burn Critical areas involved Face, upper airway, hands, feet, genitalia Preexisting medical conditions or other injuries Patient younger than 5 or older than 55 Lecture Outline E. Burn severity 1. Five factors to help determine the severity of a burn (the first two factors are the most important): a. What is the depth of the burn? b. What is the extent of the burn? c. Are any critical areas involved? i. Face, upper airway, hands, feet, genitalia d. Does the patient have any preexisting medical conditions or other injuries? e. Is the patient younger than 5 years or older than 55 years? 2. Burns to the face are of particular importance owning to the potential of airway involvement. 3. Burns to the hands or feet or over joints are considered serious because of the potential for loss of function as the result of scarring.

Burn Severity (2 of 5) Depth of burns Superficial (first-degree) burns
Involve only the top layer of skin Partial-thickness (second-degree) burns Involve the epidermis and some portion of the dermis Blisters are present. Full-thickness (third-degree) burns Extend through all skin layers Lecture Outline 4. Depth of burns a. Superficial (first-degree) burns i. Involve only the top layer of skin, the epidermis ii. The skin turns red but does not blister or burn through this top layer. iii. The burn site is often painful. iv. Example: sunburn b. Partial-thickness (second-degree) burns i. Involve the epidermis and some portion of the dermis ii. These burns do not destroy the entire thickness of the skin, nor is the subcutaneous tissue injured. iii. Typically, the skin is moist, mottled, and white to red. iv. Blisters are present. v. Can cause intense pain c. Full-thickness (third-degree) burns i. Extend through all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs ii. The burned area is dry and leathery and may appear white, dark brown, or even charred. iii. If the nerve endings have been destroyed, a severely burned area may have no feeling. iv. The surrounding, less severely burned areas may be extremely painful. d. Significant airway burns are serious. i. May be associated with singed hair within the nostrils, soot around the nose and mouth, hoarseness, and hypoxia ii. These patients should be rapidly transported to an ED or facility capable of advanced airway management.

Burn Severity (3 of 5) The illustrations on this slide show the damage that superficial, partial-thickness, and full-thickness burn injuries inflict on the skin. © Jones & Bartlett Learning © Amy Walters/ ShutterStock, Inc. © American Academy of Orthopaedic Surgeons.

Burn Severity (4 of 5) Extent of burns
Estimated using the rule of palm or rule of nines The proportions differ for infants, children, and adults. Include only partial-thickness and full-thickness in estimations of the extent of burn injury. Lecture Outline 5. Extent of burns a. Rule of palm: estimates the surface area that has been burned by comparing it to the size of the patient’s palm, which is roughly equal to 1% of the patient’s total body surface area b. Rule of nines: estimates he extent of a burn by dividing the body into sections, each representing approximately 9% of the total body surface area c. The proportions differ for infants, children, and adults. d. When you calculate the extent of burn injury, include only partial- and full-thickness burns. Document superficial burns, but do not include them in the body surface area estimation of extent of burn injury.

Burn Severity (5 of 5) The illustration on this slide shows how to apply the rule of nines to an infant, child, and adult. © Jones & Bartlett Learning

Patient Assessment of Burns
When you are assessing a burn, it is important to classify the victim’s burns. Classification of burns is based on: Source of the burn Depth of the burn Severity of the burn Lecture Outline VIII. Patient Assessment of Burns A. When assessing a burn, it is important to classify the patient’s burns. 1. Classification of burns is based on: a. Source of the burn b. Depth of the burn c. Severity of the burn

Scene Size-up (1 of 2) Scene safety Mechanism of injury
Observe the scene for hazards and safety threats. Ensure that the factors that led to the patient’s burn injury do not pose a hazard. Mechanism of injury Determine the type of burn that has been sustained and the MOI. Lecture Outline B. Scene size-up 1. Scene safety a. Observe the scene for hazards and threats to the safety of you and your crew, bystanders, and the patient. b. Ensure that the factors that led to the patient’s burn injury do not pose a hazard to you and your crew. 2. Mechanism of injury a. Attempt to determine the type of burn that has been sustained and the MOI. b. What the patient reports will often provide important information about the extent of the injury. c. Assess the scene for any environmental hazards. d. Determine the number of patients. e. Call for additional resources early, if necessary. f. Consider the potential for spinal injuries, broken bones, inhalation injuries, and other injuries.

Scene Size-up (2 of 2) Mechanism of injury (cont’d)
Gather information from the patient about the extent of the injury. Assess the scene for environmental hazards. Determine the number of patients. Call for additional resources early. Consider the potential for other injuries. Lecture Outline b. What the patient reports will often provide important information about the extent of the injury. c. Assess the scene for any environmental hazards. d. Determine the number of patients. e. Call for additional resources early, if necessary. f. Consider the potential for spinal injuries, broken bones, inhalation injuries, and other injuries.

Begin with a rapid exam. Form a general impression. Look for clues to determine the severity of injuries and the need for rapid treatment. Be suspicious of clues that may indicate abuse. Consider the need for manual spinal stabilization. Check for responsiveness using the AVPU scale. Lecture Outline C. Primary assessment 1. Begin with a rapid exam. 2. Form a general impression. a. Look for clues to determine the severity of injuries and the need for rapid treatment. b. Be suspicious of clues that may indicate abuse. c. Consider the need for manual spinal stabilization. d. Check for responsiveness using the AVPU scale. e. In all patients whose level of consciousness is less than alert and oriented, administer high-flow oxygen via a nonrebreathing mask and provide immediate transport.

Airway and breathing Ensure that the patient has a clear and patent airway. Be alert to signs that the patient has inhaled hot gases or vapors: Singed facial hair Soot present in and around the airway Lecture Outline 3. Airway and breathing a. Ensure that the patient has a clear and patent airway. b. Be alert to signs that the patient has inhaled hot gases or vapors: i. Singed facial hair ii. Soot present in or around the airway

Airway and breathing (cont’d) Heavy amounts of secretions and frequent coughing may indicate a respiratory burn. Quickly assess for adequate breathing. Inspect and palpate the chest wall for DCAP-BTLS. Lecture Outline c. Heavy amounts of secretions and frequent coughing may indicate a respiratory burn. d. Quickly assess for adequate breathing. e. Inspect and palpate the chest wall for DCAP-BTLS.

Circulation Assess the pulse rate and quality. Determine perfusion based on the patient’s skin condition, color, temperature, and capillary refill time. Control significant bleeding. Assess for shock. Lecture Outline 4. Circulation a. Quickly assess the pulse rate and quality. b. Determine perfusion based on the patient’s skin condition, color, temperature, and capillary refill time. c. Take steps to control significant bleeding. d. If the patient has obvious life-threatening external hemorrhage, control the bleeding first (before airway and breathing); then treat the patient for shock as quickly as possible. e. Treat shock in burn patients by preventing heat loss; cover the patient with a blanket.

Transport decision Consider rapid transport for a patient who has: An airway or breathing problem Significant burn injuries Significant external bleeding Signs and symptoms of internal bleeding Consider consulting ALS providers. Lecture Outline 5. Transport decision a. Consider rapid transport for a patient who has: i. An airway or breathing problem ii. Significant burn injuries iii. Significant external bleeding iv. Signs and symptoms of internal bleeding b. Consulting with ALS providers may be appropriate.

History Taking (1 of 3) Investigate the chief complaint.
Be alert for signs and symptoms of other injuries due to the MOI. Typical signs of a burn: Pain Redness Swelling Blisters Charring Lecture Outline D. History taking 1. Investigate the chief complaint. a. Be alert for signs or symptoms of other injuries due to the MOI. b. If the patient was burned in a confined space, suspect an inhalation injury. c. When burns result from explosive forces, be alert for other internal injuries and fractures. d. Obtain a medical history and be alert for injury-specific signs and symptoms and pertinent negatives. e. Typical signs of a burn: i. Pain ii. Redness iii. Swelling iv. Blisters v. Charring

History Taking (2 of 3) Investigate the chief complaint. (cont’d)
Regardless of the type of burn injury: Stop the burning process. Apply a dressing to prevent contamination. Treat the patient for shock. Lecture Outline f. Symptoms may include pain or burning at the injury site. g. Regardless of the type of burn injury: i. Stop the burning process. ii. Apply a dressing to prevent contamination. iii. Treat the patient for shock.

History Taking (3 of 3) SAMPLE history
Along with the SAMPLE history, ask the following questions: Are you having any difficulty breathing? Are you having any difficulty swallowing? Are you having any pain? Check whether the patient has an emergency medical identification device. Lecture Outline 2. SAMPLE history a. Along with the SAMPLE history, ask the following questions: i. Are you having any difficulty breathing? ii. Are you having any difficulty swallowing? iii. Are you having any pain? b. Check whether the patient has an emergency medical identification device.

Physical examination Perform an exam of the entire body. Assess the patient from head to toe looking for DCAP-BTLS. Make a rough estimate, using the rule of nines, of the extent of the burned area. Determine the classification of the burn. Determine the severity of the burn. Package the patient for transport. Lecture Outline E. Secondary assessment 1. Physical examination a. Perform an exam of the entire body. b. Assess the patient from head to toe looking for DCAP-BTLS. c. Make a rough estimate, using the rule of nines, of the extent of the burned area. d. Determine the classification of the burns that the victim has sustained. e. Determine the severity of the burns. f. Package the patient for transport based on your findings.

Physical examination (cont’d) Assessment of the respiratory system involves looking, listening, and feeling. Assess the patient’s neurologic system. Assess the musculoskeletal system. Determining an early set of vital signs will help you to know how the patient is tolerating his or her injuries. Lecture Outline g. Assessment of the respiratory system involves looking, listening, and feeling. i. Look for soot around the mouth, soot around the nose, or singed nasal hairs. ii. If any of those findings are present, open the patient’s mouth and examine for burns or swelling of the tongue. iii. Ask the patient to cough and assess for black sputum, which indicates smoke inhalation. iv. Listen to breath sounds with a stethoscope. v. Assess pulse rate and quality; determine the skin condition, color, and temperature; and check the capillary refill time. h. Assess the patient’s neurologic system: i. Level of consciousness—use AVPU ii. Pupil size and reactivity iii. Motor response iv. Sensory response i. Assess the musculoskeletal system. i. In the head, check for singed nasal or facial hair, burns or swelling of the face or ears, or burns or swelling in the mouth. In case of electrical injury, examine the scalp for entrance or exit wounds. ii. In the neck, check for burns, especially if they encircle the entire neck, which can impair circulation. iii. In the chest, check for burns that encircle the entire chest, which can impair normal chest rise. iv. In the abdomen and pelvis, feel all four quadrants for tenderness or rigidity. If the abdomen is tender, expect internal bleeding. Look for burns of the genitalia, as burns to this area are considered high risk. v. Look for burns that encircle an extremity, as they can impair circulation. If the patient sustained an electrical injury, assess thoroughly for entry or exit burn wounds. Record pulse and motor and sensory function. vi. Examine the posterior surface of the body, as large burns or electrical exit burns may be located in this body area. 2. Vital signs a. Determining an early set of vital signs will help you to know how the patient is tolerating his or her injuries. b. Blood pressure, pulse, and skin assessment for perfusion are important signs to obtain. c. Monitoring devices i. Oxygen saturation monitor ii. Carbon monoxide monitor

Reassessment (1 of 3) Repeat the primary assessment and reassess the patient’s vital signs. Reassess the chief complaint. Reevaluate interventions. Stop the burning process. Assess and treat breathing. Support circulation. Lecture Outline F. Reassessment 1. Repeat the primary assessment and reassess the patient’s vital signs. 2. Reassess the patient’s chief complaint. 3. Reevaluate interventions and treatments you have provided to the patient. a. Stop the burning process. b. Assess and treat breathing. c. Support circulation.

Reassessment (2 of 3) Reassess interventions (cont’d)
Provide rapid transport. Oxygen is mandatory for inhalation burns and large body surface area burns. If the patient has signs of hypoperfusion, treat aggressively for shock and provide rapid transport. Lecture Outline d. Provide rapid transport. e. Oxygen is mandatory for inhalation burns and large body surface area burns. f. If the patient has signs of hypoperfusion, treat aggressively for shock and provide rapid transport.

Reassessment (3 of 3) Communication and documentation
Provide hospital personnel with a description of how the burn occurred. Describe the extent of the burns: Amount of body surface area involved Depth of the burn Location of the burn Document if special areas are involved. Lecture Outline 4. Communication and documentation a. Provide hospital personnel with a description of how the burn occurred. b. Describe the extent of the burns: i. Amount of body surface area involved ii. Depth of the burn iii. Location of the burn c. If special areas are involved, they should be specifically mentioned and documented.

Emergency Medical Care for Burns
Stop the burning process. Prevent additional injury. Lecture Outline IX. Emergency Medical Care for Burns A. Your first responsibility in caring for a patient with a burn is to stop the burning process and prevent additional injury. B. When caring for a burn patient, follow the steps in Skill Drill 26-2.

Thermal Burns (1 of 3) Caused by heat
Most commonly, they are caused by scalds or an open flame. A flame burn is very often a deep burn. Hot liquids produce scald injuries. Coming in contact with hot objects produces a contact burn. Lecture Outline C. Thermal burns 1. Thermal burns are caused by heat. 2. Most commonly, they are caused by scalds or an open flame. a. A flame burn is very often a deep burn, especially if a person’s clothing catches fire. b. A scald burn is most commonly seen in children and handicapped adults but can happen to anyone, particularly while cooking. i. Hot liquids produce scald injuries. ii. Scald burns often cover large surface areas of the body because liquids can spread quickly. 3. Coming in contact with hot objects produces a contact burn. a. Contact burns are rarely deep unless the patient was prevented from drawing away from the hot object.

Thermal Burns (2 of 3) A steam burn can produce a topical (scald) burn. A flash burn is produced by an explosion. May briefly expose a person to very intense heat Lightning strikes can cause a flash burn. Lecture Outline 4. A steam burn can produce a topical (scald) burn. a. Minor steam burns are common when microwaving food covered with plastic wrap. 5. A flash burn is produced by an explosion, which may briefly expose a person to very intense heat. a. Lightning strikes can also cause a flash burn.

Thermal Burns (3 of 3) Management
Stop the burning source, cool the burned area, and remove all jewelry. Increased exposure time will increase damage to the patient. All patients should have a dry dressing applied to: Maintain body temperature Prevent infection Provide comfort Lecture Outline 6. Management of thermal burns a. Stop the burning source, cool the burned area if appropriate, and remove all jewelry. b. Maintain a high index of suspicion for inhalation injuries. c. Increased exposure time will increase damage to the patient. d. The larger the burn, the more likely the patient will be susceptible to hypothermia and/or hypovolemia. e. All patients with large surface burns should have a dry sterile dressing applied to help: i. Maintain body temperature ii. Prevent infection iii. Provide comfort

Inhalation Burns (1 of 4) Can occur when burning takes place in enclosed spaces without ventilation Upper airway damage is often associated with the inhalation of superheated gases. Lower airway damage is often associated with the inhalation of chemicals and particulate matter. Lecture Outline D. Inhalation burns 1. Inhalation injuries can occur when burning takes place in enclosed spaces without ventilation. a. When the upper airway is exposed to excessive heat, the patient can experience rapid and serious airway compromise. b. Upper airway damage is often associated with the inhalation of superheated gases. c. Lower airway damage is often associated with the inhalation of chemicals and particulate matter.

Inhalation Burns (2 of 4) You may encounter severe upper airway swelling, which requires immediate intervention. Consider requesting ALS backup. The combustion process produces a variety of toxic gases. Lecture Outline 2. When treating a patient for inhalation injuries, you may encounter severe upper airway swelling, which requires immediate intervention. a. Consider requesting ALS backup if the patient has signs and symptoms of edema. i. Stridor ii. Hoarse voice iii. Singed nasal hairs iv. Burns of the face v. Carbon particles in the sputum b. Apply cool mist, aerosol therapy, or humidified oxygen to help reduce some minor edema. c. Apply an ice pack to the throat to reduce swelling, provided the tissue in that area does not have burns. 3. The combustion process produces a variety of toxic gases. a. The less efficient the combustion process, the more toxic the gases that may be created.

Inhalation Burns (3 of 4) Carbon monoxide intoxication should be considered whenever a group of people in the same place all report a headache or nausea. Management First ensure your own safety and the safety of your coworkers. Lecture Outline 4. Carbon monoxide (CO) intoxication should be considered whenever a group of people in the same place all report a headache or nausea. 5. Cherry red skin, lips, and nail beds are commonly observed in patients who have died from CO exposure. a. Do not rule out CO exposure simply because the patient’s skin is not cherry red. 6. Hydrogen cyanide (HCN) is generated by combustion. a. Signs and symptoms involve the central nervous, respiratory, and cardiovascular systems: i. Faintness ii. Anxiety iii. Abnormal vital signs iv. Headache vi. Seizures vii. Paralysis viii. Coma 6. Management of inhalation burns a. You must first ensure your own safety and the safety of your coworkers.

Inhalation Burns (4 of 4) Management (cont’d)
Prehospital treatment of a patient with suspected hydrogen cyanide poisoning includes decontamination and supportive care. Care for any toxic gas exposure includes: Recognition Identification Supportive treatment Lecture Outline b. Prehospital treatment of a patient with suspected hydrogen cyanide poisoning includes decontamination and supportive care until an antidote can be administered by ALS providers. c. Care for any toxic gas exposure: i. Recognition ii. Identification iii. Supportive treatment

Chemical Burns (1 of 4) Can occur whenever a toxic substance contacts the body Generally caused by strong acids or strong alkalis The eyes are particularly vulnerable. Lecture Outline E. Chemical burns 1. Chemical burns can occur whenever a toxic substance contacts the body. 2. Most chemical burns are caused by strong acids or strong alkalis. 3. The eyes are particularly vulnerable.

Chemical Burns (2 of 4) Severity of the burn is directly related to three factors: Type of chemical Concentration of the chemical Duration of the exposure Wear appropriate chemical-resistant gloves and eye protection. Lecture Outline 4. The severity of the burn is directly related to three factors: a. Type of chemical b. Concentration of the chemical c. Duration of the exposure 5. To prevent exposure to hazardous materials, determine if you can safely approach the patient. In some cases, you must wait until a hazardous materials (HazMat) team has decontaminated the patient. 6. Wear appropriate chemical-resistant gloves and eye protection whenever you are caring for a patient with a chemical burn.

Chemical Burns (3 of 4) Management
Remove any chemical from the patient. Always brush dry chemicals off the skin and clothing before flushing with water. Remove the patient’s clothing. Lecture Outline 7. Treatment for chemical burns can be specific to the chemical agent. 8. Management of chemical burns a. The severity of the burn will depend on the type of chemical, its strength, duration of exposure, and the area of the body exposed. b. To stop the burning process, remove any chemical from the patient. c. Always brush dry chemicals off the skin and clothing before flushing the patient with water. d. Remove the patient’s clothing, including shoes, stockings, gloves, and any jewelry or eyeglasses. © American Academy of Orthopaedic Surgeons.

Chemical Burns (4 of 4) Management (cont’d)
For liquid chemicals, immediately begin to flush the burned area with lots of water. Continue flooding the area for 15 to 20 minutes after the patient says the burning pain has stopped. If the patient’s eye has been burned, hold the eyelid open while flooding the eye. Conduct proper decontamination prior to loading the patient. Lecture Outline e. Take great care to ensure you do not come in contact with the chemical. The patient should be properly decontaminated by properly trained personnel. f. For liquid chemicals, immediately begin to flush the burned area with large amounts of water. g. Continue flooding the area with gallons of water for 15 to 20 minutes after the patient says the burning pain has stopped. h. If the patient’s eye has been burned, hold the eyelid open (without applying pressure over the globe of the eye) while flooding the eye with a gentle stream of water. i. As with any substance, once the fluid has been contaminated with the chemical, collect it and properly dispose of it. j. Conduct a proper decontamination prior to loading any patient into the ambulance and again prior to entering a hospital.

Electrical Burns (1 of 5) May be the result of contact with high- or low-voltage electricity For electricity to flow, there must be a complete circuit between the source and the ground. Insulator: any substance that prevents this circuit Conductor: any substance that allows a current to flow Lecture Outline F. Electrical burns 1. Electrical burns may be the result of contact with high- or low-voltage electricity. a. High-voltage burns may occur when utility workers make direct contact with power lines. b. Ordinary household current can cause severe burns and cardiac arrhythmias. 2. For electricity to flow, there must be a complete circuit between the electrical source and the ground. a. Insulator; any substance that prevents this circuit from being completed b. Conductor: any substance that allows a current to flow through it c. The human body is a good conductor. d. Electrical burns occur when the body, or a part of it, completes a circuit connecting a power source to the ground.

Electrical Burns (2 of 5) The human body is a good conductor.
The type of electric current, magnitude of current, and voltage have effects on the seriousness of the burn. Your safety is of particular importance. Never attempt to remove someone from an electrical source unless you are specially trained to do so. Lecture Outline 3. The type of electric current, magnitude of current, and voltage have effects on the seriousness of burns. 4. Your safety is of particular importance when you are called to the scene of an emergency involving electricity. a. You can be fatally injured by coming into contact with power lines. b. You can be fatally injured by touching a patient who is still in contact with a live power line or any other electrical source. c. Never attempt to remove someone from an electrical source unless you are specially trained to do so. d. Always assume that any downed power line is live.

Electrical Burns (3 of 5) A burn injury appears where the electricity enters and exits the body. Two dangers: There may be a large amount of deep tissue injury. The patient may go into cardiac or respiratory arrest from the electric shock. Lecture Outline 5. A burn injury appears where the electricity enters and exits the body. a. Two dangers specifically associated with electrical burns: i. There may be a large amount of deep tissue injury. ii. The patient may go into cardiac or respiratory arrest from the electric shock. (a) If the patient is not in cardiac arrest on your arrival, he or she is unlikely to experience this problem during transport.

Electrical Burns (4 of 5) The illustration on this slide shows the damage that an electrical burn can cause. © Chuck Stewart, MD.

Electrical Burns (5 of 5) Management
If indicated, begin CPR on the patient and apply an AED. Be prepared to defibrillate if necessary. Give supplemental oxygen and monitor the patient closely. Treat soft-tissue injuries with dry, sterile dressings. Provide prompt transport. Lecture Outline 6. Management of electrical burns a. Electrical current can cross the chest and cause cardiac arrest or arrhythmias. b. If indicated, begin CPR on the patient and apply the automated external defibrillator (AED). c. Be prepared to defibrillate if necessary. d. Give supplemental oxygen and monitor the patient closely for respiratory and cardiac arrest. e. Treat the soft-tissue injuries by applying dry, sterile dressings on all burn wounds and splinting suspected fractures. f. Provide prompt transport.

Taser Injuries In recent years, law enforcement has increased its use of Tasers. Potential complications for patients with underlying disorders. Use of a Taser has been associated with dysrhythmias and sudden cardiac arrest. Make sure you have access to an AED when responding to patients who have been exposed to Taser shots. Lecture Outline G. Taser injuries 1. In recent years, law enforcement has increased its use of Tasers. 2. These weapons fire two small darts (electrodes) that puncture the patient’s skin. a. Barbs are generally treated as impaled objects and removed by a physician. b. In some jurisdictions, depending on local protocol, EMTs are permitted to remove these barbs from patients. 3. There are potential complications for the patient when these devices have been used, particularly when the patient is experiencing certain underlying disorders. a. Excited delirium is commonly associated with illegal drug ingestion. b. Excited delirium is a true emergency and warrants assisted ALS response. c. Using a Taser device in patients with true excited delirium has been previously associated with dysrhythmias and sudden cardiac arrest. 4. Make sure you have access to an AED when you respond to patients who have been exposed to Taser shots.

Radiation Burns (1 of 4) Potential threats include:
Incidents related to the use and transportation of radioactive isotopes Intentionally released radioactivity in terrorist attacks You must determine if there has been a radiation exposure and then whether ongoing exposure continues to exist. Lecture Outline H. Radiation burns 1. Acute radiation exposure has become more than a theoretical issue because the use of radioactive materials has increased in industry and medicine. 2. Potential threats include incidents related to the use and transportation of radioactive isotopes and intentionally released radioactivity in terrorist attacks. 3. You must determine if there has been a radiation exposure and then attempt to determine whether ongoing exposure continues to exist.

Radiation Burns (2 of 4) Three types of ionizing radiation: Alpha
Little penetrating energy’ easily stopped by the skin Beta Greater penetrating power, but blocked by simple protective clothing Gamma Very penetrating; easily passes through the body and solid materials Lecture Outline 4. Three types of ionizing radiation: a. Alpha i. Alpha particles have little penetrating energy. ii. They are easily stopped by the skin. b. Beta i. Beta particles have greater penetrating power and can travel much farther in air than alpha particles. ii. They can penetrate the skin but can be blocked by simple protective clothing designed for this purpose. c. Gamma i. The threat from gamma radiation is directly proportional to its wavelength. ii. This type of radiation is very penetrating and easily passes through the body and solid materials

Radiation Burns (3 of 4) Most ionizing radiation accidents involve gamma radiation (x-rays). Management Maintain a safe distance and wait for the HazMat team to decontaminate the patient. Call for additional resources to remove the patient’s clothes. Begin ABCs and treat burns or trauma. Irrigate open wounds. Lecture Outline 5. Most ionizing radiation accidents involve gamma radiation (x-rays). 6. People who have sustained a radiation exposure generally do not pose a risk to others, but in incidents involving explosions, patients may be contaminated. 7. Management of radiation burns a. Maintain a safe distance and wait for the HazMat team to decontaminate the patient before initiating care. b. Most contaminants can be removed by simply removing the patient’s clothes. Call for additional resources. c. Once there is no threat to you, begin treating the ABCs and treat the patient for any burns or trauma. d. Irrigate open wounds.

Radiation Burns (4 of 4) Management (cont’d)
Notify the emergency department. Identify the radioactive source and the length of the patient’s exposure to it. Limit your duration of exposure. Increase your distance from the source. Attempt to place shielding between yourself and the sources of gamma radiation. Lecture Outline e. Notify the emergency department. f. Identify the radioactive source and the length of the patient’s exposure to it. g. Limit your duration of exposure, increase your distance from the source, and attempt to place shielding between yourself and sources of gamma radiation.

Dressing and Bandaging (1 of 2)
All wounds require bandaging. Splints can help control bleeding and provide firm support for dressing. There are many different types of dressings and bandages. © Jones & Bartlett Learning. Courtesy of MIEMSS. Lecture Outline X. Dressing and Bandaging A. All wounds require bandaging. 1. Splints can help control bleeding and provide firm support for dressing. 2. Many different types of dressings and bandages exist. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Dressing and Bandaging (2 of 2)
Dressings and bandages have three functions: To control bleeding To protect the wound from further damage To prevent further contamination and infection Lecture Outline 3. Dressings and bandages have three functions: a. To control bleeding b. To protect the wound from further damage c. To prevent further contamination and infection

Sterile Dressings (1 of 2)
Most wounds will be covered by: Universal dressings Conventional 4″  4″ and 4″  8″ gauze pads Assorted small adhesive-type dressings and soft self-adherent roller dressings Universal dressings are ideal for covering large open wounds. Lecture Outline B. Sterile dressings 1. Most wounds will be covered by: a. Universal dressings b. Conventional 4″  4″ and 4″  8″ gauze pads c. Assorted small adhesive-type dressings and soft self-adherent roller dressings 2. The universal dressing is ideal for covering large open wounds.

Sterile Dressings (2 of 2)
Gauze pads are appropriate for smaller wounds. Adhesive-type dressings are useful for minor wounds. Occlusive dressings prevent air and liquids from entering (or exiting) the wound. Lecture Outline 3. Gauze pads are appropriate for smaller wounds. 4. Adhesive-type dressings are useful for minor wounds. 5. Occlusive dressings prevent air and liquids from entering (or exiting) the wound. a. Made of Vaseline gauze, aluminum foil, or plastic b. Used to cover sucking chest wounds, abdominal eviscerations, penetrating back wounds, and neck injuries

Bandages (1 of 3) To keep dressings in place during transport, you can use: Soft roller bandages Rolls of gauze Triangular bandages Adhesive tape The self-adherent, soft roller bandages are easiest to use. Lecture Outline C. Bandages 1. To keep dressings in place during transport, you can use: a. Soft roller bandages b. Rolls of gauze c. Triangular bandages d. Adhesive tape 2. The self-adherent, soft roller bandages are easiest to use.

Bandages (2 of 3) Adhesive tape holds small dressings in place and helps to secure larger dressings. Do not use elastic bandages to secure dressings. The bandage may become a tourniquet and cause further damage. Lecture Outline 3. Adhesive tape holds small dressings in place and helps to secure larger dressings. a. Some people are allergic to adhesive tape; with these individuals, use paper or plastic tape. 4. Do not use elastic bandages to secure dressings. a. If the injury swells, the bandage may become a tourniquet and cause further damage. b. Always check a limb distal to a bandage for signs of impaired circulation and loss of sensation.

Bandages (3 of 3) Splints are useful in stabilizing broken extremities. Can be used with dressings to help control bleeding from soft-tissue injuries If a wound continues to bleed despite the use of direct pressure, quickly proceed to the use of a tourniquet. Lecture Outline c. Air splints and vacuum splints are useful in stabilizing broken extremities and can be used with dressings to help control bleeding from soft-tissue injuries. 5. If a wound continues to bleed despite the use of direct pressure, quickly proceed to the use of a tourniquet.

Review A young male was struck in the forearm with a baseball and complains of pain to the area. Slight swelling and ecchymosis are present, but no external bleeding. Which type of injury does this describe? Abrasion Contusion Hematoma Avulsion

Review Answer: B Rationale: A contusion (bruise) is caused by direct blunt force trauma. The epidermis remains intact, but small blood vessels in the dermis are injured. The depth of the injury varies, depending on the amount of energy absorbed. Pain and swelling occur as fluid and blood leak into the damaged area. The buildup of blood produces a characteristic blue and black discoloration called ecchymosis.

Review (1 of 2) A young male was struck in the forearm with a baseball and complains of pain to the area. Slight swelling and ecchymosis are present, but no external bleeding. Which type of injury does this describe? Abrasion Rationale: An abrasion is a wound of the superficial layer of skin, caused by friction. Contusion Rationale: Correct answer

Review (2 of 2) A young male was struck in the forearm with a baseball and complains of pain to the area. Slight swelling and ecchymosis are present, but no external bleeding. Which type of injury does this describe? Hematoma Rationale: A hematoma is blood that has collected within damaged tissue or in a body cavity, associated with large blood vessel damage. Avulsion Rationale: An avulsion is an injury that separates various layers of tissue.

Review A compression injury that is severe enough to cut off blood flow below the injury is called: a contusion. a hematoma. a local thrombus. compartment syndrome.

Review Answer: D Rationale: Compartment syndrome can occur when a part of the body has been compressed for a prolonged period of time—usually greater than 4 hours. The injured tissue begins to swell, which can impede arterial blood flow and venous return. As a result, the part of the body distal to the compression site becomes hypoxic and metabolic waste products (ie, lactic acid) begin to accumulate.

Review (1 of 2) A compression injury that is severe enough to cut off blood flow below the injury is called: a contusion. Rationale: This is a bruise. a hematoma. Rationale: This is blood that has collected within damaged tissue. A hematoma occurs when a large blood vessel is injured.

Review (2 of 2) A compression injury that is severe enough to cut off blood flow below the injury is called: a local thrombus. Rationale: This is a blood clot. compartment syndrome. Rationale: Correct answer

Review A 45-year-old convenience store clerk was shot in the right anterior chest during a robbery. Your assessment reveals that the wound has blood bubbling from it every time the patient breathes. Your MOST immediate action should be to: prevent air from entering the wound. cover the wound with a bulky dressing. assess the patient’s back for an exit wound. transport the patient promptly to the closest trauma center.

Review Answer: A Rationale: Immediate treatment for a sucking chest wound (open pneumothorax) involves covering the wound with an occlusive dressing. This will prevent air from being drawn into the chest cavity. After covering the wound, assess for an exit wound, apply high-flow oxygen (if not already done), and transport promptly.

Review (1 of 2) A 45-year-old convenience store clerk was shot in the right anterior chest during a robbery. Your assessment reveals that the wound has blood bubbling from it every time the patient breathes. Your MOST immediate action should be to: prevent air from entering the wound. Rationale: Correct answer cover the wound with a bulky dressing. Rationale: You must use an occlusive dressing.

Review (2 of 2) A 45-year-old convenience store clerk was shot in the right anterior chest during a robbery. Your assessment reveals that the wound has blood bubbling from it every time the patient breathes. Your MOST immediate action should be to: assess the patient’s back for an exit wound. Rationale: Do this after the anterior chest wound is covered. transport the patient promptly to the closest trauma center. Rationale: Do this after the initial treatment of an open chest wound.

Review What effects will the application of an ice have on a hematoma?
Vasodilation and increased pain Vasodilation and decreased bleeding Vasoconstriction and increased swelling Vasoconstriction and decreased bleeding

Review Answer: D Rationale: Applying an ice pack to a closed wound, such as a hematoma, will decrease bleeding, pain, and swelling by causing constriction of the blood vessels.

Review (1 of 2) What effects will the application of an ice have on a hematoma? Vasodilation and increased pain Rationale: An ice pack causes vasoconstriction and will reduce pain. Vasodilation and decreased bleeding Rationale: An ice pack causes vasoconstriction and will reduce bleeding.

Review (2 of 2) What effects will the application of an ice have on a hematoma? Vasoconstriction and increased swelling Rationale: An ice pack causes vasoconstriction and will reduce swelling. Vasoconstriction and decreased bleeding Rationale: Correct answer

Review The primary reason for applying a sterile dressing to an open injury is to: prevent contamination. control external bleeding. reduce the risk of infection. minimize any internal bleeding.

Review Answer: B Rationale: Although prevention of contamination is an important reason for applying a sterile dressing to an open injury, the primary reason is to control the external bleeding associated with it.

Review (1 of 2) The primary reason for applying a sterile dressing to an open injury is to: prevent contamination. Rationale: This is important, but not the primary reason. control external bleeding. Rationale: Correct answer

Review (2 of 2) The primary reason for applying a sterile dressing to an open injury is to: reduce the risk of infection. Rationale: The prevention of contamination will also reduce the risk of infection. minimize any internal bleeding. Rationale: Internal bleeding is minimized by the application of a pressure bandage to an open wound.

Review The MOST appropriate way to dress and bandage an open abdominal wound with a loop of bowel protruding from it is to: cover the wound with a dry, sterile dressing and apply firm pressure. apply a moist, sterile dressing to the wound and apply firm pressure. apply a moist, sterile dressing to the wound and secure with an occlusive dressing. carefully replace the protruding bowel into the abdomen and cover the wound.

Review Answer: C Rationale: Treatment for an abdominal evisceration includes applying a moist, sterile dressing to the wound and covering the moist dressing with an occlusive dressing. Do not replace a protruding bowel back into the wound or apply firm pressure, which may force the bowel back into the wound; these actions increase the risk of infection.

Review (1 of 2) The MOST appropriate way to dress and bandage an open abdominal wound with a loop of bowel protruding from it is to: cover the wound with a dry, sterile dressing and apply firm pressure. Rationale: You must use a moist dressing. apply a moist, sterile dressing to the wound and apply firm pressure. Rationale: You should not apply pressure.

Review (2 of 2) The MOST appropriate way to dress and bandage an open abdominal wound with a loop of bowel protruding from it is to: apply a moist, sterile dressing to the wound and secure with an occlusive dressing. Rationale: Correct answer carefully replace the protruding bowel into the abdomen and cover the wound. Rationale: Never force a bowel back into the abdominal cavity.

Review A 22-year-old male was attacked by a rival gang and has a large knife impaled in the center of his chest. Your assessment reveals that he is apneic and pulseless. You should: carefully remove the knife, control any bleeding, begin CPR, and transport. stabilize the knife in place, provide rescue breathing, and transport at once. remove the knife and control any bleeding, apply the AED, and analyze his rhythm. begin CPR, control any external bleeding, and transport rapidly to a trauma center.

Review Answer: A Rationale: As a rule, impaled objects should be stabilized in place. However, if they interfere with the patient’s breathing or your ability to perform CPR, they should be removed. You cannot perform CPR on a patient if a knife is impaled in the center of the chest. Carefully remove the knife, control any bleeding, begin CPR, and transport at once. The AED is not indicated for patients with traumatic cardiac arrest; their arrest is usually caused by massive blood loss, not a primary cardiac dysrhythmia.

Review (1 of 2) A 22-year-old male was attacked by a rival gang and has a large knife impaled in the center of his chest. Your assessment reveals that he is apneic and pulseless. You should: carefully remove the knife, control any bleeding, begin CPR, and transport. Rationale: Correct answer stabilize the knife in place, provide rescue breathing, and transport at once. Rationale: The knife must be removed to provide effective CPR.

Review (2 of 2) A 22-year-old male was attacked by a rival gang and has a large knife impaled in the center of his chest. Your assessment reveals that he is apneic and pulseless. You should: remove the knife and control any bleeding, apply the AED, and analyze his rhythm. Rationale: An AED is not recommended in traumatic arrest, but CPR must be initiated. begin CPR, control any external bleeding, and transport rapidly to a trauma center. Rationale: The impaled object must be removed prior to the initiation of chest compressions.

Review Which of the following is considered a severe burn?
Any full-thickness burn 20% partial-thickness burn 10% full-thickness burn with abrasions 5% full-thickness burn with a fracture

Review Answer: D Rationale: Severe burns include the following: full-thickness burns involving the hands, feet, face, airway, or genitalia; full-thickness burns covering more than 10% of the body’s total surface area (BSA); partial-thickness burns covering more than 30% of the BSA; burns involving the respiratory tract (eg, smoke inhalation); burns complicated by fractures; and burns on patients younger than 5 years or older than 55 years that would otherwise be classified as “moderate” burns on younger adults.

Review (1 of 2) Which of the following is considered a severe burn?
Any full-thickness burn Rationale: A full-thickness burn is severe if it covers more than 10% of the body or involves the hands, face, feet, and genitalia. 20% partial-thickness burn Rationale: This burn must be greater than 30% BSA.

Review (2 of 2) Which of the following is considered a severe burn?
10% full-thickness burn with abrasions Rationale: This burn must be greater than 10% BSA. 5% full-thickness burn with a fracture Rationale: Correct answer

Review A 5-year-old boy was burned when he pulled a barbecue grill over on himself. He has partial- and full-thickness burns to his anterior chest and circumferentially on both arms. What percentage of his body surface area has been burned? 18% 27% 36% 45%

Review Answer: B Rationale: Using the pediatric rules of nines, the anterior chest accounts for 9% of the BSA (the entire anterior trunk, which includes the chest and abdomen, accounts for 18% of the BSA), and each arm accounts for 9% of the BSA. Therefore, this child has experienced 27% BSA burns.

Review (1 of 2) A 5-year-old boy was burned when he pulled a barbecue grill over on himself. He has partial- and full-thickness burns to his anterior chest and circumferentially on both arms. What percentage of his body surface area has been burned? 18% Rationale: 18% would indicate the patient’s arms only. 27% Rationale: Correct answer

Review (2 of 2) A 5-year-old boy was burned when he pulled a barbecue grill over on himself. He has partial- and full-thickness burns to his anterior chest and circumferentially on both arms. What percentage of his body surface area has been burned? 36% Rationale: The patient’s chest is 9% and both arms are 18%. 45% Rationale: The patient’s chest is 9% and both arms are 18%.

Review Which of the following statements regarding chemical burns is FALSE? Most chemical burns are caused by strong acids or alkalis. Fumes of strong chemicals can cause burns to the respiratory tract. Prior to removing a dry chemical, you should flush the area with sterile water. You should not attempt to neutralize an acid burn with an alkaline chemical.

Review Answer: C Rationale: Dry chemicals should be brushed off the patient before irrigating the wound with sterile water or saline. Failure to do so may increase the burning process and cause further tissue damage.

Review (1 of 2) Which of the following statements regarding chemical burns is FALSE? Most chemical burns are caused by strong acids or alkalis. Rationale: Chemical burns are caused by acids and alkalis. Fumes of strong chemicals can cause burns to the respiratory tract. Rationale: Chemicals are in the fumes and will cause respiratory tract burns.

Review (2 of 2) Which of the following statements regarding chemical burns is FALSE? Prior to removing a dry chemical, you should flush the area with sterile water. Rationale: Correct answer You should not attempt to neutralize an acid burn with an alkaline chemical. Rationale: It would take a chemist to perform this procedure. Too much alkaline would cause burning to the patient’s skin.

Chapter 26 Soft-Tissue Injuries Chapter 26: Soft-Tissue Injuries.

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Chapter 26 Soft-Tissue Injuries Chapter 26: Soft-Tissue Injuries.

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