1. Soft Tissue Injury

2. The Skin

3. External Bleeding BSI-always!!!! Severity of blood loss: Amount Rate
Other injuries or existing conditions
Existing medical conditions
Patients age

4. Estimated Blood Volume
Normal adult-70 ml/kg
Infants & children-80 ml/kg
A 200 ml blood loss in adult only is a 4% loss, but in an infant would be 25%.

5. Remember –severity of blood loss is a percentage of how much blood is estimated to be lost, but don’t get focused on how much rather than what signs & symptoms your patient is showing.

6. Airway & Breathing take priority
Need to control bleeding, but do not get tunnel vision. Remember the basics first
Scene Size-up
Primary
Secondary
Airway & Breathing take priority

7. Types of Bleeding

8. Controlling Bleeding Direct Pressure Tourniquets Bandages
Fingertip pressure
If foreign object seen, secure in place and place dressing around area. DO NOT remove unless affecting airway
Tourniquets

9. Scene Size-up, Primary Assessment, and Rapid Secondary Assessment
Standard Precautions
Scene safety
General impression
Control significant bleeding
ABCs
Apply O2
Rapid secondary assessment
Obtain vital signs

10. Factors that increase bleeding
Movement
Low body temperature
Medications
Intravenous fluids
Removal of dressings & bandages

11. PASG pneumatic antishock garment
Contraindications
Indications
Suspected pelvic fracture with hypotension <90 mmHg
Suspected intraperitoneal hemorrhage <90 mmHg
Penetrating thoracic trauma
Splinting of lower extremity fractures
Eviscerated abdominal organs
Impaled object in abdomen
Pregnancy
Cardiopulmonary arrest
CHF
Pulmonary Edema
Once placed, do not remove with medical control authorization

13. Wound-injury to the skin and underlying tissues Wounds categories
Closed
Open
Single
multiple

14. Closed Injuries
Hematoma
Contusion
Ecchymosis

15. Open Injuries

16. Abrasions Caused by scraping, rubbing, or shearing
Considered to be superficial
Very painful
Can be life threatening
Not necessarily to injury but potential for infection, contamination, & potential for other life threatening injuries

17. Lacerations Break in skin May be linear or stellate (irregular) Linear
Knife
Razor
Broken glass
Edges smooth
Stellate
Blunt objects
Edges are jagged

18. Avulsions
Loose flap of skin & underlying tissue that is torn loose or pulled completely off
Bleeding may be severe
Healing prolonged
Extensive scarring

19. Amputations
Disruption of the continuity of an extremity or other body part
Ripping or tearing
Incomplete amputation will bleed more than a complete
Always consider shock

20. Punctures & Penetrations
Result of sharp, pointy object
May be little, but underlying damage may be worst
Stab wounds
May be small & undetectable
Remember underlying internal damage
Gunshot wounds
Entrance and exit sites
Entrance will be smaller
Exit larger and will be bleed profusely
Assess for more than one wound and remember underlying internal damage

21. Crush Injuries Caused by blunt trauma or crushing forces
May not appear serious
May be swollen, painful, & deformity
External bleeding minimal or even absent
Always suspect internal bleeding
Walking wounded

22. Combination of crush and penetration injury
Bites
Dog bites most common
Complications
Infection
Cellulitis
Septicemia
Rabies
Tetanus
Combination of crush and penetration injury

23. Clamping injury
Body part that is caught in machinery
Time is key

24. Assessment Scene size up & primary assessment Secondary assessment
Emergency medical care
Reassessment

25. Special Considerations
Chest injuries
Abdominal injuries
Impaled objects
Amputations
Large open injuries

26. Dressings & Bandages Dressings Bandages Pressure dressings Gauze pad
Self adhering dressing
Universal or multitrauma dressing
Occlusive dressing
Bandages
Self adhering
Gauze rolls
Triangular bandage
Air splint
Pressure dressings

27. General principles of dressing & bandages
No hard or fast rules
Must adapt to what is available
Conditions
Clean
Do not tape in place until bleeding controlled
Must cover wound
Attempt to remove all jewelry
Do not leave too loose
Do not wrap too tightly
If covering small wound on extremity, wrap larger area
Once positioned, leave where it is
Tourniquet if unable to control bleeding