1. Soft-Tissue Trauma

2. State Standards
8) Outline basic concepts of normal structure and function of all body systems, and explain how homeostasis is maintained.
16) Understand principles of and successfully perform skills related to Emergency Medicine, incorporating rubrics from the American Heart Association or American Red Cross for the following: a. Basic First Aid care of bleeding and wounds b. Basic First Aid care for burns c. Basic First aid for bone and joint injuries

3. Objectives
Students will examine the different types of soft tissue injuries
Students will examine the different burn stages, and structures effected.
Students will demonstrate knowledge of burn body surface calculations through case study scenarios
Student will demonstrate knowledge of burn stages and soft tissue injuries through creation of soft tissue injury models

4. Incidence, Mortality, and Morbidity
Soft tissue can be injured by:
Blunt injury
Penetrating injury
Burns
Soft-tissue trauma is the leading form of injury.

5. Structure and Function of the Skin
Skin: complex organ with crucial role in homeostasis
Protects underlying tissue from injury
Aids in temperature regulation
Prevents excessive water loss
Acts as sense organ

6. Discussion In a small group discuss
How can soft tissue injuries affect homeostasis?
What problem can soft tissue injuries cause body systems other than the integumentary system? Name at least 2 other systems that can be indirectly affected.

7. Closed vs. Open Wounds
Closed-Soft tissue is damaged but skin is not broken
Characteristic closed wound is a contusion.
Characterized by disruption in the skin
Open-Potentially more serious than closed wounds
Vulnerable to infection
Greater potential for serious blood loss

8. Closed vs. Open Wound

9. Hematoma Collection of blood under the skin or in a cavity of the body
Due to vessel injury
Bleeding under the skin
Creates the appearance of a large extremely painful bruise

10. Hematoma

11. Skin injury Classifications

12. Activity
Create a 3D model, using the provided materials, of a laceration and one other skin injury of your choice. Make sure you are including the 3 layers of skin and skin structures found in each layer within your model. Create an education brochure over each type of injury. Include the description of the injury, a drawing of the injury, and what skin layers were affected.

13. Burns and Body Surface Area

14. BURNS
Wounds caused by exposure to: 1. excessive heat 2. Chemicals 3. fire/steam 4. radiation 5. electricity
3 Classifications of Burns
1st Degree (epidermis)
2nd Degree
(epidermis, dermis)
3rd Degree
(all 3 layers)
We will discuss these in further detail tomorrow
4/1/2011

15. BURNS Results in 10-20 thousand deaths annually
Survival best at ages 15-45
Children, elderly, and diabetics
Survival is best when burns cover less than 20% of TBA
4/1/2011

16. Discussion Questions
4/1/2011
In a small group discuss these questions Apply what you already know about the integumentary system. Why are burns so dangerous? How do they affect homeostasis? Why do you think a person has a better survival rate when they have less than 20% burned and are between the ages of 15-45?

17. RULES OF NINES Superficial burns are not involved in the calculation
Head & Neck = 9%
Each upper extremity (Arms) = 9%
Each lower extremity (Legs) = 18%
Anterior trunk= 18%
Posterior trunk = 18%
Genitalia (perineum) = 1%
4/1/2011

18. 4/1/2011

19. Activity
4/1/2011
In your small group complete the Step by Step Burn Scenario Case Study
Once you complete the step by step burn case study….
With a partner come up with a burn scenario.
How was the patient burned?
To what degree was the patient burned?
Where was the patient burned and to what extent?
Present your burn case to the class and we will try to calculate the Total Body Surface burned on your patient.
Once we determine the TBSA burned create a plan of care for that patient.

20. Classifying Burns

21. BURN WOUND ASSESSMENT
Classified according to depth of injury and extent of body surface area involved
Burn wounds differentiated depending on the level of dermis and subcutaneous tissue involved
1. superficial (first-degree)
2. deep (second-degree)
3. full thickness (third and fourth degree)
4/1/2011

22. 4/1/2011

23. SUPERFICIAL BURNS (FIRST DEGREE)
Epidermal tissue only affected
Erythema, blanching on pressure, mild swelling
no vesicles or blister initially
Not serious unless large areas involved
i.e. sunburn
4/1/2011

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25. 4/1/2011

26. SECOND DEGREE
*Involves the epidermis and deep layer of the dermis Fluid-filled vesicles –red, shiny, wet, severe pain Hospitalization required if over 25% of body surface involved i.e. tar burn, flame
4/1/2011

27. 4/1/2011

28. FULL THICKNESS (THIRD/FOURTH DEGREE)
Destruction of all skin layers
Requires immediate hospitalization
Dry, waxy white, leathery, or hard skin, no pain
Exposure to flames, electricity or chemicals can cause 3rd degree burns
4/1/2011

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30. 4/1/2011

31. Discussion questions In a small group discuss
4/1/2011
In a small group discuss
Apply what you know about the different layers of skin and classifications of burns, which burns cause pain and which do not? Why?
Why would you not want to burst a burn blister? What does that have the potential to cause?

32. Activity
Use the provided materials to create a model of a 2nd and 3rd degree burn. Make sure you include the differences between the 2 in your representation.
Be careful to protect your clothing

33. First Aid for Injuries

34. State Standards
16) Understand principles of and successfully perform skills related to Emergency Medicine, incorporating rubrics from the American Heart Association or American Red Cross for the following: a. Basic First Aid care of bleeding and wounds b. Basic First Aid care for burns

35. Objectives
Students will determine the best first aid care and dressing for the type of injury
Students will examine emergency care specific to controlling bleeding in soft tissue injuries

36. Scene Size-Up Address safety first.
Determine the number of patients involved.
Protect yourself and patient from bodily fluid.

37. Primary Assessment Airway and breathing Assess immediately.
Correct anything that interferes with airway.
Assess the patient’s breathing.
Take prompt action for compromised breathing.
Try to control bleeding

38. Control of External Bleeding
Bleeding can be characterized by type of blood vessel damaged.
Capillary bleeding—slow flow, bright or dark red
Venous bleeding—slow, steady, darker color
Arterial bleeding—spurts, bright red color

39. Control of External Bleeding
Direct pressure
Allows platelets to form blood clots
To apply pressure cover the injury with a clean dressing and press down hard.
If bleeding is not controlled, apply a tourniquet.

40. Control of External Bleeding
Tourniquet
Especially useful if:
Extremity injury below the axilla or groin is severely bleeding.
Other bleeding control methods are ineffective.
Courtesy of Steven Kasser

41. Control of External Bleeding
Tourniquet (cont’d)
Follow standard precautions.
Hold direct pressure over bleeding site.
Place tourniquet above the bleeding site.
Click the buckle into place.
Turn the tightening dial clockwise until pulses are no longer palpable distal to the tourniquet.

42. Control of External Bleeding
Tourniquet (cont’d)
To release the tourniquet, push the release button and pull the strap back.
If a commercial tourniquet is not available, use a triangular bandage and a stick or rod.
A blood pressure cuff can also be used.

43. Control of External Bleeding
Tourniquet (cont’d)
Take the following precautions:
Do not apply over a joint.
Use the widest bandage possible.
Never use material that could cut into the skin.
If possible, use wide padding under the tourniquet.

44. Discussion
Why is it important to size up a scene if you are giving emergency care?
How does the process of apply direct pressure decrease bleeding? What structures are being affected?
If you apply a tourniquet, why would you not cover it with a dressing?

45. Bandaging and Dressing Wounds
Used to:
Cover wound
Control bleeding
Limit motion
Always use as sterile technique as possible.
Irrigate open wounds with normal saline.
Apply antibiotic ointment to smaller wounds.
Do not use ointment on larger wounds.

46. First Aid for Burns 1st –Assess if the scene is safe, Call 911
2nd If the fire is not already out extinguish it following RACE and PASS protocols
3rd. Ensure that the airway is ok
4th Cover the burn wounds to help prevent infection (DO NOT REMOVE CLOTHING)
5th Provide emotional support

47. DRESSING A BURN WOUND
After burn wounds are cleaned and debrided, topical antibiotics are applied to prevent infection
Standard wound dressings are multiple layers of gauze applied over the topical agents on the burn wound
4/1/2011

48. Discussion questions In a small group discuss
4/1/2011
In a small group discuss
Which do you believe are the most important steps in the emergency care of a burn patient?
Why would you not want to remove burned clothing?

49. Activity
In small group create a skit that details a soft tissue injury.
You will need a patient, and emergency personel
A scenario of how the patient got hurt
The proper PPE to care for the injury
Walk the audience through how you will give the patient emergency care.
Write a short explanation of why the care you gave was correct and needed.

50. Activity
Practice applying a bandage with a partner