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Soft-Tissue Injuries.

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Presentation on theme: "Soft-Tissue Injuries."— Presentation transcript:

1 Soft-Tissue Injuries

2 Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves

3 Major functions of the skin
Protection Water balance Temperature regulation Excretion Shock absorption Layers Epidermis Dermis Subcutaneous

4 Closed wounds Internal injury, impact from blunt object Types Contusion Hematoma Larger blood vessels Crush injury severe bleeding and shock

5 Patient Assessment MOI and presence of shock Care Standard precautions ABCs and O2 Splint painful, swollen, deformed extremities Be observant for vomiting Monitor for shock Rapid Transport

6 Open Wounds Abrasions Lacerations Punctures penetrating perforating; entrance and exit wound Avulsions

7 Amputation Crush injuries Care Standard precautions Initial assessment ABCs Severe bleeding

8 Expose the wound Clean Control bleeding If serious, care for shock Prevent further contamination Bandage after bleeding controlled Keep pt. still and reassure In addition

9 Abrasions and lacerations
*Check PMS *Distal injury Puncture Wounds *May go to bone *May cause serious internal bleeding *GSW can fx. Bone, causing extensive sof-tissue and injury to organs

10 *Immobilize the spine when patient’s head is injured
*Transport Impaled Objects *Do not remove or put pressure on the object *Stabilize *If needed contact medical direction *Care for shock *Keep Pt. at rest

11 *Transport carefully and ASAP
Objects impaled in the cheek *If possible remove same direction it entered *If not possible turn for drainage *Suction as needed *Dress outside, taking care material doesn’t enter airway

12 *Monitor mental status
*Care for shock Eye Injury; puncture/impaled object *Stabilize; cup or cone *Dress and bandage uninjured eye Reassure and provide emotional support

13 Avulsions *Clean *Gently fold the skin back in position *Control bleeding *Dress using bulky pressure dressing

14 *Saving an avulsed part
Amputations *Control bleeding bulky pressure dressing *Amputated parts

15 Wounds to the neck *Bleeding control *Remember the characteristics of bleeding arterial venous *Danger of air embolism

16 Care Airway Place gloved hand over wound Occlusive dressing Place dressing over occlusive dressing If needed apply direct pressure do not apply pressure to both carotids at the same time

17 Once bleeding is controlled
bandage; do not restrict airway, or arteries and veins when doing so If MOI indicates, immobilize

18 Chest Injuries Pericardial Tamponade Flail chest Sucking chest wound Spontaneous pneumothorax Pneumothorax Subcutaneous Emphysema

19 Chest Injuries Blunt trauma Penetrating trauma Compression Flail Chest Paradoxical motion

20 Pt. Assessment MOI Signs of shock and hypoxia Pt. may become fatigued Care Initial assessment Airway management and O2 Stabilize with bulky dressing Carefully monitor

21 Open Chest Injuries; *Skin of chest wall is broken *Considered to be life-threatening *Assess for perforating puncture wound and treat accordingly

22 Sucking chest wound Care May be gasping for air BLS as indicated Seal O2 Care for shock Rapid transport on injured side if possible

23 Pneumothorax Diminished lung sounds JVD Tracheal deviation Shock Spontaneous pneumothorax

24 Hemothorax and hemopneumothorax
Vessels rupture Extensive bruising of face and neck May have bulging eyes, JVD, broken blood vessels in face Signs of shock

25 Traumatic Asphyxia Sudden compression of the chest Severe pressure on the heart and lungs forcing blood out of the right atrium and up into the jugulars Bulging eyes, distended neck veins, and broken blood vessels in the face

26 Cardiac Tamponade Blood in the pericardial sac JVD Signs of shock Narrowing pulse pressure

27 Aortic injury and dissection
penetrating trauma Dissection blunt trauma; deceleration injury May complain of pain in chest, abd or back Signs of shock Different pulse/b/p in Right/left arm/leg Do not palpate any pulsating mass

28 Subcutaneous emphysema

29 Abdominal injuries Evisceration Signs and symptoms of abdominal injuries Pain; mild – intolerable Cramps Nausea Weakness Thirst Obvious lacerations and puncture wounds

30 Laceration and puncture wounds to the middle and lower back or chest wounds near the diaphragm
Large bruised area Intense bruise on the ABD Signs of shock coughing or vomiting of blood Rigid or tender ABD ABD distension Lies still with legs drawn

31 Care Monitor for and manage vomiting Airway Position on back with legs flexed O2 Care for shock NPO Monitor vs

32 Control external bleeding and dress all wounds
Do not touch or replace eviscerated parts Do not remove any impaled objects Leave patients legs in place

33 Burns Patient Assessment Classified in three ways Agent and source Depth Severity

34 Agent and source Never assume Gather information scene size-up bystanders patient interview

35 Depth Superficial {1st degree} Epidermis Reddening Possibly swelling

36 Partial thickness burn
Dermis Intense pain Noticeable reddening Blisters Mottled appearance

37 Full thickness All layers Charred black or brown or areas that are brown or white

38 Layers: Epidermis: Outermost most layer Dermis: Deeper layer of the skin; contains sweat and sebaceous glands, hair follicles, blood vessels, and nerve endings Subcutaneous: The third layer of human skin is called the subcutaneous (meaning “under the skin”) fatty layer. It is made up of fat cells, connective tissue, and blood vessels. It also contains hair roots, from which hair growth takes place. The fat in this layer supplies nutrients to the other two layers. It also cushions the body and protects it from the cold.

39 Severity Agent or source Body region groin, genitalia, buttocks can be serious Circumferential burns can be very serious Depth Extent of burn rule of nines Age infants, children <5 and adults >55 are at greatest risk for death

40 Other illnesses and injuries
heart disease, respiratory dis., diabetes Classifying burns by severity Order and type of care, order of transport and destination Infants at higher risk of shock, airway compromise and hypothermia

41 Treating specific types of burns
Thermal burns Dry, sterile dressing Never apply ointment, spray or butter Never break blisters Do not apply ice Keep clean Keep pt. warm

42 Chemical burns Scene safety Requires immediate care Flush; copious amts. Of water at least 20 min. Remove all jewelry and clothing without contaminating other areas of body without contaminating yourself

43 If dry chemical, brush off
Apply sterile dressing or burn sheet Treat for shock Transport Chemical burns to eyes Immediately flush avoid flushing contaminate to other eye

44 Flush medial to lateral
Flush for at least 20 minutes After washing, cover eyes with moistened pads If reoccurring burning or irritation, flush another 5 minutes

45 Specific chemical burns
Mixed or strong acids Unidentified substances Continue flushing even if pt. c/o no pain/discomfort Dry lime Brush Take care not to contaminate eyes

46 Flush only after lime has been brushed away from body; should be done quickly and continuously
Carbolic acid embalming fluid; herbicides Do not mix with water If available use alcohol for initial flush then flush with water

47 Sulfuric acid Heat is produced but preferable to flush other than leaving on skin Hydrofluoric acid Even if burns aren’t evident, flush Rapid transport to find neutralizing agent

48 Inhaled vapors High concentration O2 Rapid transport

49 Electrical Injuries Electrical current Lightning Skin is burned where current entered and where it flows to the ground Tissue damage along the path Chemical Δs takes place in nerves, heart and muscle

50 Scene safety Make sure source of electricity is still active until a qualified person tells you otherwise Do not attempt rescue unless trained and have necessary equipment and personnel

51 Pt. Assessment Burns {entrance and exit wounds} Paralysis disrupted nerve pathways Muscle tenderness, with or without muscle twitching Respiratory distress, or failure, or arrest Irregular heartbeat or cardiac arrest

52 Elevated B/P or hypotension with s/s of shock
Restless or irritability if conscious Loss of consciousness Visual difficulties Fractures and dislocations from severe muscle contractions or from falling Seizures; in severe cases

53 Care Airway care may be swelling Cardiac arrest management Care for shock O2 Care for spinal; head injuries and fractures Serious pts should be fully immobilized

54 Elevate electrical burns
Cool the burn areas and any smoldering clothing the same as for a flame burn Apply dry, sterile dressing to burn sites Rapid transport

55 Dressing and bandaging
Bandage Dressing open wounds Standard precautions Do not remove unless to control bleeding

56 Bandaging Not too tight, not too loose Do not cover tips of fingers or toes When bandaging a joint, do not bend once wrapped


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