25)Soft Tissue Injuries
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25)Soft Tissue Injuries

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25)Soft Tissue Injuries 25)Soft Tissue Injuries Presentation Transcript

  • Soft Tissue Injuries
  • Equipment
  • Dressing v Bandages
    • Dressings
    • Function
      • Stop bleeding
      • Protect the wound from further injury
      • Prevent further contamination/infection
    • Types
      • Universal dressings
      • 4X4 gauze pads
      • Adhesive-type
      • Occlusive
    • Bandages
    • Function
      • Holds dressings in place
    • Types
      • Self adherent
      • Gauze rolls
      • Triangular bandages/Cravats
      • Adhesive Tape
      • Air splint
  • Soft Tissue Injuries the Skin
  • Integumentary System Skin
    • Function
      • Largest organ system in the body
      • Protection from environment
      • Temperature regulation
      • Senses
        • Heat, Cold, Touch, Pressure, Pain, etc.
      • Vitamin D synthesis
      • Storage
    • Structure
      • Epidermis
        • Outermost layer
        • No blood vessels
        • Protection, absorption of nutrients homeostasis
      • Dermis
        • Deeper layer
        • Contains sweat/sebaceous glands, hair folicles, blood vessels, nerve endings
        • Gives skin its flexibility
      • Subcutaneous layer
        • Fat layer
        • Insulation, protective padding, energy storage
  • Soft Tissue Injuries Types
    • Closed
      • Skin is not broken
      • Underlying tissue damage
      • “Leaky vessels” = Edema
      • Contusion/Hematoma
    • Open
      • Any wound that breaks the skin
      • Slight scrapping of skin --- amputation
  • Closed Injuries
    • Contusion (Bruise)
      • Epidermis remains intact
      • Cells and vessels are damaged in dermis
      • Swelling and pain
      • Blood accumulated
    • Hematoma
      • Collection of blood beneath the skin
      • Larger tissue damage than contusion
      • Larger vessels are damaged
      • 1 + Liter of blood loss
    • Crush injuries
      • Crushing force applied to body
      • Internal organ rupture
      • Internal bleeding may be severe = Shock
  • Soft Tissue Injuries Closed Injuries Contusion Hematoma Crush Injury Hematoma
  • Care of Closed Injuries
    • BSI
      • Gloves
    • Airway control
    • Ventilation
    • If shock or internal bleeding suspected
      • Treat for shock
    • Splint painful, deformed, swollen extremities
    • Transport
  • Soft Tissue Injuries Open Injuries
    • Abrasion
      • Outermost layer of skin is sheered off
      • Painful even though superficial
      • No/very little oozing of blood
    • Laceration
      • Break in skin of varying depth
      • May be linear or non linear
      • Caused by forceful impact with sharp object
      • Bleeding may be severe
    • Avulsion
      • Flap of skin/tissue is torn loose or torn off
  • Soft Tissue Injuries Open Injuries Abrasion Laceration Avulsion
  • Soft Tissue Injuries Open Injuries
    • Penetration/Puncture
      • Caused by sharp pointed object
      • May be no external bleeding
      • Internal bleeding may be severe
      • Exit wound may/may not be present
        • I.e. Gunshot wound, Stab wound
    • Amputation
      • Cutting away from the body of a limb/protruding structure
      • Extremities and other body parts
      • Massive bleeding may be present OR
      • Bleeding may be controlled
    • Crush Injury
      • Damage to soft tissue and internal organs
      • May cause painful, swollen, deformed extremities
      • External bleeding may be present of absent
      • Internal bleeding may be severe
  • Soft Tissue Injuries Open Injuries Penetration/Puncture Amputation Crush Injury
  • Care of Open Injuries
    • BSI
      • Gloves – Gowns – Eye protection
    • Maintain airway/Ventilation
    • Expose the wound
    • Control bleeding
    • Prevent further contamination
    • Apply dry sterile bandage to wound
    • Secure in place
    • Keep pt calm/quiet
    • Treat for shock if S/S present
  • Special Cases: Chest/Abdomen/Impalement Penetrating Chest Injury GSW Evisceration Impaled Object Impaled Object Evisceration
  • Chest Injuries
    • Flail Segment
    • Traumatic Asphyxia
    • Pneumothorax
      • Open- “Sucking Chest Wound”
      • Closed
    • Hemothorax
    • Pericardial Tamponade
  • Flail Segment
    • Definition:
      • 4 or more ribs broken in 2 or more places
      • Results in an unstable chest
    • Presentation:
      • Paradoxical motion
        • Movement of flail segment inward with inspiration and outward with exhalation
      • “ Splinting”
        • Patient reduces motion of the chest wall
      • Dyspnea
      • Pain
    • Complications
      • Hemothorax
      • Pneumothorax
      • Abdominal organ laceration/rupture
    • Treatment
      • O2
      • Apply bulky trauma dressing to injured area and secure in place OR
      • Place patient with injured side down OR
      • Place padded board splint over injured area and secure to adjacent ribs
      • Assisted ventilations
  •  
  •  
  • Traumatic Asphyxia
    • Definition:
      • Severe compression of the thorax
      • Blood within the veins are drive into:
        • Upper Thorax, Neck, Brain
    • Presentation:
      • Sever swelling and ecchymosis of the face
      • “ Air hunger”
      • DCAP-BTLS to chest
    • Complications:
      • Underlying injury
    • Treatment:
      • O2
      • Positive pressure ventilation
      • Rapid transport
  • Pneumothorax
    • Definition:
      • Collection of air in the pleural space
      • Results in a collapsed lung
    • Types:
      • Open
        • Penetration of the chest
        • “ Sucking Chest Wound”
      • Closed
        • Pneumothorax without an open wound to the chest
      • Tension
        • Air entering the chest becomes trapped
        • Increases intrathoracic pressure
        • Collapses lung and shifts thoracic contents away from injury
        • Closed and open pneumothorax can present
  • Normal Anatomy Injury resulting in pneumothorax
  • Pneumothorax S/S, Treatment
      • S/S
        • SOB
        • Chest pain
        • Absent/diminished lung sounds on injured side
        • Subcutaneous emphysema
        • Cyanosis
        • Tracheal deviation
        • Profound shock
        • JVD
    • Complication:
      • Reduced surface area of lung =Hypoxia
      • Kinking of vena cavae = Reduced blood volume = Shock
    • Treatment:
      • O2
      • Ventilatory assistance if needed
      • See next slide for “Sucking Chest Wounds” if Open pneumothorax
      • Rapid transport
  • Sucking Chest Wound: Treatment
      • Cover with gloved hand initially
      • Ask patient to forcefully exhale
      • Place an occlusive dressing over the wound
      • Tape on 3 sides
  • Occlusive Dressing
  • Complete Seal with an Occlusive Dressing
  • Hemothorax
    • Definition:
      • Injured blood vessel in thorax
      • Blood accumulates in pleural space
    • Presentation:
      • Pneumothorax S/S
      • Shock
      • Flat neck veins
      • Diminishes/distant lung sounds
      • Tachypnea
    • Complication:
      • Shock
      • Cardiac collapse/arrest
    • Treatment:
      • O2
      • Treatment for shock
      • Rapid transport
  • Pericardial Tamponade
    • Definition:
      • Collection of blood/fluid in the pericardium
    • Presentation:
      • Beck’s Triad
        • Muffled heart sounds
        • Narrowing pulse pressures
          • Systolic BP- Diastolic BP
          • 40mmHg or less
        • Shock
      • Pulsus Paradoxus
        • A BP drop of 1OmmHg on inhalation
    • Complications:
      • Decreased stroke volume
      • Shock
      • Cardiac collapse/arrest
    • Treatment:
      • O2
      • Prepare for arrest
      • Rapid transport
  • Abdominal Injuries: Evisceration
      • Definition:
        • Organs protruding through wound
      • Treatment:
        • DO NOT TOUCH OR REPLACE the organ
        • Cover with a sterile dressing moistened with sterile water
        • Cover with a dry sterile dressing and tape in place
        • Cover with plastic wrap
        • Tape completely around the border of the dressing
        • Flex the pts hips and knees, if uninjured
  •  
  • Impaled Objects
    • DO NOT REMOVE unless:
      • It is in the cheek
        • Bleeding control inside and outside of cheek
        • Keep suction ready
      • Would interfere with chest compressions
      • Interferes with transport
    • Treatment:
      • Manually secure the object
      • Expose the wound area
      • Control bleeding
      • Use a bulky dressing to help stabilize the object
  • Soft Tissue Injuries Amputations/Neck Wounds Open neck wound Air embolism…
  • Amputations/Neck Wounds Treatment
    • Amputations
      • Concerns for reattachment
      • Wrap the part in a sterile dressing
      • Wrap or bag the part in plastic and keep cool
      • Transport part with the pt
      • DO NOT COMPLETE PARTIAL AMPUTATIONS
      • Immobilize to prevent further injury
    • Large open neck injuries
      • May cause air embolism
      • Cover with an occlusive dressing
      • Compress carotid artery ONLY if NECESSARY to control bleeding
  • Eye Injuries
    • Impaled Objects:
      • NEVER REMOVE
      • Stabilize object with several 4X4s
      • Cover with paper cup/cardboard cone
      • Have patient close other eye OR dress it as well.
  • Burns
    • Sources
      • Thermal – Electrical - Chemical
    • Types
      • Superficial (1 st degree)
        • Upper level of the skin (epidermis)
        • Redness and pain
          • Sunburn
      • Partial Thickness (2 nd degree)
        • Upper and lower level of skin (Epidermis/Dermis)
        • Does not involve underlying tissue
        • White to red skin
        • Moist to mottled
        • BLISTERS
        • VERY painful
      • Full Thickness (3 rd degree)
        • Extension through upper and lower layers of skin
        • May involve subcutaneous layers, muscles, or bone
        • Black/charred red, Yellow/Brown, Dark red, White/Translucent
        • Hard to touch
        • Little pain, pain from associated 1 st and 2 nd degree burns
  •  
  •  
  •  
  • Burn Severity Rule of 9’s
    • Depth of burn
      • Superficial
      • Partial thickness
      • Full thickness
    • Percentage of body surface burned
      • Rule of 9’s
      • Pt palm = 1%
      • Adult
        • Head and neck = 9%
        • Each upper extremity= 9%
        • Anterior trunk = 18%
        • Posterior trunk = 18%
        • Each lower extremity = 18%
        • Genitalia= 1 %....
      • Child
        • Head and neck = 18%
        • Each upper extremity= 9%
        • Anterior trunk = 18%
        • Posterior trunk = 18%
        • Each lower extremity = 14%
    • Depth of burn
      • Superficial
      • Partial thickness
      • Full thickness
    • Percentage of body surface burned
      • Rule of 9’s
      • Pt palm = 1%
      • Adult
        • Head and neck = 9%
        • Each upper extremity= 9%
        • Anterior trunk = 18%
        • Posterior trunk = 18%
        • Each lower extremity = 18%
        • Genitalia= 1 %....
      • Child
        • Head and neck = 18%
        • Each upper extremity= 9%
        • Anterior trunk = 18%
        • Posterior trunk = 18%
        • Each lower extremity = 14%
  •  
  • Burn Severity Cont’d
    • Location
      • Face
      • Upper airway
      • Hands
      • Feet
      • Genitalia
    • Pre existing medical conditions
    • Age of pt
      • Less than 5 y/o
      • Greater than 55 y/o
  • Criticality of Burns
    • CRITICAL BURNS
    • Body Surface Area
      • Full thickness – 10%
      • Partial thickness- 30%
    • Location
      • Full thickness Hands/Feet
      • Burns assoc with resp. injury
    • Complications
      • Burns encompassing any body part
        • i.e. –Leg, -Arm, -Chest
      • Painful, swollen, deformed extremity
    • Age
      • Moderate burns of
        • Young Children
        • Elderly pts
    • Moderate Burns
    • Body Surface Area
      • Full thickness- 2-10%
        • Excludes: - Hands –Feet – Face –Genitalia – Respiratory tract
      • Partial Thickness- 15-30%
      • Superficial burn – Greater than 50%
    • Minor Burns
    • Body Surface Area
      • Full thickness- 2-10%
        • Excludes: - Hands –Feet – Face –Genitalia – Respiratory tract
      • Partial Thickness- 15-30%
      • Superficial burn – Greater than 50%
  • Burn Care
    • Stop the burning process, initially with water/saline
    • Remove smoldering clothing/jewelry
    • BSI
    • CONTINUALLY monitor airway for compromise
    • Prevent further contamination
    • Cover the burned area with a DRY sterile dressing
    • Do no use any lotion, ointment, or antiseptic
    • Do not break blisters
    • Transport
    • Refer to local protocols for transport decision
  • Electrical Burns
    • SCENE SAFE
      • Do not remove pt from source unless trained to do so
      • If pt still in contact with source or you are unsure… DON’T touch the pt
    • Emergency Care
      • O2
      • Monitor CLOSELY for respiratory and/or cardiac arrest
      • Often more severe than external indications
      • Treat associated soft tissue injuries
      • Note entrance and exit wounds
  • Chemical Burns Care
    • SCENE SAFETY
    • BSI
    • Emergency Care
      • Dry Powders = Brush off
      • Flush with large amounts of water
        • 20 minutes
      • Continue flushing area while en route
      • Do not contaminate uninjured areas
  • Soft Tissue Injuries Infant/Child Considerations
    • Concerns
      • Greater surface area v body size
      • Greater fluid/heat loss
      • Higher risk of
        • Shock
        • Hypothermia
        • Airway compromise
      • Consider possibility of child abuse
    • Critical Burn Values
      • Critical
        • Full Thickness OR Partial thickness – greater than 20%
        • Hands, feet, face, genitalia, or airway
      • Moderate
        • Partial thickness greater than 10-20%
      • Minor Partial thickness – less than10%
  • Now go and treat soft tissue injuries…. Reason #1 why you’re supposed to wear a helmet!