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Ch26 soft tissue

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Emergency Education Training Center

EETC - Soft-Tissue Trauma

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Emergency Care CHAPTER Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe THIRTEENTH EDITION Soft-Tissue Trauma 26
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Topics • Soft Tissues • Closed Wounds • Open Wounds • Treating Specific Types of Open Wounds • Burns • Electrical Injuries • Dressing and Bandaging
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues • Skin • Fatty tissues • Muscles • Blood vessels • Connective tissues • Membranes • Glands • Nerves
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues Soft tissues.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues • Major functions of the skin  Protection  Water balance  Temperature regulation  Excretion  Shock (impact) absorption continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Skin
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds • Internal injuries with no pathway from the outside to the injured site • Although skin unbroken, may be extensively crushed tissues beneath • Range from minor to life-threatening continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds • Contusions  Bruise • Hematomas  Similar to contusion  More tissue damage  Involves larger blood vessels continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds • Closed crush injuries  Excessive force crushing or rupturing internal (generally solid) organs • Blast injuries  Can include open and close wound types  Potential for massive internal damage is higher than with direct-force trauma.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds Closed wounds.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Assessment • Bruising may be indication of internal injury or internal bleeding. • Consider mechanism of injury. • Crush injuries are difficult to identify.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Take appropriate Standard Precautions • Manage airway, breathing, and circulation • Always manage as if there is internal bleeding and shock if there is any possibility of internal injuries continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Splint extremities that are painful, swollen, or deformed • Stay alert for vomiting • Continuously monitor for changes and transport • Apply cold pack to isolated injuries to manage pain and swelling
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Open Wounds
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Types of Open Wounds • Abrasions • Lacerations • Penetrating trauma and punctures continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Types of Open Wounds • Avulsions • Amputations
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Types of Open Wounds • Open crush injuries • Bite wounds • Blast injuries • High-pressure-injection injuries
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Think About It • Does an open wound necessitate using more than just gloves as Standard Precautions? • Can an open injury affect the patient's airway or breathing?
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Emergency Care for Open Wounds • Strict attention to Standard Precautions  In addition to wearing gloves, a gown and protective eyewear may be required. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Expose wound. • Clean surface of wound. • Control bleeding. • For all serious wounds, provide care for shock, including administration of high- concentration oxygen. • Prevent further contamination. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Bandage dressings in place after bleeding is controlled. • Keep patient lying still. • Reassure patient.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Open Wounds
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Abrasions and Lacerations • Reduce wound contamination • Hold direct pressure to control bleeding • Always check pulse, motor, and sensory function distal to injury to assure function
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Penetrating Trauma • Use caution as objects may be embedded deeper than they appear. • Check for exit wounds.  May require immediate care • Bullets can fracture bones as they enter. • Stab wounds are considered serious if in a vital area of body. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Penetrating Trauma • Reassure patient. • Search for exit wound. • Assess need for basic life support. • Follow local protocols regarding spinal immobilization. • Transport patient.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Penetrating Trauma Bullets travel in an unpredictable path once they are inside the patient’s body and can therefore cause damage to multiple organs and bones.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Penetrating Trauma A gunshot wound to the right flank. © Edward T. Dickinson, MD
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Impaled Objects • Do not remove object; may cause severe bleeding. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Impaled Objects • Expose wound area. • Control profuse bleeding by direct pressure. • Apply several layers of bulky dressing so dressing surrounds the object on all sides. • Secure dressings in place. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Impaled Objects • Care for shock. • Keep patient at rest. • Provide rapid transport. • Reassure patient throughout all aspects of care.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Impaled Objects Stabilize an impaled object with bulky dressings.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Impaled Objects Bandage the impaled object and surrounding dressings in place.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Object Impaled in the Cheek • Take care that object does not enter oral cavity, causing airway obstruction. • If cheek wall is perforated, profuse bleeding into mouth and throat can cause nausea and vomiting. • External wound care will not stop the flow of blood into the mouth. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Object Impaled in the Cheek • Examine wound site, both inside and outside mouth • If you find the perforation and can see both ends, remove object.  If this cannot be easily done, leave object in place.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Impaled Object in Cheek The process of removing an impaled object from the cheek.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Object Impaled in the Cheek • Position patient to allow for drainage. • Monitor patient's airway. • Dress outside of wound. • Provide oxygen and care for shock.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Puncture Wound or Object Impaled in the Eye • Stabilize the object. • Apply rigid protection. • Have another rescuer stabilize dressings and cut while you secure them in place with self-adherent roller bandage or with wrapping of gauze.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Puncture Wound or Object Impaled in Eye Managing an object impaled in the eye.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Puncture Wound or Object Impaled in Eye Managing an object impaled in the eye.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Puncture Wound or Object Impaled in the Eye • Dress and bandage uninjured eye. • Consider need for oxygen and care for shock. • Reassure patient and provide emotional support.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Avulsions • Clean wound surface. • Fold skin back into normal position. • Control bleeding and dress with bulky dressings. • If avulsed parts are completely torn away, save in sterile dressing and keep moist with sterile saline.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Amputations • Take steps to control hemorrhage immediately. • Apply direct pressure to control bleeding; use tourniquet only if all other methods fail.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Amputations Care for an amputated part. The amputated digit sits on sterile-saline-soaked gauze, awaiting reimplantation. © Edward T. Dickinson, MD
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Amputations • Wrap amputated part in sterile dressing, and secure dressing with self- adhesive gauze bandage. • Then wrap or bag amputated part in plastic bag; keep it cool by cold pack. • Do not immerse amputated part directly in water or saline.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Genital Injuries • Control bleeding. • Preserve avulsed parts. • Consider if injury suggests another, possibly more serious, injury. • Display calm, professional manner. • Dress and bandage wound. • Consider possibility of sexual assault.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Burns
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Burns • May involve more than just skin-level structures • If respiratory structures are affected, swelling may occur, causing life- threatening obstruction. • Do not let burn distract from spinal damage or fractures.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Assessment • Classifying burns  Agent and source  Depth  Severity
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Agent and Source • Such as chemicals or electricity • Report the agent and, when practical, the source of the agent.  Never assume the agent or source of the burn.  Always gather information from your observations of the scene, bystanders' reports, and patient's interview.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Assessment: Burns Burns are classified by depth.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Depth • Superficial burn (1st degree)  Involves only epidermis  Reddening with minor swelling • Partial thickness burn (2nd degree)  Epidermis burned through, dermis damaged  Deep, intense pain  Noticeable reddening  Blisters and mottling continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Depth • Full thickness burn (3rd degree)  All layers of skin burned  Blackened areas surrounded by dry and white patches
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Superficial Burn A superficial burn. © Edward T. Dickinson, MD
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Partial Thickness Burn Partial thickness burns. © Edward T. Dickinson, MD
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Partial Thickness Burn Partial thickness burns. © Edward T. Dickinson, MD
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Full Thickness Burn A full thickness burn. © Edward T. Dickinson, MD
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining the Severity of Burns • Consider the following factors:  Agent or source of the burn  Body regions burned  Depth of the burn  Extent of the burn  Age of the patient  Other illnesses and injuries continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining the Severity of Burns • Rule of Nines  Helps estimate extent of burn area (BSA)  Adult body is divided into 11 main areas  Each represents 9 percent of body surface
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Burns: Severity
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Practice Rule of Nines
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Severity • Must be classified to determine:  Order and type of care  Order of transport  Maximum information to provide to the emergency department.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Geriatric Note • A moderate burn in a young adult can be fatal to a geriatric adult.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Pediatric Note • Infants and children have a much greater relationship of body surface area to total body size, resulting in greater fluid and heat loss from burned skin.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for thermal burns  Stop burning process and cool burned area.  Ensure open airway and assess breathing.  Look for signs of airway injury.  Complete primary assessment.  Treat for shock. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for thermal burns  Evaluate burns by depth, extent, and severity.  Do not clear debris.  Remove clothing and jewelry.  Wrap with dry sterile dressing.  For burns to hand or feet, remove patient's rings or jewelry and separate fingers or toes with sterile gauze pads. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for chemical burns  Wash away chemical with copious amounts of flowing water.  If dry chemical, brush away, then flush with water.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Chemical Burns For a chemical burn, brush away dry powders.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Chemical Burns Then flood the area with water.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for chemical burns  Remove contaminated clothing.  Apply sterile dressings.  Treat for shock.  Transport.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Radiological Burns • Exposure to high levels of radiation can harm the human body both immediately and in a delayed fashion. • Great number of sources of radiation  Difficult to detect without specific monitoring equipment continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Radiological Burns • Extremely harmful  Do not approach a radiological injury without protective equipment and specialized training.  See patient with a radiological burn only after they have been decontaminated. • Most will present like thermal injuries.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Electrical Injuries
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Electrical Injuries • Severe damage through body by disrupting nerve pathways • Entry and exit burns are possible. • Respiratory/cardiac arrest are possible. • Bones may fracture from violent muscle contractions.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Provide airway and breathing care. • Provide basic cardiac life support; be ready to defibrillate. • Care for shock and administer high- concentration oxygen. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Care for spinal and head injuries as well as extremity fractures. • Evaluate burn sites. • Cool burning areas and smoldering clothing the same you would for a flame burn. • Apply sterile dressings. • Transport as soon as possible.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging • Dressing  Any material applied to wound to control bleeding and prevent contamination • Bandage  Any material used to hold dressing in place
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging Dressings cover wounds.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging • Universal dressing  Available for profuse bleeding, large wound • Pressure dressing  Used to control bleeding • Occlusive dressing  Used to form an airtight seal  Wounds to the abdomen, large neck veins, open wounds to chest
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging Bandages hold dressings in place.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Dressing open wounds  Take Standard Precautions.  Expose wound.  Use sterile or very clean materials.  Cover entire wound.  Control bleeding by direct pressure and/or hemostatic agents or dressings to stop or slow bleeding.  Do not remove dressings. continued on next slide
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Bandaging open wounds  Do not bandage too tightly or too loosely.  Do not leave loose ends.  Do not cover tips of fingers or toes. • Must observe distal skin color changes  Cover all edges of dressings.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Bandaging Open Wounds To apply a self-adhering roller bandage, secure it with several overlapping wraps.
Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Bandaging Open Wounds To apply a self-adhering roller bandage, keep it snug.

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Ch26 soft tissue

  • 1. Emergency Care CHAPTER Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe THIRTEENTH EDITION Soft-Tissue Trauma 26
  • 2. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Topics • Soft Tissues • Closed Wounds • Open Wounds • Treating Specific Types of Open Wounds • Burns • Electrical Injuries • Dressing and Bandaging
  • 3. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues
  • 4. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues • Skin • Fatty tissues • Muscles • Blood vessels • Connective tissues • Membranes • Glands • Nerves
  • 5. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues Soft tissues.
  • 6. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Soft Tissues • Major functions of the skin  Protection  Water balance  Temperature regulation  Excretion  Shock (impact) absorption continued on next slide
  • 7. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Skin
  • 8. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds
  • 9. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds • Internal injuries with no pathway from the outside to the injured site • Although skin unbroken, may be extensively crushed tissues beneath • Range from minor to life-threatening continued on next slide
  • 10. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds • Contusions  Bruise • Hematomas  Similar to contusion  More tissue damage  Involves larger blood vessels continued on next slide
  • 11. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds • Closed crush injuries  Excessive force crushing or rupturing internal (generally solid) organs • Blast injuries  Can include open and close wound types  Potential for massive internal damage is higher than with direct-force trauma.
  • 12. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Closed Wounds Closed wounds.
  • 13. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Assessment • Bruising may be indication of internal injury or internal bleeding. • Consider mechanism of injury. • Crush injuries are difficult to identify.
  • 14. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Take appropriate Standard Precautions • Manage airway, breathing, and circulation • Always manage as if there is internal bleeding and shock if there is any possibility of internal injuries continued on next slide
  • 15. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Splint extremities that are painful, swollen, or deformed • Stay alert for vomiting • Continuously monitor for changes and transport • Apply cold pack to isolated injuries to manage pain and swelling
  • 16. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Open Wounds
  • 17. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Types of Open Wounds • Abrasions • Lacerations • Penetrating trauma and punctures continued on next slide
  • 18. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Types of Open Wounds • Avulsions • Amputations
  • 19. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Types of Open Wounds • Open crush injuries • Bite wounds • Blast injuries • High-pressure-injection injuries
  • 20. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Think About It • Does an open wound necessitate using more than just gloves as Standard Precautions? • Can an open injury affect the patient's airway or breathing?
  • 21. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Emergency Care for Open Wounds • Strict attention to Standard Precautions  In addition to wearing gloves, a gown and protective eyewear may be required. continued on next slide
  • 22. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Expose wound. • Clean surface of wound. • Control bleeding. • For all serious wounds, provide care for shock, including administration of high- concentration oxygen. • Prevent further contamination. continued on next slide
  • 23. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Bandage dressings in place after bleeding is controlled. • Keep patient lying still. • Reassure patient.
  • 24. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Open Wounds
  • 25. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Abrasions and Lacerations • Reduce wound contamination • Hold direct pressure to control bleeding • Always check pulse, motor, and sensory function distal to injury to assure function
  • 26. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Penetrating Trauma • Use caution as objects may be embedded deeper than they appear. • Check for exit wounds.  May require immediate care • Bullets can fracture bones as they enter. • Stab wounds are considered serious if in a vital area of body. continued on next slide
  • 27. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Penetrating Trauma • Reassure patient. • Search for exit wound. • Assess need for basic life support. • Follow local protocols regarding spinal immobilization. • Transport patient.
  • 28. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Penetrating Trauma Bullets travel in an unpredictable path once they are inside the patient’s body and can therefore cause damage to multiple organs and bones.
  • 29. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Penetrating Trauma A gunshot wound to the right flank. © Edward T. Dickinson, MD
  • 30. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Impaled Objects • Do not remove object; may cause severe bleeding. continued on next slide
  • 31. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Impaled Objects • Expose wound area. • Control profuse bleeding by direct pressure. • Apply several layers of bulky dressing so dressing surrounds the object on all sides. • Secure dressings in place. continued on next slide
  • 32. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Impaled Objects • Care for shock. • Keep patient at rest. • Provide rapid transport. • Reassure patient throughout all aspects of care.
  • 33. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Impaled Objects Stabilize an impaled object with bulky dressings.
  • 34. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Impaled Objects Bandage the impaled object and surrounding dressings in place.
  • 35. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Object Impaled in the Cheek • Take care that object does not enter oral cavity, causing airway obstruction. • If cheek wall is perforated, profuse bleeding into mouth and throat can cause nausea and vomiting. • External wound care will not stop the flow of blood into the mouth. continued on next slide
  • 36. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Object Impaled in the Cheek • Examine wound site, both inside and outside mouth • If you find the perforation and can see both ends, remove object.  If this cannot be easily done, leave object in place.
  • 37. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Impaled Object in Cheek The process of removing an impaled object from the cheek.
  • 38. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Object Impaled in the Cheek • Position patient to allow for drainage. • Monitor patient's airway. • Dress outside of wound. • Provide oxygen and care for shock.
  • 39. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Puncture Wound or Object Impaled in the Eye • Stabilize the object. • Apply rigid protection. • Have another rescuer stabilize dressings and cut while you secure them in place with self-adherent roller bandage or with wrapping of gauze.
  • 40. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Puncture Wound or Object Impaled in Eye Managing an object impaled in the eye.
  • 41. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Puncture Wound or Object Impaled in Eye Managing an object impaled in the eye.
  • 42. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Puncture Wound or Object Impaled in the Eye • Dress and bandage uninjured eye. • Consider need for oxygen and care for shock. • Reassure patient and provide emotional support.
  • 43. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Avulsions • Clean wound surface. • Fold skin back into normal position. • Control bleeding and dress with bulky dressings. • If avulsed parts are completely torn away, save in sterile dressing and keep moist with sterile saline.
  • 44. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Amputations • Take steps to control hemorrhage immediately. • Apply direct pressure to control bleeding; use tourniquet only if all other methods fail.
  • 45. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Amputations Care for an amputated part. The amputated digit sits on sterile-saline-soaked gauze, awaiting reimplantation. © Edward T. Dickinson, MD
  • 46. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Amputations • Wrap amputated part in sterile dressing, and secure dressing with self- adhesive gauze bandage. • Then wrap or bag amputated part in plastic bag; keep it cool by cold pack. • Do not immerse amputated part directly in water or saline.
  • 47. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Genital Injuries • Control bleeding. • Preserve avulsed parts. • Consider if injury suggests another, possibly more serious, injury. • Display calm, professional manner. • Dress and bandage wound. • Consider possibility of sexual assault.
  • 48. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Burns
  • 49. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Burns • May involve more than just skin-level structures • If respiratory structures are affected, swelling may occur, causing life- threatening obstruction. • Do not let burn distract from spinal damage or fractures.
  • 50. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Assessment • Classifying burns  Agent and source  Depth  Severity
  • 51. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Agent and Source • Such as chemicals or electricity • Report the agent and, when practical, the source of the agent.  Never assume the agent or source of the burn.  Always gather information from your observations of the scene, bystanders' reports, and patient's interview.
  • 52. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Assessment: Burns Burns are classified by depth.
  • 53. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe
  • 54. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Depth • Superficial burn (1st degree)  Involves only epidermis  Reddening with minor swelling • Partial thickness burn (2nd degree)  Epidermis burned through, dermis damaged  Deep, intense pain  Noticeable reddening  Blisters and mottling continued on next slide
  • 55. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Depth • Full thickness burn (3rd degree)  All layers of skin burned  Blackened areas surrounded by dry and white patches
  • 56. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Superficial Burn A superficial burn. © Edward T. Dickinson, MD
  • 57. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Partial Thickness Burn Partial thickness burns. © Edward T. Dickinson, MD
  • 58. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Partial Thickness Burn Partial thickness burns. © Edward T. Dickinson, MD
  • 59. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Full Thickness Burn A full thickness burn. © Edward T. Dickinson, MD
  • 60. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining the Severity of Burns • Consider the following factors:  Agent or source of the burn  Body regions burned  Depth of the burn  Extent of the burn  Age of the patient  Other illnesses and injuries continued on next slide
  • 61. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Determining the Severity of Burns • Rule of Nines  Helps estimate extent of burn area (BSA)  Adult body is divided into 11 main areas  Each represents 9 percent of body surface
  • 62. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Burns: Severity
  • 63. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Practice Rule of Nines
  • 64. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Classifying Burns by Severity • Must be classified to determine:  Order and type of care  Order of transport  Maximum information to provide to the emergency department.
  • 65. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Geriatric Note • A moderate burn in a young adult can be fatal to a geriatric adult.
  • 66. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Pediatric Note • Infants and children have a much greater relationship of body surface area to total body size, resulting in greater fluid and heat loss from burned skin.
  • 67. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for thermal burns  Stop burning process and cool burned area.  Ensure open airway and assess breathing.  Look for signs of airway injury.  Complete primary assessment.  Treat for shock. continued on next slide
  • 68. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for thermal burns  Evaluate burns by depth, extent, and severity.  Do not clear debris.  Remove clothing and jewelry.  Wrap with dry sterile dressing.  For burns to hand or feet, remove patient's rings or jewelry and separate fingers or toes with sterile gauze pads. continued on next slide
  • 69. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for chemical burns  Wash away chemical with copious amounts of flowing water.  If dry chemical, brush away, then flush with water.
  • 70. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Chemical Burns For a chemical burn, brush away dry powders.
  • 71. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treatment: Chemical Burns Then flood the area with water.
  • 72. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Treating Specific Types of Burns • Patient care for chemical burns  Remove contaminated clothing.  Apply sterile dressings.  Treat for shock.  Transport.
  • 73. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Radiological Burns • Exposure to high levels of radiation can harm the human body both immediately and in a delayed fashion. • Great number of sources of radiation  Difficult to detect without specific monitoring equipment continued on next slide
  • 74. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Radiological Burns • Extremely harmful  Do not approach a radiological injury without protective equipment and specialized training.  See patient with a radiological burn only after they have been decontaminated. • Most will present like thermal injuries.
  • 75. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Electrical Injuries
  • 76. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Electrical Injuries • Severe damage through body by disrupting nerve pathways • Entry and exit burns are possible. • Respiratory/cardiac arrest are possible. • Bones may fracture from violent muscle contractions.
  • 77. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Provide airway and breathing care. • Provide basic cardiac life support; be ready to defibrillate. • Care for shock and administer high- concentration oxygen. continued on next slide
  • 78. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Care for spinal and head injuries as well as extremity fractures. • Evaluate burn sites. • Cool burning areas and smoldering clothing the same you would for a flame burn. • Apply sterile dressings. • Transport as soon as possible.
  • 79. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging
  • 80. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging • Dressing  Any material applied to wound to control bleeding and prevent contamination • Bandage  Any material used to hold dressing in place
  • 81. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging Dressings cover wounds.
  • 82. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging • Universal dressing  Available for profuse bleeding, large wound • Pressure dressing  Used to control bleeding • Occlusive dressing  Used to form an airtight seal  Wounds to the abdomen, large neck veins, open wounds to chest
  • 83. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Dressing and Bandaging Bandages hold dressings in place.
  • 84. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Dressing open wounds  Take Standard Precautions.  Expose wound.  Use sterile or very clean materials.  Cover entire wound.  Control bleeding by direct pressure and/or hemostatic agents or dressings to stop or slow bleeding.  Do not remove dressings. continued on next slide
  • 85. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Patient Care • Bandaging open wounds  Do not bandage too tightly or too loosely.  Do not leave loose ends.  Do not cover tips of fingers or toes. • Must observe distal skin color changes  Cover all edges of dressings.
  • 86. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Bandaging Open Wounds To apply a self-adhering roller bandage, secure it with several overlapping wraps.
  • 87. Copyright © 2016, 2012, 2009 by Pearson Education, Inc. All Rights Reserved Emergency Care, 13e Daniel Limmer | Michael F. O'Keefe Bandaging Open Wounds To apply a self-adhering roller bandage, keep it snug.

Editor's Notes

  1. Planning Your Time: Plan 155 minutes for this chapter. Soft Tissues (15 minutes) Closed Wounds (20 minutes) Open Wounds (20 minutes) Treating Specific Types of Open Wounds (20 minutes) Burns (40 minutes) Electrical Injuries (20 minutes) Dressing and Bandaging (20 minutes) Note: The total teaching time recommended is only a guideline. Core Concepts: Understanding closed wounds and emergency care for closed wounds Understanding open wounds and emergency care for open wounds Understanding burns and emergency care for burns Understanding electrical injuries and emergency care for electrical injuries How to dress and bandage wounds
  2. Teaching Time: 15 minutes Teaching Tips: Use multimedia graphics to demonstrate anatomy. Spend time now on the function of the skin to improve comprehension of later lessons.
  3. Covers Objective: 26.2 Point to Emphasize: The skin, fatty tissues, muscles, blood vessels, connective tissues, membranes, glands, and nerves are considered the soft tissues of the body. Discussion Topic: List and describe the types of soft tissue. Knowledge Application: Have students label the layers of the skin on a blank illustration.
  4. Covers Objective: 26.2 Point to Emphasize: The skin, fatty tissues, muscles, blood vessels, connective tissues, membranes, glands, and nerves are considered the soft tissues of the body. Discussion Topic: List and describe the types of soft tissue. Knowledge Application: Have students label the layers of the skin on a blank illustration.
  5. Covers Objective: 26.2 Discussion Topics: Describe the functions of the skin. List and describe the layers of the skin. Knowledge Application: Have students work in small groups to discuss the functions of the skin. Assign a function of the skin to each group; then have each group present the impact of losing skin on its particular function. Critical Thinking: Many people die from infection after a large surface-area burn. How does this fact relate to our discussion about functions of the skin?
  6. Covers Objective: 26.2 Discussion Topics: Describe the functions of the skin. List and describe the layers of the skin. Knowledge Application: Have students work in small groups to discuss the functions of the skin. Assign a function of the skin to each group; then have each group present the impact of losing skin on its particular function. Critical Thinking: Many people die from infection after a large surface-area burn. How does this fact relate to our discussion about functions of the skin?
  7. Teaching Time: 20 minutes Teaching Tips: Use multimedia graphics to illustrate closed injuries. Review anatomy to identify body areas that potentially threaten underlying vital organs. Relate to the lessons on internal bleeding. Closed injuries and internal bleeding are closely related.
  8. Covers Objective: 26.3 Points to Emphasize: In a closed wound, the skin has not been broken. Blunt trauma causes closed wounds. There are three types of closed wounds: contusions, hematomas, and crush injuries. Discussion Topics: Discuss what is meant by closed wound. Describe the three types of closed wounds. Discuss the forces that create closed injuries. How could these forces transfer damage to underlying structures?
  9. Covers Objective: 26.3 Points to Emphasize: In a closed wound, the skin has not been broken. Blunt trauma causes closed wounds. There are three types of closed wounds: contusions, hematomas, and crush injuries. Discussion Topics: Discuss what is meant by closed wound. Describe the three types of closed wounds. Discuss the forces that create closed injuries. How could these forces transfer damage to underlying structures?
  10. Covers Objective: 26.3
  11. Covers Objective: 26.3
  12. Covers Objective: 26.4 Point to Emphasize: To assess and treat a closed wound appropriately, consider the mechanism of injury and the structures that lie beneath the skin.
  13. Covers Objective: 26.3 Point to Emphasize: When treating major closed injuries, assume internal bleeding. Discussion Topic: Describe the treatment of a closed wound. Class Activity: Describe closed injuries to different areas of the body. Discuss with the class what structures and organs are at risk. Knowledge Application: Use multimedia graphics to demonstrate different types of closed injuries. Distribute pictures to groups of students and ask groups to formulate an assessment and treatment strategy.
  14. Covers Objective: 26.3 Knowledge Application: Use programmed patients to simulate closed injuries. Have teams of students practice assessment and treatment.
  15. Teaching Time: 20 minutes Teaching Tips: Use multimedia graphics to demonstrate the various types of open injuries. Discuss the specific and varied threats that each type of open wound can pose. Use specific examples.
  16. Covers Objective: 26.5 Discussion Topics: Describe the major types of open wounds. Discuss the specific dangers of each. Discuss why a small puncture wound may disguise a major injury. Use a gunshot wound as an example. Knowledge Application: Have students work in small groups. Give each group a picture of an open wound. Have the group classify the type of wound and then discuss the potential dangers.
  17. Covers Objective: 26.5 Discussion Topics: Describe the major types of open wounds. Discuss the specific dangers of each. Discuss why a small puncture wound may disguise a major injury. Use a gunshot wound as an example. Knowledge Application: Have students work in small groups. Give each group a picture of an open wound. Have the group classify the type of wound and then discuss the potential dangers.
  18. Covers Objective: 26.6 Talking Points: Yes, depending on the situation you may need more than just gloves as Standard Precautions. Always be sure to assess the situation and wear the appropriate clothing. Yes, depending on where the injury is, it can affect the patient's airway or breathing.
  19. Covers Objective: 26.6 Point to Emphasize: Controlling hemorrhage, recognizing and treating shock, preventing infection, and bandaging are important elements in emergency care of open wounds. Discussion Topic: Describe the assessment and treatment priorities for an open wound. Knowledge Application: Place a puncture wound on a manikin or full-body diagram. Have the class discuss what organs and structures lie in the potential pathway. Discuss life threats and treatment strategies.
  20. Covers Objective: 26.6 Point to Emphasize: Controlling hemorrhage, recognizing and treating shock, preventing infection, and bandaging are important elements in emergency care of open wounds. Discussion Topic: Describe the assessment and treatment priorities for an open wound. Knowledge Application: Place a puncture wound on a manikin or full-body diagram. Have the class discuss what organs and structures lie in the potential pathway. Discuss life threats and treatment strategies.
  21. Covers Objective: 26.6 Class Activity: Describe a type of open wound. Ask the students to discuss what specific threats might be posed by that particular type of injury. Knowledge Application: Have students work in small groups. Use programmed patients and moulage to simulate different types of open wounds. Practice assessment and treatment procedures. Critical Thinking: Consider a patient with a large soft-tissue injury to the face. After you dress and bandage it properly, what emotional concerns might you address? How might an injury such as this affect the emotional well-being of the patient?
  22. Teaching Time: 20 minutes Teaching Tips: Use multimedia graphics to illustrate specific types of injuries. Use moulage to simulate injuries. This will add realism to scenario work. Instill a fear of puncture wounds. Describe a variety of offending objects (knives, bullets, arrows, and so on) and discuss the potential for underlying damage despite minimal external wounding. Research local protocol on treatment of avulsed and amputated parts.
  23. Covers Objective: 26.6
  24. Covers Objective: 26.6 Point to Emphasize: Puncture wounds are particularly dangerous as they present with only small external wounds but may damage structures deep into the body. Discussion Topic: Discuss why a small puncture wound may disguise a major injury. Use a gunshot wound as an example.
  25. Covers Objective: 26.6 Knowledge Application: Have students work in small groups. Use a programmed patient and moulage and simulate various types of injuries. Practice specific treatment strategies.
  26. Covers Objective: 26.6 Knowledge Application: Have students work in small groups. Use a programmed patient and moulage and simulate various types of injuries. Practice specific treatment strategies.
  27. Covers Objective: 26.6
  28. Covers Objective: 26.6 Point to Emphasize: Do not remove or apply direct pressure to impaled objects.
  29. Covers Objective: 26.6
  30. Covers Objective: 26.6
  31. Covers Objective: 26.6 Knowledge Application: Have the students work in small groups. Simulate impaled objects and practice stabilization and treatment.
  32. Covers Objective: 26.6 Knowledge Application: Have the students work in small groups. Simulate impaled objects and practice stabilization and treatment.
  33. Covers Objective: 26.6
  34. Covers Objective: 26.6
  35. Covers Objective: 26.6
  36. Covers Objective: 26.6
  37. Covers Objective: 26.6
  38. Covers Objective: 26.6
  39. Covers Objective: 26.6
  40. Covers Objective: 26.6
  41. Covers Objective: 26.6 Point to Emphasize: Emergency care for avulsions requires the application of large, bulky pressure dressings. Preserve any avulsed parts and transport them to the medical facility along with the patient. Class Activity: Use simulated amputated parts. Practice care of amputations and avulsions. Knowledge Application: Have students work in small groups. Assign each group a specific type of injury. Have the group research and present the most appropriate treatment strategies.
  42. Covers Objective: 26.6
  43. Covers Objective: 26.6
  44. Covers Objective: 26.6 Point to Emphasize: Take care to treat amputated parts carefully as there may be a possibility of reattachment. Discussion Topic: Describe the specific treatment for the following types of injuries: lacerations, punctures, impaled objects, avulsions, amputations, genital injuries. Critical Thinking: How does the care of an amputated part impact the emotional side of patient care? What emotional benefit might the patient gain?
  45. Covers Objective: 26.6
  46. Teaching Time: 40 minutes Teaching Tips: Emphasize (and reemphasize) safety and appropriate scene size-up with burn patients. Contact a burn center or national burn care organization for specialized teaching resources. Use multimedia graphics to illustrate different types of burns. Teach students to identify critical burns rapidly. Address specific criteria to make the decision. Follow local protocols.
  47. Covers Objective: 26.7 Point to Emphasize: Burns involve immediate destruction of tissue but also can have a long-term effect, both physically and emotionally.
  48. Covers Objective: 26.8 Point to Emphasize: Burns can be classified and evaluated in three ways: by agent and source, by depth, and by severity. Discussion Topic: Describe the factors that would make a burn critical.
  49. Covers Objective: 26.8 Point to Emphasize: Burns can be classified and evaluated in three ways: by agent and source, by depth, and by severity. Discussion Topic: Describe the factors that would make a burn critical.
  50. Covers Objective: 26.8 Point to Emphasize: Burns can be classified and evaluated in three ways: by agent and source, by depth, and by severity. Discussion Topic: Describe the factors that would make a burn critical.
  51. Covers Objective: 26.8 Point to Emphasize: The three classifications of burn depth are superficial, partial thickness, and full thickness. Discussion Topic: Describe the three classifications of burn depth. Compare and contrast the findings for each. Knowledge Application: Display pictures of burns. Have students classify the depth of the burn based on presentation. Discuss.
  52. Covers Objective: 26.8
  53. Covers Objective: 26.8
  54. Covers Objective: 26.8
  55. Covers Objective: 26.8
  56. Covers Objective: 26.8
  57. Covers Objective: 26.8 Discussion Topics: Explain how to determine the surface area of a burn. Consider an adult patient and a child. Discuss how the location of a burn might impact its severity. How might a hand burn be more serious than a burn of the same size on the abdomen? Knowledge Application: Determine body surface area. Describe an area burned. Have students use various methods to determine body surface area.
  58. Covers Objective: 26.8 Point to Emphasize: The amount of skin surface involved in a burn can be calculated quickly by using the rule of nines. Discussion Topics: Explain how to determine the surface area of a burn. Consider an adult patient and a child. Discuss how the location of a burn might impact its severity. How might a hand burn be more serious than a burn of the same size on the abdomen? Knowledge Application: Determine body surface area. Describe an area burned. Have students use various methods to determine body surface area.
  59. Covers Objective: 26.8 Point to Emphasize: The amount of skin surface involved in a burn can be calculated quickly by using the rule of nines. Discussion Topics: Explain how to determine the surface area of a burn. Consider an adult patient and a child. Discuss how the location of a burn might impact its severity. How might a hand burn be more serious than a burn of the same size on the abdomen? Knowledge Application: Determine body surface area. Describe an area burned. Have students use various methods to determine body surface area.
  60. Covers Objective: 26.8
  61. Covers Objective: 26.8 Talking Points: In late adulthood, the body's ability to cope with injury is reduced due to aging tissues. Burns classified as moderate should be considered critical in adults 55 years and older.
  62. Covers Objective: 26.8 Talking Points: In late adulthood, the body's ability to cope with injury is reduced due to aging tissues. Burns classified as moderate should be considered critical in adults 55 years and older.
  63. Covers Objective: 26.9 Point to Emphasize: There are special approaches to the care of thermal burns, general chemical burns, and chemical burns to the eyes. EMTs should know the procedures for treating each type. Knowledge Application: Use a programmed patient to simulate different types of burn scenarios. Have teams of students practice assessment and identification of a critical burn.
  64. Covers Objective: 26.9 Point to Emphasize: There are special approaches to the care of thermal burns, general chemical burns, and chemical burns to the eyes. EMTs should know the procedures for treating each type. Knowledge Application: Use a programmed patient to simulate different types of burn scenarios. Have teams of students practice assessment and identification of a critical burn.
  65. Covers Objective: 26.9 Discussion Topic: Compare and contrast treatment modalities for the various types of burns. How are the modalities similar? How are they different? Class Activities: Tour a burn unit. See firsthand the impact of burns. Interview staff from a burn center. Discuss perils and pitfalls of burn care. Knowledge Application: Use student volunteers and practice flushing an eye. Discuss necessary equipment and strategies.
  66. Covers Objective: 26.9 Discussion Topic: Compare and contrast treatment modalities for the various types of burns. How are the modalities similar? How are they different? Class Activities: Tour a burn unit. See firsthand the impact of burns. Interview staff from a burn center. Discuss perils and pitfalls of burn care. Knowledge Application: Use student volunteers and practice flushing an eye. Discuss necessary equipment and strategies.
  67. Covers Objective: 26.9 Discussion Topic: Compare and contrast treatment modalities for the various types of burns. How are the modalities similar? How are they different? Class Activities: Tour a burn unit. See firsthand the impact of burns. Interview staff from a burn center. Discuss perils and pitfalls of burn care. Knowledge Application: Use student volunteers and practice flushing an eye. Discuss necessary equipment and strategies.
  68. Covers Objective: 26.9 Critical Thinking: How might a burn impact a patient emotionally? How might this be a long-term concern?
  69. Covers Objective: 26.9 Critical Thinking: How might a burn impact a patient emotionally? How might this be a long-term concern?
  70. Covers Objective: 26.9 Critical Thinking: How might a burn impact a patient emotionally? How might this be a long-term concern?
  71. Teaching Time: 20 minutes Teaching Tips: Emphasize safety. Electrical injury scenes are extremely hazardous to emergency responders. Use multimedia graphics to illustrate electrical injuries. Invite a power company representative to discuss electrical safety and associated injuries. Note the importance of cardiac evaluation. This type of injury is not readily apparent on the outside but can be life threatening.
  72. Covers Objective: 26.10 Points to Emphasize: The scenes of injuries due to electricity are often very hazardous. Assume that the source of electricity is still active unless a qualified person tells you that the power has been turned off. Electrical current can damage tissue in a variety of ways. Burns, nerve damage, and chemical changes are examples of the destruction that electricity can cause. Specific assessment findings can indicate the presence of electrical injuries. Discussion Topics: Discuss how you might determine that the scene is safe when approaching an electricity-related emergency. Describe how electricity can damage the body. Use specific examples. Describe the assessment findings that might indicate an electrical emergency. Knowledge Application: Have students work in small groups. Use programmed patients and simulate electrical emergencies. Focus on safety evaluation and approach strategies.
  73. Covers Objective: 26.10 Point to Emphasize: Proper care for electrical injuries must include treatment of cardiac dysrhythmias. In addition, spinal immobilization should be considered. Discussion Topic: Describe the treatment of a patient injured by electricity. What are the most important elements of treatment? Critical Thinking: You have identified a patient who has been electrocuted. You are not sure if the power has been turned off, so you have decided to hold back. What forces may be present to make you want to push forward? How can you overcome these issues?
  74. Covers Objective: 26.10 Knowledge Application: Present pictures of electrical injuries. Discuss treatment priorities.
  75. Teaching Time: 20 minutes Teaching Tips: Have on hand various types of dressings and bandages with which students can practice. Create a culture of infection control. Always require appropriate PPE when practicing potentially infectious skills. Moulage a programmed patient to simulate injuries and bleeding. Foster creativity. Do not always place the wound in the same convenient location. Make students bandage difficult areas. Integrate hemostatic agents with dressings and bandages.
  76. Covers Objective: 26.11 Point to Emphasize: A dressing is any material that is applied to a wound in an effort to control bleeding and prevent further contamination. A bandage is any material that is used to hold a dressing in place. Discussion Topics: Discuss what PPE might be necessary when dressing and bandaging a bleeding wound. Discuss the rules for the general dressing of wounds.
  77. Covers Objective: 26.11 Point to Emphasize: A dressing is any material that is applied to a wound in an effort to control bleeding and prevent further contamination. A bandage is any material that is used to hold a dressing in place. Discussion Topics: Discuss what PPE might be necessary when dressing and bandaging a bleeding wound. Discuss the rules for the general dressing of wounds.
  78. Covers Objective: 26.11 Points to Emphasize: Bandaging frequently exposes providers to bloodborne pathogens. EMTs always should don the correct level of personal protection prior to beginning these procedures. Bandaging is secondary to hemorrhage control. When necessary, stop bleeding before applying a bandage.
  79. Covers Objective: 26.11 Points to Emphasize: Bandaging frequently exposes providers to bloodborne pathogens. EMTs always should don the correct level of personal protection prior to beginning these procedures. Bandaging is secondary to hemorrhage control. When necessary, stop bleeding before applying a bandage.
  80. Covers Objective: 26.11 Knowledge Applications: Select and don appropriate PPE for treating open soft-tissue injuries. Have students work in small groups. Practice the sequence of bleeding control and bandaging. Discuss how the steps flow together. Critical Thinking: If you did not have EMS equipment, what common items could you use to dress and bandage a wound?
  81. Covers Objective: 26.11 Point to Emphasize: Completely cover the wound with a dressing. Apply the bandage over the dressing and completely cover the dressing. Discussion Topic: Discuss the rules for the general bandaging of wounds. Class Activity: Brainstorm creative bandaging techniques. List an unusual wound site and ask students to formulate creative bandaging solutions. Knowledge Application: Using a manikin or programmed patient, practice applying dressings and bandaging wounds.
  82. Covers Objective: 26.11 Point to Emphasize: Completely cover the wound with a dressing. Apply the bandage over the dressing and completely cover the dressing. Discussion Topic: Discuss the rules for the general bandaging of wounds. Class Activity: Brainstorm creative bandaging techniques. List an unusual wound site and ask students to formulate creative bandaging solutions. Knowledge Application: Using a manikin or programmed patient, practice applying dressings and bandaging wounds.
  83. Covers Objective: 26.11 Point to Emphasize: Completely cover the wound with a dressing. Apply the bandage over the dressing and completely cover the dressing. Discussion Topic: Discuss the rules for the general bandaging of wounds. Class Activity: Brainstorm creative bandaging techniques. List an unusual wound site and ask students to formulate creative bandaging solutions. Knowledge Application: Using a manikin or programmed patient, practice applying dressings and bandaging wounds.