25)Soft Tissue Injuries

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25)Soft Tissue Injuries

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

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