PREVIEW OF

EMT/EMR SOFT TISSUE INJURIESPOWERPOINT TRAINING

PRESENTATION

FUNCTION OF THE SKIN

The skin providesProtection from the environmentExtreme temperaturePathogens (Bacteria, viruses)Blunt trauma Helps regulate temperatureFeeling of sense

Helps maintain body fluid balance

CLOSED SOFT TISSURE INJURY

Injury injury with no pathway from outside the injured area

Types of injurySigns and SymptomsAssessmentManagement

Outermost layer of skin is scraped off

PainfulSuperficialNo bleeding or small amount of blood oozes

from wound

ABRASION

AVULSION

Flaps of skin or tissue are torn loose or pulled completely off

IMPALED OBJECT

Object that creates the puncture wound remains embeddedLeave in place unless it is in the cheek with uncontrolled bleedingApply pressure around the object and secure in

placeAvoid movement

AMPUTATION

Involves the extremities and other body partsMassive bleeding may be present or bleeding may be limited

BLAST INJURY/HIGH PRESSURE

Often seen in WMD attacksBe careful of secondary explosionsThese injuries are compounded when the explosion occurs in a confined space

CONTUSION (Bruise)

Epidermis remains intactCells are damaged & blood vessels torn from dermisSwelling & pain

HEMATOMA

Collection of blood beneath the skinLarger amount of tissue damage as compared to contusionLarger vessels are damagedMay lose one or more liters of blood

COMPLICATIONS OF SOFT TISSUE INJURY

Bleeding – shockPainInfection

Mechanisms of infectionRisk factors

GENERAL ASSESSMENT

Safety of Environment / Standard PrecautionsAirway PatencyRespiratory DistressConcepts of Open Wound Dressings/BandagingHemorrhage ControlAssociated Injuries

CONCEPTS OF OPEN WOUND DRESSING/BANDAGING

SterileNon-sterileOcclusiveNon-occlusiveWetDryTourniquetComplications of dressings/bandages

DRESSING & BANDAGING

Used toStop bleedingProtect the wound from further

damagePrevent further contamination and

infection

Dressing

Bandage

DRESSINGS

Usually sterileTypes

Sterile gauze padsNon-stick gauze padsOcclusive dressingsTrauma dressings

BANDAGES

Hold dressings in placeTypes

Adhesive bandagesRoller gauze

ElasticNon-elastic

Tape

MANAGEMENT

Appropriate PPEAirway managementExpose the woundControl hemorrhage

Dress/bandage open wounds with dry sterile dressing

Prevention of shockPrevent infectionTransport to the appropriate facility

THERMAL

TypesSeverity related to

Exposure timeTemperature

Enclosed space versus openScalds with unusual history patterns may be abuse

CHEMICAL

Severity related toType of chemicalConcentration of chemicalDuration of exposure

Solutions and powders are different

DEPTH CLASIFICATION OF BURNS

SuperficialPartial-thicknessFull-thickness

SUPERFICIAL1st DEGREE

Involves only the epidermisReddened skinPain at the site

Head & Neck 9%

Posterior Trunk 18%

Anterior Trunk 18%

Each Upper Extremity 9%ExternalGenitalia 1%

Each Lower Extremity 18%

RULE OF 9‘s ADULT

RULE OF ONES

The patient's palm can serve a reference point roughly equivalent to 1% of the body

surface area

DEPTH

Full thickness extends through all layers of the skin

White, yellow, tan, brown or charred appearance

Leathery feelNo pain in those areasUsually there is pain in surrounding areas

with other depth of burns

RESPIRATORY BURNS

Facial burns are an indication of respiratoryburns

Patient may have burns to airway & lungs

Respiratory burns have double the mortality rate

PART OF BODY BURNED

Severity should be increased with certain body parts including

FingersFaceGenitalsFeet

INFANTS & CHILDREN

Greater surface area in relationship to the total body size

Results in greater fluid and heat lossAny full thickness burn or partial thickness

burn greater than 20%, or burn involving the hands, feet, face , airway or genitalia is considered to be a critical burn in a child

GERIATRIC PATIENTS

Severity of burn should be increased for patients over 55 years old

THERMAL

Complete general managementMay be associated with an inhalation injuryLarge burns may cause hypovolemia and hypothermiaCool small burns or those remaining hot (patient who has just been rescued from fire)Dry dressing help prevent infection and provide comfortTime in contact with heat increases damage

COMPLICATIONS ARE RELATED TO TOXIC CHEMICALS WITHIN INHALED AIR

Carbon monoxideCyanideOther toxic gasses

INHALATION

Edema of mucosa of airway can be rapid Consider ALS backup if signs and symptoms of

edema are present, such as:HoarsenessSinged nasal or facial hairBurns of faceCarbon in sputum

Burns in enclosed spaces without ventilation cause inhalation injuries

ELECTRICAL

Scene safety - never touch a patient in contact with an electric source

Often internal damage more severe than external injuries appearSometimes electric current crosses the chest

and causes cardiac arrest or arrhythmiasPatient may be in cardiac arrest when EMT arrives (probably V-fib or asystole)

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