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Chapter 21
Soft Tissue Injuries
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Learning Objectives
State major functions of skin
List layers of skin
List types of open & closed soft tissue injuries
Establish relationship between BSI & soft tissue injuries
Describe emergency medical care of patient with open & closed soft tissue injury
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Learning Objectives
Establish the relationship between airway management and a patient with chest injury, burn, blunt injury, or penetrating injury
Describe emergency care of a patient with an amputation
Describe emergency medical care of a patient with an impaled object
List functions of dressing & bandaging
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Learning Objectives
Describe the purpose of a bandage
Describe steps in applying pressure dressing
Describe effects of improperly applied dressings, splints, tourniquets
List categories of burn injuries
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Learning Objectives
Define a superficial burn and list it characteristics
Define a partial-thickness burn and list it characteristics
Define full-thickness burn and list it characteristics
Describe emergency medical care of a patient with a superficial burn, partial-thickness burn, and a full-thickness burn
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Learning Objectives
Describe emergency care for a chemical burn
Describe emergency care for an electrical burn
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Introduction
Soft tissues include: Skin
Subcutaneous layer of fat
Connective tissue beneath the skin
Skeletal muscles
Tendons
Ligaments
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Introduction
Injuries are classified as: Open – skin is broken
Closed – Skin remains intact
Must look at skin in conjunction with the mechanism of injury for clues to the type of trauma sustained
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Anatomy & Physiology
Skin Largest organ
Provides protective covering & insulation
Separates internal environment from external environment
Barrier to infection and loss of body fluids
2 major layers• Epidermis
• Dermis
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Anatomy & Physiology
Epidermis Surface, outermost layer
Avascular
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Anatomy & Physiology
Epidermis 4 separate sublayers
• When intact, is impermeable and cannot be penetrated by microorganisms
• Prevents water loss from cells underneath
• Most superficial layer is dead tissue
• Filled with protein called keratin as new cells move toward skin surface
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Anatomy & Physiology
Epidermis Responsible for color of skin
• Contains pigment called melanin
• Influenced by blood flow in the skin capillaries contained within the dermis
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Anatomy & Physiology
Dermis Dense connective tissue that contains:
• Nerves
• Blood vessels
• Sweat glands• Sebaceous glands• Hair follicles
Skin grafting
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Anatomy & Physiology
Subcutaneous tissue Layer of fat and connective tissue
Serves as body insulator
Fascia
Mucous Membranes Lines internal surface of the body
Rich in mucus glands
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Anatomy & Physiology
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Wounds
DCAP-BTLS Deformities
Contusions
Abrasions
Punctures
Burns
Tenderness
Lacerations
Swelling
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Wounds
Closed wounds Result of blunt force
Do not break integrity of skin
Bruise/contusion• Blood vessels leak or rupture from blunt or compression
force
• May be accompanied by swelling from leakage or plasma into injured area
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Wounds
Closed wounds Ecchymosis
• Blood leakage from injured vessels
• Visible just under skin Black-blue area
Hematoma• Blood collects in pocket beneath skin
• Tumor or swelling containing blood
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Wounds
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Wounds
Open wounds Skin surface broken
Abrasion• Scraping of surface of skin or mucous membrane
• May damage superficial capillaries
• No significant blood loss
• Subject to infection
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Wounds
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Wounds
Open wounds Laceration
• Tearing of skin or other soft tissues
• Result from blunt tearing force or sharp object
• Extent of tissue damage dependent on mechanism of injury
• Severe bleeding possible
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Wounds
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Wounds
Open wounds Avulsion
• Tearing away of the skin’s surface
• Complete avulsion
• Incomplete avulsion
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Wounds
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Wounds
Open wounds Puncture, penetrations
• Occurs when sharp instrument is driven through the skin’s outer layer
• Punctures can be deceiving
• Little external bleeding, but may have severe internal bleeding
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Wounds
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Wounds
Open wounds Amputations
• Cutting away from the body of a limb or protruding structure
• Can be caused by sharp or crushing forces
• Amputated part has no blood supply
• Bleeding massive/limited
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Wounds
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Wounds
Open wounds Crush injury
• May result in both open and closed wounds
• Result of severe compressing force that damages/tears the soft tissues and underlying structures
• Can cause significant damage to underlying structures with minimal/no external bleeding
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Wounds
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Wounds
Severity and complications Severity depends on:
• Mechanism
• Site
• Extent
• Introduction of foreign bodies/contamination into the wound
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Wounds
Severity and complications Must consider damage to underlying structures
Common complications• Bleeding
• Infection
• Damage to underlying structures
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Wounds
Severity and complications Possible loss of function from:
• Nerve damage
• Fractures
• Injury to muscles, tendons, and ligaments
Wounds over the major body cavities carry the risk of damage to internal organs
• Head
• Chest
• Abdomen
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Wounds
Wound management Use appropriate PPE
• Gloves
• Eyewear
• Mask
• Gown
Routine hand-washing – precedes and follows every call
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Wounds
Wound management Obtain history
Life-threatening conditions to ABCs take priority
For projectile injuries, look for exit wound
If loss of function, consider damage to bones and muscles or nerves and vessels
Check for neurovascular function distal to injury
Record findings
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Wounds
Wound management Procedures
• Control bleeding
• Prevent further contamination
• Immobilize affected part
• Preserve avulsed/amputated parts
• Stabilize impaled objects
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Wounds
Wound management Bleeding control
• 1st expose wound
• Control bleeding through: Direct pressure
Elevation
Use of pressure points
Tourniquet application
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Wounds
Wound management Bleeding control
• Extent of blood loss should be assessed
• Blood loss in infants and children
• Large contusions with swelling or hematomas
• Cover open wounds with sterile dressing
• Patient is at greatest risk from associated injuries
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Wounds
Infection All open wounds are subject to infection
Sterile dressings applied when possible
Superficial abrasions can be washed gently with sterile saline solution before dressing is applied
Abrasions washed gently with sterile saline solution/sterile water before dressing
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Wounds
Special considerations Chest and abdominal injuries
• Require special attention because of the major organs that lie within
• Wounds through chest wall Require airtight, occlusive dressing
• Abdominal wounds with exposed organs (evisceration) Can dry out and be damaged when exposed to air for an
extended period
Cover with moist, sterile dressing
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Wounds
Special considerations Amputations, avulsions
• Avulsed portion of skin may be reattached to cover an open wound
• Parts detached from body remain viable for a few hours when left at room temperature If cooled, can be viable for up to 18 hours
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Wounds
Special considerations Parts detached from
body• May be reattached
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Wounds
Special considerations Impalement injury
• Stabilize object with bulky dressings
• Remove object if it interferes with CPR
• Identify available resources when special rescue techniques needed
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Wounds
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Wounds
Special considerations Neck wounds
• May lead to air embolism when large veins are torn
• Cover with occlusive, airtight dressing
• Transport in supine or head-down position to reduce chance of air embolism
• When torn/lacerated, bleeding is usually severe because the neck is highly vascular
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Wounds
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Dressings & Bandages
Dressings Any material that
covers wounds
Prevent further contamination
Bleeding control
Basic dressing is sterile gauze
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Dressings & Bandages
Dressings Multitrauma/universal dressing
• For large surface area
• Thick, absorbent material that is 9x36 inches
• Can be used as a pressure dressing over long, open wounds or as a padding for splints
Occlusive airtight dressing• Sterile plastic wrap/sterile aluminum foil may be used
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Dressings & Bandages
Bandages Material used to secure dressing in place
Provides pressure to help in bleeding control
Must be tight enough to control bleeding but must not cut off circulation to the limb
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Dressings & Bandages
Bandages Types
• Self-sticking
• Self-adherent
• Gauze roller
• Triangular bandages
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Dressings & Bandages
Bandages Self-adherent bandages
• Rolls of slightly elastic, gauzelike material
Elastic/ace bandages support joints• If not properly applied, result is uneven pressure to limb
May cause obstruction of distal blood flow and pressure on local nerves
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Dressings & Bandages
Bandages Gauze roller bandages
• Used for extremity, head-dressing application
Triangular bandages• Most versatile
• Fold as necessary for multiple uses
• Used for direct pressure or to support any portion of the body
• Slings
• Cravat-type bandage
• Used in application of tourniquets
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Dressings & Bandages
Related materials Adhesive tape
Pneumatic antishock garment
BP cuffs
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Dressings & Bandages
Bandage application May be attached to various parts of body
• Extremities
• Head
• Trunk
Roller bandage• Self-adherent/gauze material
• Pressure dressing
• Head bandage
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Skill 21-1: Applying Pressure Dressing with Roller Bandage
Cover wound with sterile dressing
Apply firm pressure until bleeding stops
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Skill 21-1: Applying Pressure Dressing with Roller Bandage
If bleeding continues, reinforce dressing with more absorbent material
Apply more pressure
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Skill 21-1: Applying Pressure Dressing with Roller Bandage
Once controlled, continue pressure Attach self-
adherent/roller bandage around part
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Skill 21-1: Applying Pressure Dressing with Roller Bandage
After encircling body part, anchor bandage
Overlap halfway over previous layer
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Skill 21-1: Applying Pressure Dressing with Roller Bandage
Once in place, tape/tie off end
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Skill 21-2:Applying Head Bandage
Apply gentle pressure to wound with flat hand
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Skill 21-2:Applying Head Bandage
Begin head bandage by anchoring bandage below occipital protuberance
Circle head completely
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Skill 21-2: Applying Head Bandage
Transverse bandage back/forth across top of head until completely covered
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Skill 21-2:Applying Head Bandage
Circle head twice
Tape
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Dressings & Bandages
Bandage application Figure-eight bandage
• Secures dressing over joint
• Allows mobility
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Skill 21-3:Applying Bandage to Knee/Elbow
Start roller bandage below joint, anchor in place
Transverse diagonally across joint over dressing
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Skill 21-3:Applying Bandage to Knee/Elbow
Circle bandage above joint
Transverse downward to form “X” over dressing on joint
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Dressings & Bandages
Bandage application Object impaled
• Stabilized to limit movement
• Never remove impaled object unless penetrating cheek or interfering with CPR
• If significant bleeding occurs in cheek after removal
• Apply dressing from within the mouth, with finger pressure applied to control bleeding
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Skill 21-4: Stabilizing Impaled Object
Place surgical pads on both sides of object
Tape on all 4 sides
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Skill 21-5:Managing Impaled Object in Cheek
As object is withdrawn, control bleeding from inside
Manually control bleeding outside of cheek
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Skill 21-5:Managing Impaled Object in Cheek
Keep suction ready to remove blood & secretions from airway
Position patient to permit blood drainage from mouth, to prevent aspiration
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Dressings & Bandages
Bandage application Chest and back dressings
• Most dressing applications can be done with tape across skin’s surface
• Sweaty/wet skin surface Use triangular bandage
• Chest dressings When securing bandage around circumference, do not
exert excessive pressure that may restrict movement
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Facial Injuries
Face, neck 1st concern is airway
Facial bones give structural support to the airway• Loss of their integrity can compromise airway patency
• Possible airway obstructions Bleeding
Foreign bodies
Broken teeth and dentures
Vomitus
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Facial Injuries
Clear airway techniques Manual extraction of foreign bodies
Control bleeding
Suctioning
Position patient to permit drainage
Can cause excessive bleeding
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Facial Injuries
Facial bones are part of the skull and offer protection to the brain Must search for signs of injury to brain and the
cervical spine
Special handling techniques
Remove blood, blood clots or loose teeth from airway with finger sweep/suction
• Unconscious patients
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Facial Injuries
Bleeding from face or within oral cavity should be controlled with direct pressure
Impaled objects in cheek should be removed Do not use excessive force
Stabilize object
Position patient to allow for drainage
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Facial Injuries
Eye injuries Anatomy and physiology
• Proper handling can preserve eye function
• Globular structure filled with vitreous humor
• Rotates within the bony orbit through action of the orbital muscles
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Facial Injuries
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Facial Injuries
Eye injuries Anatomy and physiology
• Sclera Outer layer of eye
Composed of tough, fibrous, opaque protective membrane
• Cornea Outer layer
Transparent to light
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Facial Injuries
Eye injuries Anatomy and physiology
• Cornea Outer layer
Transparent to light
• Iris Pigmented/colored portion of the eye
Circular muscular structure
Controls amount of light that enters eye through the pupil
Made of constricting and dilating muscles
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Facial Injuries
Eye injuries Anatomy and physiology
• Pupillary size Constricts in response to light
Dilates in dim light, permits more light to enter
Changes in size when focusing on close objects
Used to evaluate brain function
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Facial Injuries
Eye injuries Anatomy and physiology
• Retina Posterior wall of the eye
Ciliary muscles are attached to the lens to change its shape so light can be focused
Composed of millions of sensory receptors
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Facial Injuries
Eye injuries Anterior chamber
• Filled with aqueous humor Circulating watery fluid
Specialized capillaries
Is drained and reabsorbed back into other capillaries
When drainage is obstructed, pressure builds is and causes glaucoma
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Facial Injuries
Eye injuries Posterior chamber
• Filled with vitreous humor Firmer, gel-like fluid
Not formed or drained continuously
Cannot be lost without permanent damage
Direct pressure must never be applied to the eyeball
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Facial Injuries
Eye injuries Protection
• Eye is set deep within orbits/sockets formed by many bones
• Eye is protected in front by eyelids
• Blinks quickly to protect from oncoming object
• Eyelashes act as filters to help small particles from entering
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Facial Injuries
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Facial Injuries
Eye injuries Protection
• Conjunctiva Mucous membrane
Lines of interior surface of the eyelids
Covers the anterior surface of the eye
Changes its composition as it extends over the sclera and cornea
When irritated by a foreign body or inflamed, the capillary vessels become prominent
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Facial Injuries
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Facial Injuries
Eye injuries Protection
• Lacrimal glands Located at superior lateral surface of eyeball
Secrete tears
• Layer of fat behind the eye serves as cushion between eyeball and the bony orbit
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Facial Injuries
Eye injuries Management
• Principles of care Avoid pressure
Cover both eyes to limit movement
Patient’s cooperation needed
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Facial Injuries
Eye injuries Management of eye injuries
• Foreign body removal
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Skill 21-6:Removing Foreign Bodies from Eye
Use sterile water, saline, eye-irrigating solution
Explain your actions
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Skill 21-6:Removing Foreign Bodies from Eye
Allow stream of water to pass from medial portion of sclera
Do not use high-pressure stream
Rinse eyelid if needed
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Skill 21-6:Removing Foreign Bodies from Eye
If irrigation unsuccessful, gently whisk foreign body off eye with clean, moistened, cotton-tipped applicator
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Facial Injuries
Eye injuries Management
• Corneal abrasions Will notice a small defect on normally smooth corneal
surface
Possible accompanying inflammation of conjunctiva over the sclera
Patching the eye may offer some relief
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Facial Injuries
Eye injuries Management of eye injuries
• Impaled objects Never remove protruding object
Stabilize object with 4x4 gauze squares built up around object
Cover dressing with paper cup or cardboard folded into cone shape
Cover other eye
Transport in supine position
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Facial Injuries
Eye injuries Management
• Lacerations Can cause brisk bleeding because of rich blood supply
Check to see if there is accompanying damage
Use gentle and direct pressure to control bleeding
Avoid transmitting pressure to eye itself. Cover eye with plastic eye shield or cup to protect from external pressure
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Facial Injuries
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Facial Injuries
Eye injuries Management of eye injuries
• Extruded eyeball Do not attempt to replace
Place several layers of 4x4 gauze squares, hole cut in center, and moistened with sterile saline solution around eyeball
Attach cup/cone-shape cardboard over dressing with bandages
Cover opposite eye
Transport to hospital
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Facial Injuries
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Facial Injuries
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Facial Injuries
Eye injuries Management of eye injuries
• Orbit fracture Blows can result in fractures
Possible signs of soft tissue trauma at orbital ridge
May be complicated by impaired eye movement and visual disturbance
Muscles that move eye become entrapped in the fracture
Patient may not be able to move both eyes symmetrically
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Facial Injuries
Ear injuries Anatomy, physiology
• Ear functions Hearing
Establishing potential sense
Provides balance
• Blood extruding from the ear after trauma is sign of possible skull fracture
• Ear infections are potential cause of meningitis
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Facial Injuries
Ear injuries Anatomy, physiology
• External ear Composed of auricle/pinna
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Facial Injuries
Ear injuries Anatomy, physiology
• Middle ear Air-filled cavity transmits sound waves from external to
inner ear
Begins at tympanic membrane (eardrum)
Ends at oval window of the inner ear
Auditory ossicles act as levers to transmit sound waves collected at eardrum to the inner ear
Communicates with nasopharynx by Eustachian tube
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Facial Injuries
Ear injuries Anatomy, physiology
• Inner ear Encased within skull
Contains coiled, looped tubes filled with fluid, lined with sensory cells
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Facial Injuries
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Facial Injuries
Ear injuries Management of ear injuries
• Blood extruding from ear Sign of possible skull fracture
Apply loose sterile dressing
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Facial Injuries
Ear injuries Management of ear injuries
• Auricle Remove gross contamination
Apply sterile dressing
Apply bulky dressing around auricle before bandaging
Treat incomplete avulsed parts of the auricle by approximating their anatomic position
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Facial Injuries
Ear injuries Management of ear injuries
• Completely avulsed/amputated part Remove gross contamination
Wrap amputated part in gauze moistened with sterile saline solution
Place part in plastic bag
Keep part cool
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Facial Injuries
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Facial Injuries
Ear injuries Management of ear injuries
• Foreign bodies Removed in emergency department unless directed
otherwise by local protocol
Do not obstruct blood flow from ear canal
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Facial Injuries
Ear injuries Management of ear injuries
• Barotrauma During exposure to changing environmental pressures,
middle ear maintains equal pressure on each side of the tympanic membrane
Moves air through Eustachian tubes
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Facial Injuries
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Facial Injuries
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Burns
Injury cause Thermal
Chemical
Electrical
Skin most often injured by burns – 15% of body weight in an adult
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Burns
Skin serves as: Protective barrier against infection
Barrier to water loss
Major thermoregulatory organ
Sensory organ for touch, pain, temperature, pressure perception
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Burns
Outer dermis – impermeable to water and bacteria
Dermis – contains blood vessels, nerves and other structures
Subcutaneous tissue – protects and insulates
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Burns
Burns result in: Loss of temperature control
Loss of body fluids and water
Susceptibility to infection
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Burns
Thermal burns Most occur in the home from flames or scalding
water
Ages 3 to 4 years: burning clothing most common source
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Burns
Thermal burns Smoke produced by burning materials contains
toxins• Most common is CO
Colorless
Tasteless
Odorless gas
Impairs O2 transport
Smoke inhalation
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Burns
Thermal burns Assessment of burn injuries
• Wide criteria used to assess severity Depth
Extent
Location
Age
Respiratory involvement
Associated medical/traumatic conditions
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Burns
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Burns
Thermal burns Assessment of burn injuries
• Depth of burns Based on skin anatomy
Referred to in terms of degree
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Burns
Assessment of burn injuries Depth of burns
• Superficial/1st -degree burns Involve epidermis only
Skin appears reddened and is dry and warm
1st degree burns are generally painful because the nerves in the deeper layers are left intact
Possible slight edema from congestion and dilation of the intradermal vessels
Heal spontaneously
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Burns
Assessment of burn injuries Depth of burns
• Partial-thickness/second-degree burns Involve epidermis, extend into dermis but not through
entire dermis
Flash injuries or hot-liquid scalds
Appearance depends on extent of dermal injury
Common characteristics caused by tissue damage and accumulation of plasma from injured capillaries
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Burns
Assessment of burn injuries Depth of burns
• Partial-thickness/second-degree burns Color varies depending on depth
Vary in sensitivity
Skin functions lost
Heal spontaneously
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Burns
Assessment of burn injuries Depth of burns
• Partial-thickness/2nd -degree burns Common characteristic edema, blister
Blisters left intact
Color may vary, depending on depth
Extremely painful, sensitive
Deeper burns, normal/decreased sensation
Very deep, no sensation
Skin functions lost
Heal spontaneously
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Burns
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Burns
Assessment of burn injuries Depth of burns
• Full-thickness/3rd -degree burns Involve entire thickness of epidermis, dermis
Skin charred, yellow-brown, dark red, white, translucent
No pain, nerves destroyed
Texture of skin is leathery
Skin has restricted skin movement
Heal only from margins of the wound
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Burns
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Burns
Assessment of burn injuries Depth of burns
• Other burns 4th -degree burn
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Burns
Assessment of burn injuries Depth of burns
• Extent of burns Amount of skin burned indicates severity of the burn
Calculations made according to the “rule of nines”
Always describe depth of burns in reports and communications:
Do not delay transport to calculate burn severity
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Burns
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Burns
Assessment of burn injuries Depth of burns
• Location of burns Perineum & genital prone to infection
Facial burns can involve special structures, with respiratory tract involvement
Circumferential burns involve extremities, neck, torso
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Burns
Assessment of burn injuries Complicating factors
• Age
• Inhalation injuries cause direct damage to respiratory tract Hot air
Smoke particles
Toxic gases
Cause airway compromise
Damage to lungs
Smoke interferes with O2 delivery and use
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Burns
Assessment of burn injuries Depth of burns
• Physical signs of inhalation injury Singed nasal hairs
Sputum with black particles
Burns around mouth, nose
Hoarseness of voice
Respiratory distress
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Burns
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Burns
Assessment of burn injuries Associated conditions
• Take precedence over burn injury Medical conditions
Lung, heart disease
Diabetes
Other severe injury/illness
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Burns
Assessment of burn injuries Burn severity
• Local protocols often use burn severity as criterion for determining which facility selected
• Nationally accepted criteria used to reflect local resources
• Depth & extent are major determinants in classifying severity
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Burns
Management of burns Management steps
• Stop burning process
• Remove patient from smoky environment
• Provide high-concentration supplemental O2
• Treat for shock
• Prevent infection
• Transport to appropriate facility
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Burns
Management of burns Stop burning
• Remove patient from burning/smoky environment
• Extinguish flames with blankets or water
• Remove smoldering clothing and jewelry
• Pour cool, sterile water over articles of clothing that adhered to skin to stop the burning process
• Use caution in applying cool, wet compresses
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Burns
Management of burns Treat life-threatening conditions first
• Assess for airway compromise, respiratory distress signs Stridor
Hoarseness
Use of accessory muscles
Cyanosis
Other signs of respiratory distress
Signs of inhalation injury
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Burns
Management of burns Treat life-threatening conditions 1st
• If evidence of inhalation injury, shock or extensive burns: Administer high-concentration supplemental O2
• Assume patient inhaled CO Administer high-concentration O2
• Assess for associated trauma and shock caused by other injuries
• Obtain history
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Burns
Management of burns Cover the wound
• Sterile clean dressings/sheets
• Remove rings/bracelets that may constrict
• Never apply ointments
• Leave blisters intact
• Covering the wound often gives some pain relief
• In cool environments, use blankets to insulate and maintain body temperature
Transport per local protocols
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Burns
Chemical burns Type, concentration, duration determines severity
Chemicals continue to burn until removed
Initiate immediate thorough irrigation
Position patient, self to avoid runoff, splashes
Wear gloves, eye protection, gown, mask
Powders/dried chemicals
Yellow/white phosphorus
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Burns
Chemical burns Sodium, potassium
• Extinguish with fire extinguisher
• Smother with sand
• Cover with petroleum jelly
Hydrofluoric acid• Water used for irrigation
• Soak dressing Calcium chloride
Calcium gluconate
Magnesium oxide paste
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Burns
Chemical burns Burns to eyes
• Chemical damage depends on nature of chemical, duration of contact
• Flush eye immediately with clean water/irrigating solution
• Irrigate at least 20 minutes
• Longer contact with eye, greater risk of injury
• Exposure to infrared light, ultraviolet light
• Burns to eyelids
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Burns
Electrical burns When electricity traverses the body, it is converted
to heat that burns tissues in its path
High-voltage arcs generate intense amount of heat and can burn nearby person
Death can occur from passage of current through vital organs
EMTs must take precautions to protect self and patient
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Burns
Electrical burns Electrical basics
• Amperage
• Voltage
• Resistance
• Conductors
• Insulator
• Electricity seeks to flow along path of least resistance from higher to lower potential
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Burns
Electrical burns Electrical effects on body
• Electrical current passes through body as part of circuit
• Follows internal path of least resistance
• Burns to soft tissues extend from superficial to full thickness burns
• Longer duration of contact - greater severity of burn
• Immediate life-threatening effects Respiratory
Cardiac arrest
• Lightning injuries burn skin, soft tissue
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Burns
Assessment, management 1st priority
• Assess whether hazards continue to exist
Fallen wires• If patients trapped in vehicle in contact with downed wire
Have them remain in vehicle
Do not touch vehicle/patient until authorities confirm power is off
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Burns
Assessment, management Ensure rescuer safety
• After, assess & manage life-threatening conditions
• Look for cervical spine injury if falls or violent contractions have occurred
• Look for fractures and splint
When assessing the skin, look for entrance and exit wounds
Cover wounds with sterile dressings
Transport
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Burns
Chemicals continue to burn until removed
Initiate immediate thorough irrigation
Position patient, self to avoid runoff, splashes
Wear gloves, eye protection, gown, mask
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Burns
Powders/dried chemicals Brushed off
Contaminated clothing & shoes removed before irrigation
Yellow/white phosphorus Affected part kept submerged in water or covered
with soaked dressings
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Burns
Sodium, potassium Extinguished with fire extinguisher
Smothered with sand
Covered with petroleum jelly
Hydrofluoric acid Water used for irrigation
Soak dressing
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Burns
Burns to eyes Chemical damage depends on nature of chemical,
duration of contact
Flush eye immediately with clean water/irrigating solution
Irrigate at least 20 minutes
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Burns
Burns to eyes Longer contact with eye, greater risk of injury
Exposure to infrared light, ultraviolet light• Cover eyes with moist patches
Burns to eyelids• Cover eyelids with moist, sterile dressing
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Burns
Electrical basics Amperage
• Number/volume of electrons flowing
Voltage• Force which movement occurs
Resistance• Degree of hindrance to electron flow
Current can be direct/unidirectional in flow, alternate/switch direction of electron flow
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Burns
Electrical basics Low voltage less serious than high voltage
Symptoms range• Tingling
• Sustained muscular contraction
• Fatal organ damage
Resistance• Measure of hindrance to electron flow through given
material
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Burns
Electrical basics Conductors
• Low resistance
• Conduct electricity readily
Insulator• Very high resistance to electrical flow
Electricity seeks to flow along path of least resistance from higher to lower potential
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Burns
Electrical effects on body Electrical current passes through body as part of
circuit
Follows internal path of least resistance
Burns to soft tissues extend from superficial to full thickness burns
Longer duration of contact, greater severity of burn.
Lightning injuries burn skin, soft tissue
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Burns
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Burns
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Burns
Assessment, management 1st priority
• Assess whether hazards continue to exist
Patients trapped in vehicle in contact with downed wire
Ensure rescuer safety
Assess, manage life-threatening conditions
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Summary
Skin has 2 major layers; epidermis, dermis
Subcutaneous tissue lies beneath skin, consists of fat, connective tissue
Closed wounds caused by blunt trauma
Open wounds caused by blunt/penetrating trauma
Crush injuries may result in closed open wounds
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Summary
Severity/complications of wounds are determined by MOI, site of injury, extent of injury, introduction of foreign bodies/contaminants into wound
Common complications of wounds include bleeding, infection, damage to underlying structures
Wound management may include control bleeding, immobilization of affected part, prevention of contamination, preservation of avulsed/amputated parts, stabilization of impaled objects
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Summary
Partially avulsed body parts rinsed of gross debris, dressed, bandaged in original anatomic position
Amputated parts rinsed of gross debris, wrapped in sterile gauze, placed in plastic bag placed on ice
Dressing, material used to cover wound; bandage, material used to secure dressing in place/provide pressure over wound
Foreign bodies in eye irrigated out of eye/removed with cotton swab
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Summary
Impaled objects should never be removed from body, except from cheek
Cover extruded eyeballs with moistened dressing, cup, bandage; cover good eye
Burns may be caused by thermal, electrical, chemical mechanisms
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Summary
General burn management includes Stopping burning process
Removing patient from burning environment
Providing supplemental O2
Treating for shock
Preventing shock
Transporting to appropriate facility
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Summary
3 major categories of burn injuries: superficial, partial-thickness, full-thickness
Superficial burns, painful, cause reddened, dry, warm skin
Partial-thickness burns - very painful, characterized by pink, red, blotchy appearance, wet, weepy surface, edema, blisters
Full-thickness burns - not painful, characterized by deep-red, black, brown appearance; edema, disrupted skin, may have no sensation to touch
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Summary
Extent of burns evaluated with “rule of nines”
Factors that complicate/affect severity of burns include inhalation injuries, age, associated conditions, location of burn
Irrigate chemical burns at least 20 to 30 minutes before/during transport to hospital
Brush dry chemicals from skin before irrigation
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Summary
Electrical burns have entrance, exit wounds, may be more extensive than they appear on surface
Electrical injuries may cause fractures/lead to respiratory/cardiac arrest
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Questions?
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