Soft Tissue Trauma. Lesson Goal. Lesson Objectives 9/10/2012. Recognize and manage various types of soft tissue injuries. State function of skin

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1 Soft Tissue Trauma Lesson Goal Recognize and manage various types of soft tissue injuries Lesson Objectives State function of skin List and describe 3 layers of skin Explain why BSI is a critical safety element when treating patient with soft tissue injuries Explain Rule of Nines and how it relates to soft tissue injuries 1

2 Lesson Objectives Differentiate between 3 types of bleeding: arterial, venous, and capillary Distinguish between closed and open soft tissue injuries Identify and treat different types of closed soft tissue injuries Lesson Objectives Identify and treat different types of open soft tissue injuries Explain difference between dressing and bandage and state their functions & purposes Demonstrate various methods of controlling bleeding Lesson Objectives Differentiate penetrating trauma to the chest & to the abdomen Define and be able to treat partial thickness burns Define and be able to treat full thickness burns 2

complications Explain how to treat chemical burn and associated

3 Lesson Objectives Explain how electrical & chemical burns are different from thermal burns Explain how to treat electrical burn and associated complications Explain how to treat chemical burn and associated complications Introduction Skin Largest organ Commonly injured Protective barrier Use BSI 3

4 Protection Major Functions of Skin Prevention Maintenance of body temperature Layers of Skin Epidermis Dermis Subcutaneous layer Rule of Nines 4

5 Bleeding Occurs when blood vessels are torn or cut May be external or internal Each type of vessel has characteristic type Under pressure Arterial Bleeding May spurt Blood loss can be significant Lower pressure Venous Bleeding Steady, slower flow Can still be life threatening, depending on size of vessel involved 5

based on MOI, signs & symptoms Must understand kinematics & assessment findings Must be treated in the

6 Capillary Bleeding Tiny vessels Some areas of skin have richer capillary supply than others Face & scalp can bleed quite heavily because of large number of capillaries Internal Bleeding Not visible Suspicion based on MOI, signs & symptoms Must understand kinematics & assessment findings Must be treated in the hospital Closed Soft Tissue Injuries Contusions Bruise Discoloration Swelling Pain Can indicate underlying injury 6

Apply pressure dressing tightly enough to hold ice pack in place, but not so tight that it cuts off circulation 2.

7 Closed Soft Tissue Injuries Hematoma Blood pools under skin Notable swelling Consider underlying injury Skill 26-1: Applying Ice for Swelling 1. Apply pressure dressing tightly enough to hold ice pack in place, but not so tight that it cuts off circulation 2. Check capillary refill after applying pressure dressing 3. Elevate extremity with pillow or blanket Soft Tissue Injuries Crush injury Tissue compressed between 2 surfaces Can result in distal injury 7

Open Soft Tissue Injuries Abrasions Epidermis & part of dermis

Open Soft Tissue Injuries Lacerations Tear in skin Bleeding

Tissue Injuries Punctures Object penetrates body Includes stab

8 Open Soft Tissue Injuries Abrasions Epidermis & part of dermis scraped away Generally minor Risk of infection if extensive Open Soft Tissue Injuries Lacerations Tear in skin Bleeding minor or severe Primary concern control bleeding Open Soft Tissue Injuries Punctures Object penetrates body Includes stab wounds & GSW Path of damage may be greater than external wound indicates 8

Open Soft Tissue Injuries Impaled objects Penetrating object

interferes with airway or CPR Open Soft Tissue Injuries Avulsions

the wound Treat pieces of completely avulsed tissue as amputated

severed Care for patient first, then part If possible, transport

9 Open Soft Tissue Injuries Impaled objects Penetrating object remains in wound Stabilize in place with bulky dressings unless it interferes with airway or CPR Open Soft Tissue Injuries Avulsions Flap injury Severity varies If flap still attached, replace over the wound Treat pieces of completely avulsed tissue as amputated parts Open Soft Tissue Injuries Amputations Body part completely severed Care for patient first, then part If possible, transport part with patient Wrap in sterile gauze, place in plastic bag, keep it cool 9

point pressure Tourniquet Bleeding Control Elevation slows bleeding Direct pressure applied by placing dressing

10 Bleeding Control Dressing & bandaging Control bleeding, prevent contamination Dressings cover wound Bandages hold dressing in place Bleeding Control Techniques Elevation Direct pressure Pressure dressing Proximal pulse point pressure Tourniquet Bleeding Control Elevation slows bleeding Direct pressure applied by placing dressing over wound & applying hand pressure Do not remove dressing if saturated; add additional dressing material on top 10

Bleeding Control Use pressure dressings if direct pressure does

Use proximal pulse points if pressure dressing not effective

when other methods have proven ineffective Document application

11 Bleeding Control Use pressure dressings if direct pressure does not work or EMT cannot apply direct pressure to multiple sites Use proximal pulse points if pressure dressing not effective Bleeding Control Tourniquet Used only as life-saving measure when other methods have proven ineffective Document application Skill 26-2: Bleeding Control 1. Elevate extremity above level of heart 11

12 Skill 26-2: Bleeding Control 2. Apply gauze pad to wound and apply direct pressure with gloved hand to blood flow Skill 26-2: Bleeding Control 3. Pulse point pressure: Locate strongest pulse point immediately proximal to injury; apply deep pressure to obstruct blood flow Skill 26-2: Bleeding Control 4. Place tourniquet as close as possible to point of injury and tighten stick (or pen) only until bleeding stops; secure stick; write date & time of application on tourniquet 12

13 Skill 26-2: Bleeding Control Tourniquets should be removed only by hospital personnel To ensure tourniquet is not overlooked, write letters TK on patient s forehead or on piece of tape placed on forehead Skill 6-2: Direct Pressure & Pressure Points Video Clip coming soon Skill 6-2: Tourniquet Application Video Clip coming soon 13

determined by involvement with layers of skin Burns Superficial First degree

14 Burns Assessment & classification May be isolated or part of multisystem problems Prioritize care properly with respect to other problems Depth of burn determined by involvement with layers of skin Burns Superficial First degree Epidermis only Red Painful Burns Partial thickness Epidermis & dermis Painful Blisters 14

Burns Full thickness Not painful White, gray, charred All skin layers & possibly deeper tissues Rule of Nines Estimate of percentage of BSA involved Combined with other assessment information for

15 Burns Full thickness Not painful White, gray, charred All skin layers & possibly deeper tissues Rule of Nines Estimate of percentage of BSA involved Combined with other assessment information for decision making Burn Center Criteria Inhalation injury Partial thickness burns >10% BSA Full thickness burns any age group Face, hands, feet, genitalia, perineum, or major joints Electrical burns (including lightning) Chemical burns 15

16 Burn Center Criteria Burn injury in a compromised patient Concomitant trauma in which burn is greatest threat to life Children if inadequate resources Patients requiring special social, emotional, or long-term rehabilitation Burn Treatment Stop the burning! Remove clothing from affected areas Remove jewelry Burn Treatment Exposure to superheated air can cause airway burns Be prepared for aggressive airway management Provide high-flow O 2; assist ventilations as necessary 16

Burn Treatment Keep patient warm Do not apply ointment or salve Moist, sterile dressings if burns are superficial or partial thickness and <10% BSA Dry sterile dressings or burn sheets for others Do

17 Burn Treatment Keep patient warm Do not apply ointment or salve Moist, sterile dressings if burns are superficial or partial thickness and <10% BSA Dry sterile dressings or burn sheets for others Do not break blisters Chemical Burns Exposed to caustic substance Protect yourself Determine whether hazmat response necessary Find MSDS, call poison control or CHEMTREC as needed Chemical Burns Wear appropriate protective gear Remove patient s clothing & shoes Brush away dry powders Irrigate with copious amounts of water Do not use neutralizing agents Notify receiving hospital 17

18 Electrical Burns Injury depends on the amount of energy, path, & duration of exposure Direct contact burns Arc burns Flash burns Safety is critical Electrical Burns Damage may be largely internal Be prepared to perform CPR & defibrillate Other injuries can be produced by exposure to electricity Summary Soft tissue trauma common Soft tissue trauma includes closed injuries, open injuries, & burns Recognize & be able to treat various soft tissue injuries 18

Soft Tissue Injuries

KNOWLEDGE OBJECTIVES Soft Tissue Injuries 1. List two signs of closed wounds. 2. List four purposes of bandaging. 3. Describe the best initial defence against infection of an open wound. 4. Describe how