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 to care for open and closed wounds and wounds with an impaled object. 6. Describe the three degrees of burns. 7. List five conditions under which you would summon more advanced medical help for a burn injury. 8. Describe how to care for thermal, chemical, electrical, and radiation burns. 9. Define the key terms for this chapter. 5. List the four causes of burn injury. SKILL OBJECTIVES After reading this chapter and completing the class activities, you should be able to 1. Demonstrate techniques for controlling severe bleeding. 2. Make appropriate decisions about care when given an example of an emergency involving soft tissue injuries. 165
OUTLINE Introduction 203 Soft Tissues 203 Types of Soft Tissue Injuries 204 Infection 207 Dressings and Bandages 209 Care for Wounds 211 Burns 215 KEY POINTS Factors Affecting Injury Age. Gender. Environment. Alcohol use/abuse. Injury-Prevention Strategy Alter behavior of people at risk. Require change by law. Provide automatic protection. Wounds Open. Closed. Types Abrasion. Laceration. Avulsion. Puncture. Care for Wounds Closed Wound. Minor Open Wound. Major Open Wound. Impaled Objects. Applying a Roller Bandage Elevate the injured body part. Secure the end of the bandage. Completely cover dressings. Don't cover finger or toes. Apply additional dressings, if necessary. Causes of Burns Heat. Chemicals. Electricity. Radiation. Degrees of Burns Superficial (first-degree). Partial-thickness (second degree). Full-thickness (third degree). Seve rity of Burns Depends on: Temperature of object. Location of burn. Extent of burn. Casualty's age and medical condition. 166
Care for Burns Cool the burned area. Cover the burned area. Minimize shock. Care for Electrical Burns Make sure the scene is safe. Turn electricity off. Do a primary survey. Do a secondary survey. Minimize shock. 167
LEARNING ACTIVITIES Matching Match each term with its definition. Write its letter on the line in front of the definition. Terms a. Abrasion b. Pressure bandage c. Layer of fat d. Full-thickness burn e. Dermis f. Avulsion g. Soft tissue h. Superficial burn i. Dressing j. Laceration k. Puncture 1. Bandage m. Critical burn Definitions 1. The layer of the skin containing nerves and sweat glands 2. Material used to hold a splint or wound covering in place 3. Any burn that is potentially life threatening, disabling, or disfiguring 4. A burn injury that involves only the epidermis 5. An injury created when the skin is pierced with a pointed object 6. A burn injury involving both layers of skin and underlying tissues 7. An injury in which a portion of the skin is partially torn away and hangs like a flap 8. Body structures including the layers of skin, fat, and muscles 9. An open wound in which the. skin has been rubbed or scraped away 10. A structure that lies beneath the skin and helps maintain body temperature 11. Material applied snugly over a covering on a wound to help control bleeding 12. A cut with jagged or smooth edges, caused by a sharp object 13. Material placed directly over a wound to absorb blood and prevent infection 168
Short Answer Read each statement or question and write the correct answer or answers in the space provided. 1. Describe three steps in the care for a casualty who has an impaled object in the lower leg. 1. 2. 3. 2. What should you do to minimize shock in a casualty of extensive burns? 3. What are the four main types of open wounds? 1. 2. 3. 4. 4. Describe six aspects of how you would care for a major open wound. 1. 2. 3. 4. 5. 6. CASE STUDIES Read the case studies and answer the questions that follow. Case 11.1 You are working at a metal shop and are called to help an injured worker. The worker's left arm was caught in a cutting machine and has been amputated at the middle of the forearm. He is lying on the floor of the shop, conscious, and in severe pain. 1. T F Since the upper forearm has been completely severed, you can expect severe bleeding, which can probably be controlled by using a pressure point. 2. T F To minimize the danger of infection, wash the wound with water for a few seconds before controlling the bleeding. 3. Which of these measures should you take to minimize the danger of disease transmission? a. Wear a pair of disposable gloves while controlling bleeding and applying a bandage. b. Wear protective eyewear and a surgical mask while caring for the casualty. c. Wash your hands after completing care and removing your gloves. d. a and c. 169
4. Which condition will the casualty probably suffer shortly? a. Infection b. Respiratory shock c. Shock d. High blood pressure 5. What four things would you do for the amputated arm to maximize the chances for successful reattachment? 1. 2. 3. 4. Case 11.2 You are summoned to the scene of a fire. While you are preparing to enter the house, a woman runs out with her clothes on fire. 1. Which is your first step in responding to this casualty? a. Do a primary survey. b. Cool the burned area. c. Summon specially trained personnel. d. Extinguish the flames on the clothing. 3. T F You should carefully remove all pieces of charred clothing that are sticking to the woman's skin by gently washing the area to loosen the clothing. 4. The woman has partial-thickness (second degree) burns covering her entire chest, abdomen, and back. You see no other burns during your secondary survey. Using the Rule of Nines, identify what percentage of her body is burned? a. 9 percent b. 18 percent c. 27 percent d. 36 percent 5. T F This would be considered a critical burn, and advanced medical personnel should be called immediately. 6. What should you use to cover this woman's burns to keep out air and decrease pain? a. Moist, sterile dressings b. Dry, sterile dressings c. Sterile occlusive dressings d. Burn ointment and sterile dressings 2. You determine that the woman is conscious and able to talk. Parts of her dress are charred. She has partial-thickness (second degree) burns on her left arm and back. How will you cool these burns? What will you not use to cool them? 170
SELF-ASSESSMENT Circle the letter of the best answer. 1. Which of the following describes skin that has been superficially burned (first degree burn)? a. Red, dry, and painful b. Pale, wet, and painful c. Red, wet, and painless d. Mottled, dry, and painless 2. When bandaging a forearm, you should a. Cover the hand and fingers loosely. b. Leave the fingers of the hand exposed. c. Wrap the hand and fingers tightly to prevent swelling. d. Place a rolled dressing in the palm of the hand, close the hand, and wrap it completely. 3. A woman has splashed paint remover into her eyes. What should you do? a. Flush her eyes with tap water until more advanced medical personnel arrive. b. Flush her eyes with vinegar and water to neutralize the chemical. c. Flush her eyes with warm water for 10 minutes. 4. A wound in which the skin is not broken and the area discolours and swells is a(n) a. Closed wound. b. Open wound. c. Superficial wound. d. Avulsion. 5. In which of the following situations should you immediately call for more advanced medical personnel? a. A partial-thickness water scald to the arm of a 30-year-old man b. A blistering grease burn on the arm of a 68-year-old woman c. A partial-thickness sunburn on the back of a 26-year-old woman d. All of the above 6. When a burn appears brown or charred, shows white tissue underneath, and is almost painless, which layer(s) of soft tissue have been injured? a. The epidermis b. The epidermis and dermis c. The epidermis, dermis, and fatty tissues d. The epidermis, dermis, and underlying soft tissue structures d. Bandage her eyes without flushing them, and wait for advanced medical personnel. 171
7. How would you minimize the risk of infection in a minor abrasion? a. Wash the abrasion with soap and water. b. Clean the area with hydrogen peroxide or alcohol. c. Take the casualty to a doctor for a tetanus booster. d. All of the above. 10. A woman has full-thickness burns covering the front of her chest and abdomen, and her back. Using the Rule of Nines, what percentage of her body is burned? a. 9 b. 18 c. 27 d. 36 8. Which purposes do bandages serve? a. Provide a sterile covering for wounds, and control bleeding. b. Apply pressure to control bleeding, and provide support to injured body parts. c. Reduce pain in open wounds, and hold dressings in place. d. Prevent air from reaching a wound, and apply ointments. 9. In treating the casualty of an electrical injury, you should a. Push the casualty away from the electrical wires with a dry pole or stick. b. Cover any burns with a dry, sterile dressing. c. Look for an entrance and an exit wound. d. b and c. 11. Which type of bandage or dressing would you use to stop air from passing through? a. Occlusive dressing. b. Universal dressing. c. Elastic bandage. d. Bandage compress. 12. In which situation would you remove an impaled object from a wound? a. When direct pressure around an object in the forearm fails to stop the bleeding. b. When the object is impaled in the lower leg, making it impossible to apply a board splint to a fractured tibia. c. If an object impaled in a casualty's cheek obstructs breathing. d. All of the above. 172
13. You have bandaged a profusely bleeding wound, and the bandage becomes soaked with blood. You should a. Remove the bandage, and quickly apply a tourniquet. b. Leave the bandage on, and apply a tourniquet. c. Add another dressing on top of the soaked one, and apply more direct pressure. d. Do nothing; given time, the blood will clot and the bleeding will stop. 14. You have cooled a thermal burn. What should you do next? a. Remove any clothing that is sticking to the skin. b. Apply a commercial burn ointment, if available. c. Cover the burn with a dry, sterile dressing, and bandage loosely. d. Place an occlusive dressing over the burn, and apply a bandage. 16. 17. In which situation would you remove an impaled object from a wound? a. When direct pressure around an object in the forearm fails to stop the bleeding. b. When the object is impaled in the lower leg, making it impossible to apply a board splint to a fractured tibia. c. If an object impaled in a casualty's cheek obstructs breathing. d. All of the above. 18. How should you cool a partialthickness thermal burn? a. Apply burn ointment. b. Use water to cool the burn, c. Apply ice packs. d. Gently fan the casualty with a damp towel. 15. Which purposes do bandages serve? 19. In treating the casualty of an electrical burn, you should- a. Push the casualty away from any electrical wires with a dry pole or stick. b. Cover any burns with a dry, sterile dressing. c. Look for an entrance and an exit wound. d. b and c. 173
Answers to Exercises Unit 11-Soft Tissue Injuries Matching: 1. e 2. 1 3. m 4. h 5. k 6. d 7. f 8. g 9. a 10. c 11. b 12. j 13. i. Short Answer: 1. Do not remove the object.; Use bulky dressings to stabilize the object.; Control any bleeding by bandaging the dressings in place around the object. 2. Cool and cover burns to reduce pain.; Place the casualty lying down unless it causes breathing difficulty.; Elevate the burned areas above the level of the heart.; Maintain normal body temperature, prevent chilling.; Administer oxygen if it is available and it is safe to do so. 3. Abrasion; laceration; avulsion; puncture. 4. Do not waste time trying to wash the wound.; Quickly control bleeding by applying a dressing and using direct pressure and elevation.; Continue direct pressure by applying a pressure bandage.; Use a pressure point to control bleeding if necessary.; Summon more advanced medical care.; Wash your hands immediately after completing care and removing your gloves. Case Study 11.1: 1. F 2. F 3. d 4. c 5. Wrap the part in sterile gauze or clean material; place the wrapped part in a plastic bag; place the bag on ice-no ice directly on the part; transport the part to the hospital with the casualty. Case Study 11.2: 1. d 2. Use cool water until the areas around the burns are not warm to the touch.; Do not use ice or ice water. 3. F 4. d 5. T 6. b. Self-Assessment: 1. a 2. b 3. a 4. a 5. b 6. d 7. a 8. b 9. d. 10. d. 11. a. 12. c. 13. c. 14. c. 15. 16. 17. c 18. b 19. d 174
PRACTICE SESSION: Care for a Major Open Wound (Forearm) Apply direct pressure Place sterile dressings or clean cloth over wound. Press firmly against wound with your hand. Elevate the body part Raise wound above level of heart if possible. Apply a pressure bandage Using a roller bandage, cover dressing completely, using overlapping turns. Secure the bandage. If blood soaks through the bandage, place additional dressings and bandages over the wound. If bleeding stops... Determine if further care is needed. If bleeding does not stop... Summon more advanced emergency personnel. 175
Use a pressure point Maintain direct pressure and elevation. Locate brachial artery. Press the brachial artery against the underlying bone. Continue to take steps to minimize shock Maintain direct pressure, elevation, and pressure point. Position person on back. Monitor ABCs. Maintain normal body temperature. Apply additional dressings and/or bandages as necessary. 176
PRACTICE SESSION: Care for a Major Open Wound (Leg) Apply direct pressure Place sterile dressing or clean cloth over wound. Press firmly against wound with your hand. Elevate the body part Raise wound above level of heart, if possible. Apply a pressure bandage Using a roller bandage, cover dressing completely, using overlapping turns. Secure the bandage. If blood soaks through the bandage, place additional dressings and bandages over the wound. If bleeding stops... Determine if further care is needed. If bleeding does not stop... Summon more advanced emergency personnel. 177
Use a pressure point Maintain direct pressure and elevation. Locate femoral artery. Press the femoral artery against the underlying bone. Continue to take steps to minimize shock Maintain direct pressure, elevation, and pressure point. Position person on back. Monitor ABCs. Maintain normal body temperature. Apply additional dressings and/or bandages as necessary. 178
PRACTICE SESSION: Care for a Wound With an impaled Object Apply direct pressure Avoid moving the body part. Place sterile dressings or clean cloth over the wound, around the object. Press lightly against the wound with your hands. Support the object Pack bulky dressings around the object to stabilize it in place. Continue to apply light pressure. Apply a pressure bandage Using a roller bandage, cover the dressings completely, using overlapping turns so that the object is stabilized. If bleeding stops... Determine if further care is needed. If bleeding does not stop... Summon more advanced emergency personnel. 179
Use a pressure point Maintain direct pressure. Press the proper pressure point by squeezing the artery against the bone. Continue to take steps to minimize shock Maintain direct pressure and pressure point. Position person on back. Monitor ABCs. Maintain normal body temperature. Apply additional dressings and/or bandages as necessary. 180