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Equipment
Dressing v Bandages
Dressings Function Stop bleeding Protect the wound from further injury Prevent further contamination/infection Types Universal dressings 4X4 gauze pads Adhesive-type Occlusive Bandages Function Holds dressings in place Types Self adherent Gauze rolls Triangular bandages/Cravats Adhesive Tape Air splint
Function
Largest organ system in the body Protection from environment Temperature regulation Senses Heat, Cold, Touch, Pressure, Pain, etc. Vitamin D synthesis Storage
Structure
Epidermis
Outermost layer No blood vessels Protection, absorption of nutrients homeostasis Deeper layer Contains sweat/sebaceous glands, hair folicles, blood vessels, nerve endings Gives skin its flexibility
Dermis
Subcutaneous layer
Closed
Skin is not broken Underlying tissue damage Leaky vessels = Edema Contusion/Hematoma
Open
Any wound that breaks the skin Slight scrapping of skin --- amputation
Closed Injuries
Contusion (Bruise)
Epidermis remains intact Cells and vessels are damaged in dermis Swelling and pain Blood accumulated Collection of blood beneath the skin Larger tissue damage than contusion Larger vessels are damaged 1 + Liter of blood loss Crushing force applied to body Internal organ rupture Internal bleeding may be severe = Shock
Hematoma
Crush injuries
BSI
Gloves
Abrasion
Outermost layer of skin is sheered off Painful even though superficial No/very little oozing of blood Break in skin of varying depth May be linear or non linear Caused by forceful impact with sharp object Bleeding may be severe Flap of skin/tissue is torn loose or torn off
Laceration
Avulsion
Penetration/Puncture
Caused by sharp pointed object May be no external bleeding Internal bleeding may be severe Exit wound may/may not be present
Amputation
Cutting away from the body of a limb/protruding structure Extremities and other body parts Massive bleeding may be present OR Bleeding may be controlled Damage to soft tissue and internal organs May cause painful, swollen, deformed extremities External bleeding may be present of absent Internal bleeding may be severe
Crush Injury
Amputation
Crush Injury
BSI
Maintain airway/Ventilation Expose the wound Control bleeding Prevent further contamination Apply dry sterile bandage to wound Secure in place Keep pt calm/quiet Treat for shock if S/S present
Evisceration Evisceration
Impaled Object
Chest Injuries
Flail Segment
Definition: 4 or more ribs broken in 2 or more places Results in an unstable chest Presentation: Paradoxical motion Movement of flail segment inward with inspiration and outward with exhalation Splinting Patient reduces motion of the chest wall Dyspnea Pain Complications Hemothorax Pneumothorax Abdominal organ laceration/rupture Treatment O2 Apply bulky trauma dressing to injured area and secure in place OR Place patient with injured side down OR Place padded board splint over injured area and secure to adjacent ribs Assisted ventilations
Traumatic Asphyxia
Definition:
Severe compression of the thorax Blood within the veins are drive into:
Presentation:
Sever swelling and ecchymosis of the face Air hunger DCAP-BTLS to chest Underlying injury O2 Positive pressure ventilation Rapid transport
Complications:
Treatment:
Pneumothorax
Definition:
Types:
Penetration of the chest Sucking Chest Wound Pneumothorax without an open wound to the chest Air entering the chest becomes trapped Increases intrathoracic pressure Collapses lung and shifts thoracic contents away from injury Closed and open pneumothorax can present
Closed
Tension
Normal Anatomy
S/S
SOB Chest pain Absent/diminished lung sounds on injured side Subcutaneous emphysema Cyanosis Tracheal deviation Profound shock JVD
Complication:
Reduced surface area of lung =Hypoxia Kinking of vena cavae = Reduced blood volume = Shock
Treatment:
O2 Ventilatory assistance if needed See next slide for Sucking Chest Wounds if Open pneumothorax Rapid transport
Cover with gloved hand initially Ask patient to forcefully exhale Place an occlusive dressing over the wound Tape on 3 sides
Occlusive Dressing
Hemothorax
Definition:
Injured blood vessel in thorax Blood accumulates in pleural space Pneumothorax S/S Shock Flat neck veins Diminishes/distant lung sounds Tachypnea Shock Cardiac collapse/arrest O2 Treatment for shock Rapid transport
Presentation:
Complication:
Treatment:
Pericardial Tamponade
Definition:
Collection of blood/fluid in the pericardium Becks Triad Muffled heart sounds Narrowing pulse pressures Systolic BP- Diastolic BP 40mmHg or less Shock Pulsus Paradoxus A BP drop of 1OmmHg on inhalation
Presentation:
Complications:
Treatment:
Definition:
Organs protruding through wound DO NOT TOUCH OR REPLACE the organ Cover with a sterile dressing moistened with sterile water Cover with a dry sterile dressing and tape in place Cover with plastic wrap Tape completely around the border of the dressing Flex the pts hips and knees, if uninjured
Treatment:
Impaled Objects
It is in the cheek
Would interfere with chest compressions Interferes with transport Manually secure the object Expose the wound area Control bleeding Use a bulky dressing to help stabilize the object
Treatment:
Amputations
Concerns for reattachment Wrap the part in a sterile dressing Wrap or bag the part in plastic and keep cool Transport part with the pt DO NOT COMPLETE PARTIAL AMPUTATIONS Immobilize to prevent further injury May cause air embolism Cover with an occlusive dressing Compress carotid artery ONLY if NECESSARY to control bleeding
Eye Injuries
Impaled Objects:
NEVER REMOVE Stabilize object with several 4X4s Cover with paper cup/cardboard cone Have patient close other eye OR dress it as well.
Burns
Sources Thermal Electrical - Chemical Types Superficial (1st degree) Upper level of the skin (epidermis) Redness and pain Sunburn Partial Thickness (2nd degree) Upper and lower level of skin (Epidermis/Dermis) Does not involve underlying tissue White to red skin Moist to mottled BLISTERS VERY painful Full Thickness (3rd degree) Extension through upper and lower layers of skin May involve subcutaneous layers, muscles, or bone Black/charred red, Yellow/Brown, Dark red, White/Translucent Hard to touch Little pain, pain from associated 1st and 2nd degree burns
Depth of burn
Child
Head and neck = 9% Each upper extremity= 9% Anterior trunk = 18% Posterior trunk = 18% Each lower extremity = 18% Genitalia= 1 %....\
Head and neck = 18% Each upper extremity= 9% Anterior trunk = 18% Posterior trunk = 18% Each lower extremity = 14%
Location
Criticality of Burns
Location
Complications
Age
Burn Care
Stop the burning process, initially with water/saline Remove smoldering clothing/jewelry BSI CONTINUALLY monitor airway for compromise Prevent further contamination Cover the burned area with a DRY sterile dressing Do no use any lotion, ointment, or antiseptic Do not break blisters Transport Refer to local protocols for transport decision
Electrical Burns
SCENE SAFE Do not remove pt from source unless trained to do so If pt still in contact with source or you are unsure DONT touch the pt Emergency Care O2 Monitor CLOSELY for respiratory and/or cardiac arrest Often more severe than external indications Treat associated soft tissue injuries Note entrance and exit wounds
20 minutes
Concerns
Greater surface area v body size Greater fluid/heat loss Higher risk of
Full Thickness OR Partial thickness greater than 20% Hands, feet, face, genitalia, or airway Partial thickness greater than 10-20%
Moderate