Transcript Soft Tissue Injury

Soft Tissue Injury
The Skin
External Bleeding
• BSI-always!!!!
• Severity of blood loss:
– Amount
– Rate
– Other injuries or existing conditions
– Existing medical conditions
– Patients age
Estimated Blood Volume
• Normal adult-70 ml/kg
• Infants & children-80 ml/kg
• A 200 ml blood loss in adult only is a 4%
loss, but in an infant would be 25%.
Remember –severity of blood loss is a percentage of
how much blood is estimated to be lost, but don’t get
focused on how much rather than what signs &
symptoms your patient is showing.
• Need to control bleeding, but do not get
tunnel vision. Remember the basics first
– Scene Size-up
– Primary
– Secondary
• Airway & Breathing take priority
Types of Bleeding
Controlling Bleeding
• Direct Pressure
– Bandages
– Fingertip pressure
– If foreign object seen, secure in place and
place dressing around area. DO NOT remove
unless affecting airway
• Tourniquets
Scene Size-up, Primary
Assessment, and Rapid
Secondary Assessment
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Standard Precautions
Scene safety
General impression
Control significant bleeding
ABCs
Apply O2
Rapid secondary assessment
Obtain vital signs
Factors that increase bleeding
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Movement
Low body temperature
Medications
Intravenous fluids
Removal of dressings & bandages
PASG
pneumatic antishock garment
Indications
• Suspected pelvic fracture
with hypotension <90
mmHg
• Suspected intraperitoneal
hemorrhage <90 mmHg
Contraindications
• Penetrating thoracic trauma
• Splinting of lower extremity
fractures
• Eviscerated abdominal
organs
• Impaled object in abdomen
• Pregnancy
• Cardiopulmonary arrest
• CHF
• Pulmonary Edema
Once placed, do not remove with
medical control authorization
• Wound-injury to the skin and underlying
tissues
• Wounds categories
– Closed
– Open
– Single
– multiple
Closed Injuries
• Hematoma
• Contusion
• Ecchymosis
Open Injuries
Abrasions
• Caused by scraping,
rubbing, or shearing
• Considered to be
superficial
• Very painful
• Can be life
threatening
• Not necessarily to
injury but potential
for infection,
contamination, &
potential for other
life threatening
injuries
Lacerations
• Break in skin
• May be linear or
stellate (irregular)
• Linear
• Knife
• Razor
• Broken glass
• Edges smooth
• Stellate
• Blunt objects
• Edges are
jagged
Avulsions
• Loose flap of skin
& underlying
tissue that is torn
loose or pulled
completely off
• Bleeding may be
severe
• Healing prolonged
• Extensive scarring
Amputations
• Disruption of the
continuity of an
extremity or
other body part
• Ripping or
tearing
• Incomplete
amputation will
bleed more than
a complete
• Always consider
shock
Punctures &
Penetrations
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Result of sharp, pointy
object
May be little, but underlying
damage may be worst
Stab wounds
• May be small &
undetectable
• Remember underlying
internal damage
Gunshot wounds
• Entrance and exit sites
• Entrance will be
smaller
• Exit larger and will be
bleed profusely
• Assess for more than
one wound and
remember underlying
internal damage
Crush
Injuries
• Caused by blunt
trauma or crushing
forces
• May not appear
serious
• May be swollen,
painful, & deformity
• External bleeding
minimal or even
absent
• Always suspect
internal bleeding
• Walking wounded
Bites
• Dog bites most
common
• Complications
• Infection
• Cellulitis
• Septicemia
• Rabies
• Tetanus
• Combination of
crush and
penetration injury
Clamping
injury
• Body part that
is caught in
machinery
• Time is key
Assessment
• Scene size up & primary
assessment
• Secondary assessment
• Emergency medical care
• Reassessment
Special Considerations
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Chest injuries
Abdominal injuries
Impaled objects
Amputations
Large open injuries
Dressings & Bandages
• Dressings
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Gauze pad
Self adhering dressing
Universal or multitrauma dressing
Occlusive dressing
• Bandages
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Self adhering
Gauze rolls
Triangular bandage
Air splint
• Pressure dressings
General principles of dressing &
bandages
• No hard or fast rules
• Must adapt to what is available
• Conditions
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Clean
Do not tape in place until bleeding controlled
Must cover wound
Attempt to remove all jewelry
Do not leave too loose
Do not wrap too tightly
If covering small wound on extremity, wrap larger
area
– Once positioned, leave where it is
– Tourniquet if unable to control bleeding