1 soft tissue injuries. 2 skin anatomy and physiology body’s largest organ body’s largest organ...
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Skin Anatomy and Skin Anatomy and PhysiologyPhysiology
Body’s largest Body’s largest organorgan
Three layers:Three layers:EpidermisEpidermis
DermisDermisSubcutaneous Subcutaneous
tissuetissue
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Skin Anatomy and Skin Anatomy and PhysiologyPhysiology
Complex system, variety of functionsComplex system, variety of functionsSensationSensation
Control of water lossControl of water lossProtection against microbesProtection against microbes
Temperature controlTemperature control
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Wear BSI.Wear BSI.Do not touch equipment with Do not touch equipment with
bloody gloves; wear several pairs.bloody gloves; wear several pairs.Beware of contaminating one Beware of contaminating one
patient with another patient’s patient with another patient’s blood.blood.
Wear eye protection.Wear eye protection.Consider MOI.Consider MOI.
Scene Size-upScene Size-up
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Decide SICK/NOT SICK.Decide SICK/NOT SICK.There may be internal underlying There may be internal underlying
injuries.injuries. Injuries can affect airway and Injuries can affect airway and
breathing.breathing.Provide spinal immobilization.Provide spinal immobilization.Open chest wound? Evaluate for Open chest wound? Evaluate for
bubbling or sucking soundsbubbling or sucking sounds..
Initial AssessmentInitial Assessment
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Quickly place an occlusive Quickly place an occlusive dressing over wound (SCW)dressing over wound (SCW)
Provide high-flow oxygen.Provide high-flow oxygen.Assess pulse and skin for shock.Assess pulse and skin for shock.Control significant bleeding.Control significant bleeding.
Initial AssessmentInitial Assessment
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Focused physical examFocused physical examFocus on isolated injury, complaint, Focus on isolated injury, complaint,
and affected body region.and affected body region.Rapid physical examRapid physical examPerform if there is significant trauma Perform if there is significant trauma
affecting multiple systems.affecting multiple systems.Look for DCAP-BTLS.Look for DCAP-BTLS.Be sure that spine is stabilized.Be sure that spine is stabilized.
Focused ExamFocused Exam
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Perform if patient is stable and time Perform if patient is stable and time allows.allows.
Detailed ExamDetailed Exam
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Reassess all bandaging.Reassess all bandaging. Reassess ABCs.Reassess ABCs. Communication and documentationCommunication and documentation Include description of MOI and Include description of MOI and
patient’s position.patient’s position. Describe location, size, depth of Describe location, size, depth of
injury.injury. Provide accurate account of how you Provide accurate account of how you
treated injuries.treated injuries.
Ongoing AssessmentOngoing Assessment
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Baseline Vitals/SAMPLE Baseline Vitals/SAMPLE Baseline vital signsBaseline vital signs
Will help determine if patient is going Will help determine if patient is going into shock into shock
SAMPLE historySAMPLE historyAnemia and hemophiliaAnemia and hemophiliaMedications that thin the blood Medications that thin the blood
(aspirin, prescribed blood thinners)(aspirin, prescribed blood thinners)
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Closed InjuryClosed InjuryAssociated with blunt traumaAssociated with blunt trauma
Skin remains intactSkin remains intactDamage occurs below skin surfaceDamage occurs below skin surface
Types:Types:ContusionsContusionsHematomasHematomas
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ContusionContusionBlunt force Blunt force
damages dermal damages dermal structuresstructures
Blood, fluid leak Blood, fluid leak into injury area into injury area (pain/swelling)(pain/swelling)
EcchymosisEcchymosis
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HematomaHematomaLarger vessel Larger vessel
damage with damage with mass of blood mass of blood collecting at collecting at injury siteinjury site
Fist-sized = 10% Fist-sized = 10% volume lossvolume loss
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Closed Soft Tissue InjuryClosed Soft Tissue Injury
Considerations:Considerations:How much blood is tied up in How much blood is tied up in
that injury rather than that injury rather than circulating in the vessels?circulating in the vessels?
What could the force that What could the force that caused the soft tissue trauma caused the soft tissue trauma have done to underlying have done to underlying organs?organs?
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BLS Care BLS Care Request ALS if indicatedRequest ALS if indicatedO2, assist ventilationsO2, assist ventilationsMaintain airway, breathing, c-spineMaintain airway, breathing, c-spineRICERICEMaintain body temperatureMaintain body temperatureMonitor vital signsMonitor vital signsCalm and reasssureCalm and reasssureTransportTransport
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Closed Injury Closed Injury ManagementManagement
RestRestIceIce
CompressionCompressionElevationElevation
SplintSplint
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Open InjuryOpen Injury
Skin brokenSkin broken
Protective function lostProtective function lost
External bleeding, infection External bleeding, infection become problemsbecome problems
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Open Injury TypesOpen Injury Types
AbrasionsAbrasionsLacerationsLacerationsPuncturesPuncturesAvulsionsAvulsions
AmputationsAmputations
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AbrasionAbrasion
Loss of portions of epidermis, upper Loss of portions of epidermis, upper dermis by rubbing or scraping force. dermis by rubbing or scraping force.
Usually associated with capillary Usually associated with capillary oozing, leaking of fluidoozing, leaking of fluid
““Road rash”Road rash”
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LacerationLacerationCut by sharp objectCut by sharp objectTypically longer than it is deepTypically longer than it is deepMay be associated with severe blood May be associated with severe blood
loss, damage to underlying tissuesloss, damage to underlying tissuesTypesTypes
LinearLinearStellateStellate
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PuncturesPuncturesResult from stabbing forceResult from stabbing forceWound is deeper than it is longWound is deeper than it is longDifficult to assess injury extentDifficult to assess injury extentObject producing puncture may Object producing puncture may
remain impaled in woundremain impaled in wound
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AvulsionsAvulsionsPiece of skin torn loose as a flap or Piece of skin torn loose as a flap or
completely torn from bodycompletely torn from bodyResult from accidents with Result from accidents with
machinery and motor vehiclesmachinery and motor vehiclesReplace flap into normal position Replace flap into normal position
before bandagingbefore bandagingTreat completely avulsed tissue like Treat completely avulsed tissue like
amputated partamputated part
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AmputationsAmputationsDisruption of continuity of Disruption of continuity of
extremity or other body partextremity or other body partPart should be wrapped in sterile Part should be wrapped in sterile
gauze, placed in plastic bag, gauze, placed in plastic bag, transported on top of cold packtransported on top of cold pack
Do Do NOTNOT pack part directly in ice pack part directly in iceDo Do NOTNOT let part freeze let part freeze
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Open Wound Open Wound ManagementManagement
Manage ABCs firstManage ABCs firstPosition of comfortPosition of comfortControl bleedingControl bleedingPrevent further contamination, but do Prevent further contamination, but do
not worry about trying to clean woundnot worry about trying to clean wound Immobilize injured partImmobilize injured partMange hypoperfusion if present (O2)Mange hypoperfusion if present (O2)
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Special ConsiderationsSpecial Considerations Impaled objectsImpaled objects
EviscerationsEviscerationsOpen chest woundsOpen chest wounds
Neck woundsNeck woundsGunshot woundsGunshot wounds
Crush InjuriesCrush Injuries Injection InjuriesInjection Injuries
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Impaled ObjectsImpaled Objects
Do Do NOTNOT remove removeStabilize in placeStabilize in placeException:Exception:
Object in cheekObject in cheekRemove, dress inside and Remove, dress inside and
outside mouthoutside mouth
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EviscerationsEviscerations Internal organs exposed through Internal organs exposed through
woundwoundCover organs with large Cover organs with large
unmoistened dressing, then with unmoistened dressing, then with aluminum foil or dry multi-trauma aluminum foil or dry multi-trauma dressing dressing
Do Do NOTNOT use individual 4 x 4’s use individual 4 x 4’sDo Do NOTNOT attempt to replace organs attempt to replace organs
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Open Chest WoundOpen Chest WoundMay prevent adequate ventilationMay prevent adequate ventilationCover with occlusive dressingCover with occlusive dressingMonitor patient for signs of air Monitor patient for signs of air
becoming trapped under pressure becoming trapped under pressure in chest (tension pneumothorax)in chest (tension pneumothorax)
If tension pneumo develops lift If tension pneumo develops lift dressing corner to relieve pressuredressing corner to relieve pressure
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Neck WoundsNeck WoundsRisk of severe bleeding from large Risk of severe bleeding from large
vesselsvesselsRisk of air entering vein and moving Risk of air entering vein and moving
through heart to lungsthrough heart to lungsCover with occlusive dressingCover with occlusive dressingDo NOT occlude airway or blood Do NOT occlude airway or blood
flow to brainflow to brainSuspect presence of spinal injurySuspect presence of spinal injury
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Gunshot WoundsGunshot WoundsSpecial type of puncture woundSpecial type of puncture woundTransmitted energy can cause Transmitted energy can cause
injury remote from bullet trackinjury remote from bullet trackBullets change direction, tumbleBullets change direction, tumble Impossible to assess severity in Impossible to assess severity in
field or ERfield or ERPatient must go to ORPatient must go to OR
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Crush InjuriesCrush Injuries MOI will determine MOI will determine
sverity of injurysverity of injury Do not be fooled by Do not be fooled by
signd of minimal signd of minimal injuryinjury
Beware of crush Beware of crush syndrome syndrome (rhabdomyolysis)(rhabdomyolysis)
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Injection InjuriesInjection Injuries Serious tissue Serious tissue
injury caused by injury caused by high pressure high pressure injectionsinjections
External injury may External injury may look minor but look minor but internal injury may internal injury may be very severebe very severe
Treat like a Treat like a puncture injurypuncture injury
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Eye InjuriesEye Injuries LacerationsLacerations Lacerations to the eyes Lacerations to the eyes
require very careful require very careful repair.repair.
Never exert pressure on Never exert pressure on or manipulate the eye.or manipulate the eye.
If part of the eyeball is If part of the eyeball is exposed, apply a moist, exposed, apply a moist, sterile dressing.sterile dressing.
Cover the injured eye Cover the injured eye with a protective metal with a protective metal eye shield.eye shield.
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Eye InjuriesEye Injuries Blunt traumaBlunt trauma Blunt trauma can Blunt trauma can
cause a number of cause a number of serious injuries.serious injuries.̶O A fracture of the orbit A fracture of the orbit
(blowout fracture)(blowout fracture)̶O Retinal detachmentRetinal detachment
May range from a May range from a black eye to a black eye to a severely damaged severely damaged globeglobe
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Eye InjuriesEye Injuries HyphemaHyphema Bleeding in the Bleeding in the
anterior chamber of anterior chamber of the eyethe eye
May seriously impair May seriously impair visionvision
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Eye InjuriesEye Injuries Blowout fractureBlowout fracture May occur from blunt May occur from blunt
trauma caused by a trauma caused by a fracture of the orbitfracture of the orbit
Bone fragments may Bone fragments may entrap muscles that entrap muscles that control eye control eye movement, causing movement, causing double vision.double vision.
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Eye InjuriesEye Injuries Retina detachmentRetina detachment Often seen in sports Often seen in sports
injuriesinjuries Produces flashing Produces flashing
lights, specks, or lights, specks, or floaters in field of floaters in field of visionvision
Needs prompt medical Needs prompt medical attentionattention
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BLS IndicatorsBLS IndicatorsConscious and alertConscious and alertStable vital signsStable vital signsSoft tissue injuries limited to the Soft tissue injuries limited to the
superficial layer of skinsuperficial layer of skinSingle digit amputationsSingle digit amputationsControlled bleeding by direct Controlled bleeding by direct
pressure and/or elevationpressure and/or elevation
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BLS Care BLS Care Request ALS if indicatedRequest ALS if indicatedO2, assist with ventilationsO2, assist with ventilationsMaintain airway, breathing, c-spineMaintain airway, breathing, c-spineControl bleedingControl bleedingMaintain body temperatureMaintain body temperatureMonitor vital signsMonitor vital signsCalm and reassureCalm and reassureTransportTransport
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ALS IndicatorsALS IndicatorsSignificant head injurySignificant head injurySigns/symptoms of shockSigns/symptoms of shockAirway compromiseAirway compromiseExcessive, uncontrolled bleedingExcessive, uncontrolled bleedingAltered LOCAltered LOCHigh index of suspicion based on MOIHigh index of suspicion based on MOI