soft-tissue injuries - shenandoah county · 2011-10-13 · chapter 27 soft-tissue injuries limmer...
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CHAPTER 27
Soft-Tissue Injuries
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Injuries
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Soft Tissue Soft Tissue Anatomy & Anatomy & PhysiologyPhysiology
Limmer et al., Emergency Care Update, 10th Edition
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Open andOpen andClosed WoundsClosed Wounds
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Closed WoundsClosed Wounds
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Closed Wound
Key Term
Internal injury with no open pathway
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Internal injury with no open pathway
from the outside to the injured site
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Types of Closed Wounds
Contusion
Hematoma
Crush Injury
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Crush Injury
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Closed Wound Closed Wound –– ContusionContusion
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Emergency Care ofClosed Wounds
Take appropriate BSI precautions.
Manage airway; apply oxygen.
If shock is suspected, treat it.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
If shock is suspected, treat it.
Splint painful, swollen, or deformed
extremities.
Transport.
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Open Wound
Key Term
An injury in which the skin is
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
An injury in which the skin is
interrupted, or broken, exposing
the tissue underneath
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Types of Open Wounds
Abrasions & Lacerations
Avulsions
Punctures
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Amputation
Crush
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Open Wounds Open Wounds –– Abrasions & LacerationsAbrasions & Lacerations
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Open Wound Open Wound –– LacerationLaceration(Smooth Edges)
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Open Wound Open Wound ––Laceration Laceration (Jagged Edges)
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Open Wound Open Wound –– AvulsionAvulsion
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Open Wound Open Wound –– PuncturePuncture
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Entrance and Exit WoundsEntrance and Exit Wounds
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Open Wound Open Wound –– AmputationAmputation
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Crush injuries may cause both open and Crush injuries may cause both open and closed wounds.closed wounds.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Emergency Care ofOpen Wounds
Take BSI precautions.
Manage airway; apply oxygen.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Expose the wound.
Control bleeding.
Continued…
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Emergency Care ofOpen Wounds
Bandage & prevent contamination.
Keep patient calm, quiet.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Treat for shock; transport;
reevaluate.
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Specific Injuries
Amputations
Neck Wounds
Impaled Objects
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Chest Wounds
Abdominal Wounds
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Amputations
Monitor airway; administer oxygen.
Control bleeding.
Do not complete partial
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not complete partial
amputations.
Treat for shock.
Continued…
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Amputations
Wrap the amputated part in sterile
dressing.
Wrap part in plastic. Keep cool.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Transport with patient if possible.
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Open Neck Wound
May cause air embolism.
Cover with occlusive dressing.
Do not compress both carotids at
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not compress both carotids at
same time.
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Cover wound with gloved hand.Cover wound with gloved hand.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Place occlusive dressing over wound.Place occlusive dressing over wound.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Place dressing over occlusive dressing.Place dressing over occlusive dressing.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Bandage. Do not compress both carotids Bandage. Do not compress both carotids or restrict breathing.or restrict breathing.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Impaled Object
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Impaled Object
Do not remove object unless:
Through the cheek
Interferes with chest compression
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Interferes with chest compression
Interferes with transport (relative)
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Emergency Care of an Impaled Object
Manually stabilize object.
Expose area.
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Control bleeding.
Stabilize with bulky dressing.
Bandage.
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Impaled Object Impaled Object –– CheekCheek
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Impaled Object in the EyeImpaled Object in the Eye
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Signs of Chest Wounds
Wound or trauma to the chest.
Sucking sound.
Patient may be short of breath or
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Patient may be short of breath or
gasping for air.
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Chest wounds may cause damage to lungs.Chest wounds may cause damage to lungs.
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Lung Lung
Chest Wall
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Emergency Care of Chest Wounds
Manage airway.
Expose area.
If open wound, apply occlusive
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
If open wound, apply occlusive
dressing.
Administer oxygen.
Place in position of comfort (if no
spine injury suspected).
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Occlusive DressingOcclusive Dressing
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Flutter Valve Flutter Valve –– InspirationInspiration
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Flutter Valve Flutter Valve –– ExhalationExhalation
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Manual StabilizationManual Stabilization
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Use bulky dressings and bandage toUse bulky dressings and bandage tostabilize.stabilize.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Closed Abdominal Wounds
Monitor airway; administer oxygen.
Be alert for vomiting.
Flexing patient’s knees may reduce
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Flexing patient’s knees may reduce
pain.
Treat for shock.
Transport.
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Monitor airway; administer oxygen.
Do not touch or try to replace
exposed organs.
Abdominal Evisceration(Open Abdominal Wounds)
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exposed organs.
Cover exposed organs & wound
with dressing moistened with sterile
saline.Continued…
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Treat for shock; maintain warmth.
Transport.
Abdominal Evisceration(Open Abdominal Wounds)
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Transport.
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Abdominal EviscerationAbdominal Evisceration
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Expose the wound.Expose the wound.
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Cover with sterile dressing.Cover with sterile dressing.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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BurnsBurns
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BurnsBurns
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Source
Depth
Conditions That May Affect Burn Severity
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Extent and regions burned
Age of patient
Preexisting medical conditions
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Sources of Burns
Thermal
Chemical
Electrical
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Electrical
Light
Radiation
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Layers of the SkinLayers of the Skin
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Reddened skin
Pain at burn site
Superficial Burn(1st Degree Burn)
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Involves only epidermis
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Partial-Thickness Burn(2nd Degree Burn)
Intense pain
White to red skin
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Blisters
Involves epidermis and dermis
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Full-Thickness Burn(3rd Degree Burn)
Dry, leathery skin (white, dark
brown, or charred)
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Loss of sensation (little pain)
All dermal layers may be involved
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Classifying Classifying BurnsBurnsby Depthby Depth
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Classifying Burns by DepthClassifying Burns by Depth
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Full-Thickness
Partial-Thickness
Superficial
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Body Surface Area
A burn equivalent to the size of the patient’s hand is equal to 1% body
surface area (BSA).
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Rule of Nines Rule of Nines ––AdultAdult
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Rule of NinesRule of Nines––Child and InfantChild and Infant
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Burns with respiratory injury
Full-thickness burns > 10% BSA
Determining Burn Severity:Critical BurnsCritical Burns
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Partial-thickness burns > 30% BSA
Burns with painful, swollen, or
deformed extremity
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Moderate burns in young or elderly
Burns to face, hands, or feet
Determining Burn Severity:Critical BurnsCritical Burns
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Burns to genitalia
Burns encircling any body part (arm,
chest, etc.)
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Determining Burn Severity:Moderate BurnsModerate Burns
Full-thickness burns 2-10% BSA
Superficial burns > 50% BSA
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Superficial burns > 50% BSA
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Determining Burn Severity:Minor BurnsMinor Burns
Full-thickness burns < 2% BSA
Partial-thickness burns < 15% BSA
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Greater surface area relative to
total size
Greater fluid and heat loss
Burns in Infants and Children
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Higher risk for shock
May be a result of abuse
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Infants and Children
Burn Severity
Critical Any full-thickness burns
Partial thickness >20% BSA or involving hands, feet, face,
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
involving hands, feet, face, genitalia
Moderate Partial-thickness, 10-20% BSA
Minor Partial-thickness, <10% BSA
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Emergency Care of Burns
Body substance isolation,
protective gear.
Stop the burning process with
water or saline.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
water or saline.
Remove smoldering clothing and
jewelry.
Prevent further contamination.
Continued…
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Emergency Care of Burns
Monitor the airway for closure.
Cover burn area with dry, sterile
dressing.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not use ointments/lotions.
Do not break blisters.
Transport following local protocols.
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Chemical Burns
Protect yourself from exposure.
Wear appropriate protective gear.
Activate Hazmat team if necessary.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Activate Hazmat team if necessary.
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Emergency Care ofChemical Burns
Brush dry powders off the skin
before flushing.
Flush with large amounts of water.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Flush with large amounts of water.
Do not contaminate uninjured
areas while flushing.
Continue flushing during transport.
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Electrical Burns
Do not touch a patient who is in
contact with an electrical source.
Contact trained personnel for rescue.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Emergency Care ofElectrical Burns
Administer oxygen.
Watch for cardiac or respiratory
arrest.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
arrest.
Internal injuries often more severe
than external ones.
Treat soft-tissue injuries.
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Electrical burns may have entry and exit Electrical burns may have entry and exit wounds.wounds.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Dressings andDressings andBandagesBandages
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BandagesBandages
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Purpose
Stop the bleeding
Protect wound from further damage
Prevent contamination and
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infection
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Dressings
Sterile, directly cover wound
Gauze pads
Universal (trauma dressing)
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Occlusive
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Bandages
Hold dressings in place
Roller gauze
Triangular bandage
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Triangular bandage
Tape, air splints
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Dressings and BandagesDressings and Bandages
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Dressing/Bandage: ForeheadDressing/Bandage: Forehead
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Dressing/Bandage: ElbowDressing/Bandage: Elbow
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Dressing/Bandage: HandDressing/Bandage: Hand
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Dressing/Bandage: ShoulderDressing/Bandage: Shoulder
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Bandaging & DressingTechnique
Use BSI precautions.
Expose area.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Cover wound; control bleeding.
Bandage securely.
Reevaluate.
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1. Distinguish between open and
closed wounds
2. Describe the emergency care for:
Review Questions
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
2. Describe the emergency care for:
Open chest wound
Impaled object
Amputation
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3. List and differentiate between the
3 depths of burns.
4. Describe the emergency care for
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
4. Describe the emergency care for
chemical, electrical burns.
5. What is the difference between a
dressing and a bandage?
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What is your general impression
STREET SCENESSTREET SCENES
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of the patient?
What priority would you assign to
her?
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What interventions are appropriate at
STREET SCENESSTREET SCENES
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What interventions are appropriate at
this time?
Would you change the priority of
transport of this patient based on what
you now know? Why or why not?
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What interventions are appropriate
STREET SCENESSTREET SCENES
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What interventions are appropriate
for this patient?
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Sample Documentation
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ