Soft Tissue Injuries and Burns for EMT-Basic

Paul Vogt UT Southwestern Dallas, Texas

Structure and Function of Skin
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Most durable and largest organ Three Layers

Epidermis, dermis, and subcutaneous layers Protection from the environment

Roles

Bacteria, viruses, and other micro-organisms

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Body temperature regulation Receptor organ

Heat, cold, touch pressure, and pain

Eliminates water and salts

BSI and Soft Tissue Injuries
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Open soft tissue injuries Body fluids Exposure risk Protect your self

Closed Soft Tissue Injuries

A wound that is beneath unbroken skin

Skin is intact Contusions Hematomas Crush Injury

Types
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Closed Soft Tissue Injuries

Contusions

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Damage in the dermis layer Swelling pain Ecchymosis

Closed Soft Tissue Injuries

Hematoma

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Similar to contusion – Larger vessel, larger amount of tissue affected Goose egg Fist can be equal 10% of blood loss

Closed Soft Tissue Injuries

Crush Injuries
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Blunt force trauma Soft tissue damage and internal bleeding Organ rupture possible

Open Soft Tissue Injuries

Continuity of skin is broken  External bleeding  Contamination

Types  Abrasion  Laceration

Penetrations/Punctu re

 Amputations  Crush

injuries

Open Soft Tissue Injuries

Abrasions

Scrapping, rubbing or shearing of the epidermis Painful – Nerve ending exposed Blood – Oozing in nature Contamination and infection

Open Soft Tissue Injuries

Laceration

Break in skin of varying depth Arteries can be involved

Open Soft Tissue Injuries

Avulsion
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Loose flap of skin Partial or complete Significant bleeding can occur Scarring can be extensive

Open Soft Tissue Injuries

Amputations

Disruption of the continuity of the extremity or other body part Extensive bleeding possible (partial vs. complete)

Open Soft Tissue Injuries

Penetrations/Punct ures

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Object being pushed into the body Wound can be deep Severity depends on location, depth, force of object

Open Soft Tissue Injuries

Blunt trauma or crushing forces

Suspect internal injuries Concern of when the object is removed Profuse bleeding

Closed

General Management of Open and Closed Soft Tissue Injuries

BSI precautions  Ensure adequate airway and breathing

Supply oxygen? Keep them warm, feet elevated?

Treat for shock

Splint painful, swollen, deformed extremities

Additional soft tissue injury, if a fracture is involved

General Management of Open and Closed Soft Tissue Injuries  Open
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BSI precautions Ensure an adequate airway and breathing  Provide oxygen? Expose he wound Control bleeding through direct pressure with elevation (when possible)  Pressure point, tourniquet (last

Prevent further contamination Dress and bandage the wound

CMS checks – pre and post

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Keep the patient calm and quiet Treat for shock Transport

Amputations
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General Management of Open and Closed Soft Tissue Injuries
Take care of the patient first Search for missing body part
Do not delay transport while searching for body part if not immediately available Wrap in dry or slightly moistened sterile dressing

Part found

Do not immerse in water or saline

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Place part in a plastic bag Keep the body part cool

Ice, ice pack – do not allow the part to freeze

Transport the patient and part (if found)

Chest Injuries

General Management of Open and Closed Soft Tissue Injuries
Occlusive dressings

Abdominal injuries
Do not touch or replace abdominal organs  Cover the exposed organs

Sterile dressings large enough to cover all tissue  Occlusive dressing

Flex the patient’s knees and hips, if not contraindicated

Impaled objects

General Management of Open and Closed Soft Tissue Injuries
Should never be removed
EXCEPT:

In the cheek or airway and creating an obstruction

Manually secure the object  Expose the wound  Control bleeding  Use bulking dressings to stabilize the object

Neck Injuries  Major vessels, airway structures, spinal cord  Air embolism an issue to be considered  Blood Flow – Arterial or Venous

General Management of Open and Closed Soft Tissue Injuries Care

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Place a gloved hand over the wound to control bleeding Apply an occlusive dressing (tape on all sides) Cover the occlusive dressing with a regular dressing Apply only enough pressure to stop bleeding When bleeding is controlled, apply a pressure dressing Consider spinal

Burns

Burn Classifications

Superficial/1st degree

Epidermis

Partial Thickness/2nd degree

Epidermis and dermis

Full Thickness/ 3rd degree

Epidermis, dermis, fat and muscle

Burns

Superficial (1st)

Flash type burns, liquid, or sun S/S – Red skin, pain at site, tenderness, no blisters Days to heal

Burns

Partial Thickness (2nd)

Contact with fire, hot liquids or objects, chemical substances, severe sun burn S/S – Blisters, Intense pain, White or red skin, moist and mottled skin Damaged blood vessels leak plasma

Burns

Full Thickness (3rd)

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Hot liquids or solids, flame, chemicals, and electricity Lathery appearance, charring (dark brown or white), skin is hard to the touch, no pain, pain in periphery Eschar Confined space?

Rule of Nines

Rule of Palm

Palm approximation 1%

Critical, Moderate, Minor burns
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Respiratory tract involvement Other major trauma Full or partial thickness burn that involves:

Faces, eyes, ears, hands, feet, or genitalia

Any full thickness > 10% BSA

Any partial thickness >20% BSA Burn injuries with a suspected fractures extremity Any burn that encircles a body part Specialized burns – Electrical, chemical, inhalation Extreme of ages

Critical, Moderate, Minor burns

Full thickness burns with 2-10% BSA

Excluding the face, hands, feet, genitalia, or respiratory tract

Partial thickness burns with 15-20% BSA

Critical, Moderate, Minor burns
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Full thickness involving less than 2% BSA Partial thickness less than 15% BSA Superficial burns less than 50% BSA

General Burn Care (Thermal)

Remove the patient from the source of the burn and stop the burning process  Do not enter an unsafe environment Establish and maintain an effective airway  Oxygen, BVM… Classify the severity of the burn

Remove jewelry, belts, shoes… Cover the burned area with dry sterile dressings Keep the patient warm and seek other injuries Transport to an appropriate facility

Inhalation Burns
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Considered a Critical Burn Sources and S/S

Burns of the face, mouth, throat or history of an enclosed space entrapment, and/or smoke, toxic gas inhalation are all possible causes

Result = Possible laryngeal edema

Airway obstruction – Be prepared to aggressively manage

Inhalation Burns

Management –
Ensure good oxygenation and ventilation  Rapid transportation  Other burn care  May have a difficult airway to manage

Electrical Burns

Sources and Other Relevant Points

Electrical current or lightning Can injure soft tissue or the whole body Electricity seeks to be grounded, will take the path of least resistance to exit Exit and Entrance – Burns in between Heart – Electrical current can be disturbed

Electrical Burns

Management - Critical Burn
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Ensure your safety first Ensure an adequate airway and good ventilation

Oxygen or BVM

Cardiac arrest? – AED & CPR Assess more muscle tenderness Assess Exit and Entrance wounds – Provide appropriate

Chemical Burns

Immediate care required

Skin contact = Continued burning Dry chemicals should be brushed off, then flushed for at least 15 minutes Protect yourself from exposure Remove patient’s clothing

Chemical Burns

Management
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Protect yourself first

HazMat

Brush off dry chemicals – then flush with copious amounts of water (ensure water will not make matters worse) Flush for at least 20 minutes

Allow fluid to run away from wound

The End