Lecture 9B: Soft tissue injuries

Question 1

What is considered soft tissue?

Answer 1

Skin
epidermis
dermis (nerves, sweat glands, blood vessels)
fat
muscle
tendon
ligament

Question 2

What is a closed wound?

Answer 2

soft tissue damage
secondary hypoxia
epidermis layer of skin intact

Question 3

What is the general treatment of closed wounds?

Answer 3

PIER/ PRICE/ RICE

Question 4

what does the time of application of a cryotherapy modality depend on?

Answer 4

tissue type/ location/ latest research

Question 5

What is an open wound?

Answer 5

Break in the epidermis layer of skin
Abrasion
Laceration
Avulsion
Puncture wound
Crush injury
Amputation

Question 6

What is the general treatment of minor open wounds?

Answer 6

Wash wound with saline solution or clean under running water for 3-5min
disinfect periphery of wound with clear anti-septic solution

On the sideline: anti-septic solution is okay for cleaning small minor wounds, use clean running water or sterile saline solution once available

Question 7

What are the steps to acute wound management?

Answer 7

direct pressure a few minutes to control bleeding
if wound is clean and bleeding has stopped, apply new non-adhesive dressing
Apply triple anti-biotic ointment such as polysporin
adhesive bandage over dressing
educate: home care, follow-up, referral

Question 8

What are the three types of tetanus shots?

Answer 8

Diphtheria, tetanus, and pertussis (DTaP)

Question 9

What is tetanus?

Answer 9

disease caused by a bacterial infection following a break in the skin or mucous membrane. bacteria makes a toxin that causes severe muscle spasms and seizures. Also called lockjaw because muscle spasms in your jaw make it hard to open your mouth, difficult to swallow or breathe

Question 10

What is the best way to prevent a tetanus infection?

Answer 10

it is to have a tetanus shot before and if you need one. Having the DTaP vax series and getting the Tdap booster and then as an adult getting the Td booster every 10 years

Question 11

When should you refer your athletes to a physician?

Answer 11

Puncture wounds or animal bites
burns that are more severe than minor second degree
gaping wounds that may require stitches (>1in, face, hands)
wounds that have exposed fatty tissue, white tissue, or muscle
Wounds with embedded visible foreign material
wounds with blood spurting from them
wounds causing severe pain or resulting in a numb feeling or inability to move structures below the wound
new wounds in patients with diabetes or bleeding problems
Chronic wounds that do not heal
infected wounds
do not glue or put ointment on wounds being sent for assessment/advanced care

Question 12

What are the general instructions for wound care when using skin glue?

Answer 12

Day 1-5: keep wound dry
Day 5-10: okay to wash (do not soak)
If wound is on head, can wash hair after 5 days
Pat your wound dry gently do not rub it
monitor wound healing
don’t stick a bandaid on top of skin glue
don’t put creams or lotions on wound
don’t try to remove skin glue (will come off in 7-10 days)
don’t scratch, pick or mess with wound

Question 13

When should you seek medical advice when using skin glue for wound care?

Answer 13

if wound:
splits open again
starts to bleed
infected: red or swollen, increase pain, discharge or pus, fever

Question 14

what are the different types of dressings?

Answer 14

Woven: dry gauze, impregnated gauze, paraffin gauze
Skin tapes: closure or superficial or linear lacerations with minimal tension
semi-occlusive/occlusive: film, foam, hydrogel, hydrocolloid, dermal adhesives

Question 15

What are the general treatment steps for major open wounds?

Answer 15

do not waste time washing wound
sterile gauze dressing
Bleeding control (direct pressure, wound packing, tourniquet)
Pressure bandage to maintain compression
seek further medical care

Question 16

What should you do with an impaled object?

Answer 16

Do not remove object unless it is in the cheek/jaw or it affects airway
Bulky dressing to stabilize it
Control bleeding by bandaging dressing in place around object
log cabin technique/donut
Styrofoam/paper cup/ gauze for eye

Question 17

What are the management steps for amputations?

Answer 17

control bleeding (easier with complete versus partial)
Sterile/diaper bandage over stump and severed amputated part
Keep amputated part (gauze on wound) in a dry plastic bag on ice (tissue should not be in contact)
Transport part with victim when possible

Question 18

What are avulsions?

Answer 18

tearing away of soft tissue with no bone tissue, complete or partial avulsion flap

Question 19

What are the management steps for complete avulsions?

Answer 19

use sterile gauze and direct pressure to stop bleeding and dress wound for complete avulsion.

Question 20

What are the management steps for partial avulsions?

Answer 20

use flap to close wound for bleeding control
ideally irrigate first with sterile saline before replacing flap
Dress wound/flap with sterile gauze, inform EMS of approx. avulsion flap depth/size

Question 21

What are the types of burns (etiology)?

Answer 21

thermal
chemical
electricity
solar radiation
other forms of radiation

Question 22

What does the severity of burns depends on?

Answer 22

temperature of object
location of burn
victim’s age
under 5 or over 55 - thin skin
medical conditions: chronic diseases, heart disease, diabetes, impaired circulation

Question 23

What are the typical MOIs of 1st degree (epidermis) burns?

Answer 23

flash
flame
scald
sun

Question 24

What are the s/s of 1st degree burns?

Answer 24

dry
red
swelling possible
pain at site
heals in a few days without scarring

Question 25

What are the typical MOIs of 2nd degree (epidermis+ dermis) burns?

Answer 25

hot liquids/solids
flash/flame contact with clothing
direct flame from fire
chemical contact
sun

Question 26

What are the s/s of 2nd degree burns?

Answer 26

Moist/wet
mottled
white to red
blisters - may open and weep clear fluid
intense pain
swelling possible
peeling possible
heal in 3-4 weeks
scarring possible

Question 27

What are the typical MOIs of 3rd degree burns?

Answer 27

hot liquids/solids
flame
chemicals
electricity

Question 28

What are the s/s of 3rd degree burns?

Answer 28

dry
leathery or hard
white, dark brown, charcoal, charred (black)
underlying tissue white
charred blood vessels
little or no pain in nerve endings destroyed
extreme pain at periphery
long healing time
scarring

Question 29

What are the thermal burns management steps?

Answer 29

Scene survey
stop the burning process
primary assessment
Wound care (minimize shock)

Question 30

How should you stop the burning process for dry chemical burns (lime powder)?

Answer 30

brush powder off first before flushing with water

Question 31

How should you stop the burning process for phenol/carbolic acid?

Answer 31

flush with alcohol before water

Question 32

What should you determine for continued cooling?

Answer 32

must determine if continued cooling is beneficial (<pain) or harmful (<temp/shock)

Question 33

How long should it take to “Put the fire out and Cool the tissue”?

Answer 33

15min

Question 34

What is the rule of nines for an adult?

Answer 34

Head: 9%
Arms: 9% each
Torso and back: 18% each
Groin: 1%
Legs: 18% each

Question 35

What is the rule of nines for a child?

Answer 35

head: 18%
Arms: 9% each
Torso and back: 18%
Groin: 1%
Legs: 13.5% each

Question 36

When should you use wet vs dry dressings?

Answer 36

Burn <10% BSA: wet dressing may stay on until arrival at ER
Burn >10% BSA: wet dressing only for 15min after Dry sterile dressing to protect and insulate sheet or clean sheet (shock prevention a priority)

Question 37

What are the management steps of electrical burns?

Answer 37

scene survey
turn off electrical current first
downed power lines: need emergency power/rescue crew
primary assessment for life threatening injuries
ABCs
Secondary survey
Entry vs exit wound
worse than they look
minimize shock
call for more advanced medical care