Hemorrhaging & Soft Tissue Injuries

Question 1

T/F: Blood loss can be internal or external

Answer 1

True

Question 2

How can you tell the difference between Arterial, venous and capillary bleeding?

Answer 2

Arterial bleeds spurt bright red blood, with high pressure, profuse and rapid blood loss ensuing.
Venous blood is a steady flow, due to reduced pressure, and a much darker colour. Can be life threatening if enough vessels are ruptured.
Capillary bleeding is a slow ooze, normal red in colour.

Question 3

What are the normal amounts of blood (L) in humans and what is the max they can loose?

Answer 3

Adult: 6.6L / lethal loss 2.2L
Adolescent: 3.3L / lethal loss 1.3L
Child: 1.5-2L / lethal loss 0.5-0.7L
Infant: 300+ml / lethal loss 30-50ml

Question 4

What are the 4 phases of wound healing?

Answer 4

1. Exudative
2. Resorptive
3. Proliferative
4. Repair

Question 5

Open wounds are dangerous to leave exposed, not just for bleeding, but for what other major consideration?

Answer 5

Infections. An open wound is a direct gateway into the body and disease can easily penetrate in.
Minor wounds must be cleansed and disinfected prior to bandage application. Major wounds must have bleeding under control first.

Question 6

What are some signs of local infection?

Answer 6

Swelling and redness
Warm to touch
Throbbing pain
Pus discharge

Question 7

Why can infections become life threatening so quickly?

Answer 7

If an infection makes it way into the circulatory system, it will be spread around the entire body, becoming systemic, and needs antibiotic treatment. Red streaks, swollen lymph nodes and flu like symptoms are common signs.

Question 8

What is Tetanus and why must it be treated quickly?

Answer 8

Colostridium Tetani is a bacteria that multiplies in environments with low O2. Often introduced via puncture wounds. Must be treated expeditiously before it can attack the nervous system.

Question 9

What are the S/S’s of Tetanus?

Answer 9

1. Difficulty swallowing
2. Irritability
3. Headache
4. Fever
5. Muscle spasms near injected area

Question 10

What is Gangrene?

Answer 10

Bacterial infection that thrives in absence of O2 or loss of blood supply.

Sudden onset of pain and swelling
Tissue discolouration
Foul smelling watery discharge (may be infectious)
Low grade fever
Shock

Question 11

When caring for an external bleed what is one of the highest priorities for bandage application?

Answer 11

Direct pressure. This causes the blood vessels to compress, restricting blood flow and allowing the wound to clot as soon as possible.

Question 12

What are some rules and considerations for bandage application?

Answer 12

1. Avoid covering fingers or toes unless they are injured
2. Applying bandages the same way as tape: distal to proximal so as not to constrict blood flow
3. Keep bandages broad so as not to dig into tissue and constrict
4. 2 layers minimum must be applied. If bleeding persists after 4 layers, apply a tourniquet
5. Check “P” and “S” but not M during PMS checks so as not to pump blood to wound

Question 13

What are the 9 situations that would most likely require stitches?

Answer 13

1. Actively hemorrhaging
2. Jagged edges
3. 2.5cm in length or longer
4. On face or head (stitches help reduce scarring)
5. Gapes widely or shows muscle/bone
6. On a joint, hands or feet (functional impairment)
7. Large or deep puncture
8. Large or deep embedded object
9. Human or animal bite

Question 14

Why is a tourniquet a last resort?

Answer 14

It completely ceases blood flow to extremity and can cause complications if applied improperly or left on too long.

Question 15

When CAN you use a tourniquet?

Answer 15

1. Unable to use standard hemorrhaging interventions
2. Mass casualties and there are not enough responders to patients
3. Unsafe environment warrants a quick patient removal
4. Hemorrhaging from a wound that cannot be assessed

Question 16

How do you apply a tourniquet?

Answer 16

1. Apply 5-10cm above injury or closest joint
2. Tightened until bleeding stops
3. Document time it was applied and tightened

Question 17

What is the most important factor when assessing someone with internal bleeding?

Answer 17

Finding out the MOI and history. If MOI matches, then the internal bleeding should be assumed and could be life threatening.

Question 18

What are 10 S/S of internal bleeding?

Answer 18

1. Bruising around injured area
2. Anxiety or restlessness
3. Cool/moist/pale/blue skin
4. Excessive thirst
5. Rapid & weak pulse
6. Soft tissue that palpates the opposite of what it should feel like
7. Tachypnea
8. Nausea & vomitting
9. Decreased LOR
10. Decreased BP

Question 19

How should someone be cared for is internal bleeding is suspected?

Answer 19

RTD is req’d for anyone suspected of an internal hemorrhage!
1. Minimize movement of person or body part
2. Keep patient calm
3. Monitor ABC’s & Vitals
4. Administer supplemental O2
5. Maintain normal body temp

Question 20

How should Epistaxis be treated?

Answer 20

Pinch nostrils in a seated/forward position
block nose with nasal plugs/gauze
Apply ice to bridge of nose
Avoid rubbing, blowing for 2-3 hours
Inquire about blood thinners

If nose is suspected to be broken, ADULT athletes must have informed consent AND be breathing through both nostrils to return to play. Children must not return to play regardless.

Question 21

What is an Open wound and what are the 5 classifications?

Answer 21

An open wound is defined as any wound that breaks skin.

1. Abrasion
2. Laceration
3. Puncture
4. Avulsion
5. Impalement

Question 22

Characteristics of an Abrasion

4

Answer 22

• Most common open wound
• Only capillaries are damaged so blood loss is minimal
• Often painful because it exposes nerve endings
• Infection is a high risk because dirt and debris can easily end up under the skin

Question 23

Characteristics of a Laceration

4

Answer 23

• Occurs from blunt force to skin
• Could be jagged or smooth edges
• Bleed freely w/ possibility of hemorrhages
• Can expose fat and muscle if deep enough

Question 24

Characteristics of an Avulsion

3

Answer 24

• Portion of skin and soft tissue is partially or completely torn away
• Usually involve deeper layers of tissue so bleeding is significant
• Do not remove any remaining/flaps of skin. Can be compressed/bandaged to assist with bleeding control

Question 25

Characteristics of a Puncture | 4

Answer 25

- Entry wound is usually small so external bleeding is minimal, but depending on the depth, internal bleeding can be a factor, especially if it ruptures major vessels - Any object that remains in the wound is considered *impaled* - High risk of infection - May have an entry AND an exit wound

Question 26

Characteristics of an Impaled object | 4

Answer 26

* Small objects like splinters can be removed with little risk * Large objects must remain in place and bulky dressings applied around the object to control bleeding * ONE EXCEPTION: object must be removed if it impedes patients airway

Question 27

Characteristics of Amputations

Answer 27

When a body part is partially or completely severed from the body * Involved multiple soft tissue injuries * Bleeding is less than expected - vessels constrict into body * Often can be surgically reattached if cared for properly

Question 28

How would you care for an amputation injury? | 4

Answer 28

* Rinse with saline, do not rub * Wrap amputated body part with non stick sterile dressing * Wrap body part in moist cloth, place in pastic bag and place that bag in another bag with ice * Write name, date and time of incident on bag and send with patient

Question 29

What is the most important thing to be aware of in the case of a crush injury?

Answer 29

If the object has pinned the patient for longer than an hour, toxins have had enough time to accumulate in the hypoxic tissue that when the object is removed, can spread freely within the body and cause catastrophic systemic damage, causing mass organ failure. One of the only times when a tourniquet is advised as a prioritized intervention

Question 30

What are the main MOI's that could be realted to ACUTE compartment syndrome? | 5

Answer 30

* Traumatic injury * Badly bruised muscle * Post-surgical complications * Crush injury * Anabolic steroid use

Question 31

What is compartment syndrome?

Answer 31

When an MOI causes soft tissue to swell and increase pressure within the muscle compartment, choking off circulation to everything distal

Question 32

What are the 6 P's of Compartment Syndrome?

Answer 32

1. Pain 2. Pressure 3. Parasthesia 4. Paralysis 5. Pallor 6. Pulselessness

Question 33

What are the classifications of MOI's related to blast injuries?

Answer 33

1. Primary: from the blast itself 2. Secondary: shrapnel propelled by the blast 3. Tertiary: Being launched by the force of the blast

Question 34

What is an HPI injury?

Answer 34

A substance is injected into the body under extremely high pressure, usually industrial accidents. Very minor puncture wound would be visible but internal damage could be severe. 2000psi (pressure of a full O2 tank) is well beyond the level required to break skin.

Question 35

What are the 4 types of burns, and their classifications?

Answer 35

Types: 1. Thermal 2. Electrical 3. Chemical 4. Radiation Classifications: 1. Superficial 2. Partial Thickness 3. Full thickness

Question 36

# s What are 9 situations in which burns require immediate advanced medical care?

Answer 36

* Any size full thickness burn * Partial thickness burn that covers more than 10% of the body * Any partial/full thickness burn to a child or older adult * Inhalation injuries * Burns around nose/mouth * Significant burns on head/neck/hands/feet/genitals (functional areas) * Chemical, explosive or electrical burns * Excessive pain * Result in unresponsiveness

Question 37

What are the two numerical rules regarding burns?

Answer 37

The rule of 9's is a tool used to quickly estimate burn surface area. Each limb has a certain percentage associated with it and can be used when determining if advanced care is needed. The rule of Palms states that your palm is approximately 1% of total body surface area. Useful when estiamting small burns.

Question 38

What are 6 factors that affect burn severity? | 6

Answer 38

* Intensity of source * Amount of time exposed * Location of burn * How much surface area the burn covers * Age of patient * Patients current medical condition

Question 39

What 3 basic care steps should always be practiced with burns?

Answer 39

1. Prevent any additional damage to tissue 2. Cover burned area in DRY, non stick, sterile dressings 3. Take steps to manage shock

Question 40

What unique care steps should be taken with a chemical burn

Answer 40

* Brush away any powders on skin PRIOR to washing * Continuously flush with water for 20 mins minimum

Question 41

What are some general care guidelines for treating burns?

Answer 41

* Cover the area to prevent further injury or infection * Leave blisters intact * Use loosely bandaged dry, sterile, non stick dressings * Do not put pressure on burn * If large SA, cover with a clean dry sheet * Burns that are less than 10% SA can be covered in a moist dressing * Do not use ointments or oils for care * Manage shock