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Flashcards in Soft Tissue Trauma Deck (64)
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What are the Soft Tissues?

• Skin
• Fatty tissues
• Muscles
• Blood vessels
• Fibrous tissues
• Membranes
• Glands
• Nerves


Functions of Skin?

• Protection
• Water balance
• Temperature regulation
• Excretion
• Shock absorption


Closed wounds: Contusion



Closed wounds: Hematoma

– Similar to contusion
– More tissue damage
– Involves larger blood vessels


Closed wounds: Crush Injury

• Closed crush injury
– Excessive force crushing or rupturing internal (generally solid) organs


Assessment: Closed Wounds

• Bruising may be internal injury or bleeding
• Consider mechanism of injury
• Crush injuries are difficult to identify


Treatment: Closed Wounds

• Take appropriate Standard Precautions
• Manage airway, breathing, and circulation
• Always manage for internal bleeding and shock if there is a possibility of internal injuries
• Splint extremities that are painful, swollen, or deformed
• Stay alert for vomiting
• Continuously monitor for changes and transport


Types of Open Wounds

• Abrasion
• Laceration
• Puncture
• Avulsion
• Amputation
• Crush injury
• Blast injury


Think about it Open Wound

• Does an open wound necessitate using more than just gloves as standard precautions?
• Can an open injury affect the patient’s airway or breathing?


Treatment Open Injuries

• Expose wound
• Clean surface of wound
• Control bleeding
• Provide care for shock
• Prevent further contamination
• Bandage dressings in place after bleeding is controlled
• Keep patient still
• Reassure patient


Treatment: Abrasions & Lacerations

• Reduce wound contamination
• Hold direct pressure to control bleeding
• Always check pulse, motor, and sensory
function distal to injury to assure function
• Never open edges of laceration to see inside or further clean wound


Treatment: Puncture Wounds

• Use caution—objects may be embedded deeper than they appear
• Check for exit wounds
– May require immediate care
• Bullets can fracture bones as they enter
• Stab wounds are considered serious if in a vital area of body
Reassure patient
• Search for exit wound
• Assess need for shock care
• Follow local protocols regarding
spinal immobilization
• Transport patient


Treatment: Impaled Objects

• Do not remove object; may cause severe bleeding
• Expose wound area
• Control profuse bleeding by direct pressure
• Apply several layers of bulky dressing to “splint” object in place
• Secure dressings
• Treat for shock
• Provide rapid transport


Impaled Object in Cheek

• Take care that object does not enter oral cavity, causing airway obstruction
• If cheek wall is perforated, profuse bleeding into mouth and throat can cause nausea and vomiting
• External wound care will not stop the flow of blood into the mouth


Treatment: Impaled Object in Cheek

• Examine wound site, both inside and outside mouth
• If you find the perforation and can see both ends, remove object
• If object is impaled into another structure, stabilize in place
• Position patient to allow for drainage
• Monitor patient’s airway
• Dress outside of wound
• Provide oxygen
• Provide care for shock


Treatment: Avulsions

• Clean wound surface
• Fold skin back into normal position
• Control bleeding and dress with bulky dressings
• If avulsed parts are completely torn away, save in sterile dressing and keep moist with sterile saline


Treatment: Amputations

• Apply pressure dressing over stump
• Use pressure points to control bleeding; use tourniquet only if all other methods fail
• Wrap amputated part in sterile dressing and place in plastic bag; put bag in pan with water and cold packs
• Do not immerse amputated part directly in icy cold water


Treatment: Genital Injuries

• Control bleeding
• Preserve avulsed parts
• Consider if injury suggests another, possibly more serious, injury
• Calm, professional manner
• Maintain patient’s dignity
• Dress and bandage wound



• May involve more than just skin-level structures
• If respiratory structures are affected, swelling may occur, causing life threatening
• Don’t let burn distract from spinal damage or fractures


Assessment: Burns

• Classifying burns
– Agent and source
– Depth
– Severity


Burns: Depth
• Superficial (1st Degree)

– Involves only epidermis
– Reddening with minor swelling

"Sunburn" - damaged outside layer of the skin


Burns: Depth
• Partial Thickness (2nd Degree)

– Epidermis burned through, dermis damaged
– Deep, intense pain
– Blisters and mottling

"Blisters Burns"


Burns: Depth
• Full Thickness (3rd Degree)

– All layers of skin burned
– Blackened areas surrounded by dry and white patches

black or white waxy appearance

epidermis and dermis are burned - into the subcutaneous layer

more than 15% of body Trauma alert

2nd or 3rd degree burns - only - count


Burns: Severity Rule of Nines

– Helps estimate extent of burn area
– Adult body is divided into 11 main areas
– Each represents 9 percent of body surface


Burn Rule of Nines in an Adult

Anterior head= 4.5%
Posterior head= 4.5%
Anterior torso= 18%
Posterior torso= 18%
Anterior leg, each= 9%
Posterior leg, each = 9%
Anterior arm, each= 4.5%
Posterior arm, each= 4.5%
Genitalia/perineum= 1%


Burn Rule of Nines in an Child - change to the figures in the book

Anterior head = 9%
Posterior head= 9%
Anterior torso= 18%
Posterior torso= 18%
Anterior leg, each= 6.75%
Posterior leg, each = 6.75%
Anterior arm, each= 4.5%
Posterior arm, each= 4.5%
Genitalia/perineum= 1%


Burn Rule of Nines in an Infant
change to what is in the book

Head and neck= 20%
Anterior torso= 16%
Posterior torso= 16%
Leg, each= 16%
Arm, each =8%
Genitalia/perineum= 1%


Burns: Geriatrics and Pediatrics

• “Minor” burn area in a young adult can be fatal to a geriatric adult
• Infants and children have a much greater
relationship of body surface area to total
body size, resulting in greater fluid and
heat loss from burned skin


Treatment: Thermal Burns

• Use sterile dressings
• Never apply ointments, sprays, or butters
• Do not break blisters


Treatment: Chemical Burns

• Wash away chemical with
copious amounts of flowing water
• If dry chemical, brush away, then flush with water
• Remove contaminated clothing
• Apply sterile dressings
• Treat for shock