Transcript Document

Chapter 18
Soft-Tissue Injuries
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
18.1 List four functions of the skin.
18.2 List the layers of the skin.
18.3 List and describe three types of closed
soft-tissue injuries.
18.4 List and describe nine types of open
soft-tissue injuries.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
18.5 Describe the emergency care for the
following injuries:
a. closed soft-tissue injury
b. amputation
c. open soft-tissue injury
d. impaled object
18.6 Describe and demonstrate three
methods for controlling external
bleeding.
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
18.7 Compare and contrast a dressing and a
bandage.
18.8 Demonstrate the proper procedure for
applying each of the following:
a. dressing
b. compression dressing
c. bandage
d. tourniquet
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology of Skin
 Physiology of Bleeding and Clotting
 Types of Soft-Tissue Injuries
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
During a bike race, a rider loses control and falls on a
gravel road.
His left arm and leg are covered in blood, with a
significant laceration in his left bicep.
He is wearing a helmet, is responsive and alert, and
has no neck or back pain. He is in obvious pain from
the laceration and from multiple abrasions on his
arms and legs.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
of the Skin
 Largest
organ of the body
 Multi purpose
 Two layers
◦ Epidermis
◦ Dermis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
of the Skin
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physiology of Bleeding
and Clotting
 Bleeding
is a leak in a blood vessel
◦ Artery
◦ Vein
◦ Capillary
 Clotting
/coagulation naturally close
wounds so skin repair can begin
◦ Multiple body systems are involved
◦ Medications may alter the normal
clotting process
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physiology of Bleeding
and Clotting
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Soft-Tissue Injuries
 Closed
◦
◦
◦
◦
Injury: Skin remains intact
Contusion
Hematoma
Crush injuries
Compartment syndrome
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Soft-Tissue Injuries
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Soft-Tissue Injuries
 Open
BRADY
◦
◦
◦
◦
◦
◦
◦
◦
◦
Injury: Skin is disrupted
Abrasion
Incision
Laceration
Avulsion
Amputation
Puncture
Open crush injury
High pressure injection
Mechanical tattooing
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Soft-Tissue Injuries
Copyright E. M. Singletary, MD
continued
Copyright E. M. Singletary, MD
BRADY
Copyright E. M. Singletary, MD
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Soft-Tissue Injuries
 Burns
Injury: Exposure to excessive
energy
◦
◦
◦
◦
◦
Thermal
Friction
Chemicals
Electricity
Nuclear radiation
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
 What
actions does the patroller take?
 What injuries are found?
 Are there any complications?
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Use
PPE / Standard Precautions
 Standard assessment procedures –
ABCDs, SAMPLE, and vitals
 Be aware of other potential injuries
 Check for shock
 Check CMS
 Document findings
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Direct
Pressure
 Pressure Bandage
 Hemostatic Bandage
 Tourniquet
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries

Contusions (closed injuries)
◦ Cold therapy
◦ R. I. C. E. S

Open Injuries
◦
◦
◦
◦
◦
BRADY
Control bleeding
Provide wound care
Cover wound with a dressing
Bandage
Splint extremity wounds
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
 Complex
Injuries:
◦ Avulsion
• Clean, replace flap, bandage
◦ Amputation
• Preserve part, keep moist and cool, send
with patient
• Splint injured area
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
 Complex
Injuries:
◦ Impaled object
• Stabilize in place; rarely needs to be
removed
• Airway obstructions may need to be
removed
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Treating for Specific Injuries
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Dressing and Bandaging
 Multiple
materials may be used as
dressings:
◦
◦
◦
◦
◦
◦
BRADY
Sterile
Non-sterile
Pressure
Occlusive
Stabilizing
Hemostatic
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Dressings and Bandages
 Different
locations/injuries need
different types of bandages:
◦
◦
◦
◦
Joints
Conical regions
Head
Hands and fingers
 Check
CMS before and after
bandaging
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
How were the patient’s wounds treated?
Were any other forms of treatment given?
What transportation decision was made?
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
The skin is the largest organ in the body,
and it serves three purposes: it provides a
protective barrier, it functions in the control
of body temperature, and it acts as a
sensory organ.
 The three types of soft-tissue injuries are
closed injuries, open injuries, and burns.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
External bleeding is controlled using direct
pressure, a pressure dressing, or rarely a
tourniquet.
 When applying a dressing to control
bleeding, do not remove it because doing
so can disrupt clots and cause more
bleeding. Instead, add additional dressings.
 Hemostatic bandages contain a substance
that helps stop external bleeding.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Do not use elastic bandages to secure
dressings.
 Splinting a soft-tissue injury helps decrease
bleeding and reduces pain.
 Applying an effective field dressing and
bandage is an important skill for OEC
Technicians.

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Far Side Comics The Far Side