Transcript Injuries to Muscles, Bones and Joints

Soft Tissue Injuries
Chapter 7
Wounds
• Any injury to the soft tissue is called a wound
• Two types of wounds:
– Open
– Close
• Closed wounds do not involve the tearing of
the skin
– Bruises – Usually non-life threatening
– Violent force can cause deeper bruising and
damage blood vessels / organs
Internal Bleeding
• Signs and Symptoms
• Tender, Swollen, Bruised or Hard (Rigid) areas of
the body such as the abdomen
• Rapid / Weak Pulse
• Cool or Moist Skin
• Vomiting Blood / Coughing up Blood
• Excessive Thirst
• Extremity below the injury is blue or pale
When to call?
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Patient complains of severe pain
Serious force caused the injury
Blue / Pale Extremity
Tender Abdomen / Rigid Area
Vomiting Blood / Coughing up Blood
Decreased LOC, Confused, Drowsy, etc.
Care for Closed Wounds
• Most cases are not serious and can be treated
with ice and rest.
• When applying ice:
– Be sure to have a barrier between the ice and skin
– Apply for 20 minutes and then remove for at least 20
minutes before reapplying
– Elevate the injured area if possible
• Take the time to be sure the injury is not more
serious. Ask questions! Poke and Prod
Open Wounds
• Skin break can be minor or severe. Bleeding
will vary, pain will vary.
• Four main types of Open Wounds:
– Abrasions
– Lacerations
– Avulsions
– Punctures
Abrasions
• Most Common
• Usually caused by
something rubbing the
skin away
• Minimal Bleeding
• High Opportunity for
infection from dirt and
debris
Lacerations
• Cut in the skin
• Deep lacerations can
cut layers of fat, muscle,
damage nerves and
blood vessels
• Bleeding will vary,
shallow lacerations =
more bleeding, Deeper
may not bleed as much
unless there is vessel
damage
Lacerations (con’t)
Avulsions
• Very serious
• Portion of the soft tissue
is completely torn away
• If body part is completely
torn away – amputation
• Bleeding may be hard to
control due to the violent
tearing, twisting, crushing
of the extremity
Punctures
• Pointed object causes a
hole in the soft tissue
• Nails, wood, glass,
bullets, etc.
• Minimal bleeding unless
blood vessel damage
• High risk of infection
• Items that remain in the
wound is considered
embedded
Punctures (con’t)
• A note about
embedded objects –
LEAVE THE OBJECT IN
PLACE – DO NOT
PULL IT OUT
When to call?
• Any major open wound –
– Heavy bleeding
– Deep wound
– Violent Nature
– Signs of Shock
– Loss of Consciousness
What to do while waiting
• General Care includes
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Care for bleeding
Prevent Infection
Dress the wound
Monitor ABC’s and Treat for Shock
Preventing Infection
• Clean the area – Warm Water and Soap
• Irrigate with large amounts of water
• If the wound is deep, requires medical attention, or
heavy bleeding – don’t worry about cleaning as much
as stopping the bleeding
• Signs of Infection:
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Tenderness around the wound site
Red / Swollen tissue
Warm to touch / Throbbing
Fever and Chills (more serious infections)
Nausea
Stitches or Not?
• If ever in doubt – Yes
• If the wound involves and artery or the bleeding
can’t be stopped
• Wounds that show muscle, bone, involve joints,
wide gapes, hands and feet
• Human or Animal Bits (depth)
• Face wounds
• If the skin does not fall together or the wound is
over ½ inch long
Dressings and Bandages
• Dressings are pads
placed directly on the
wound
• Porous
• Sterile
• May have non-stick
surface
• Occlusive – complete
seal to prevent air and
water from the wound
• Bandages are any
material used to wrap
or cover any part of the
body
• Hold the dressings in
place
• May be used to apply
pressure
• Support limbs or body
parts
Dressings and Bandages (con’t)
• Any bandage applied snugly to create pressure is
known as a pressure bandage
• 2x2
• 4x4
• Trauma Dressing
• Roller Bandages
• Bandage Compress
Guidelines for Bandaging
• Check for feeling in extremities, warmth, color,
etc.
• Elevate the injury if possible
• Secure one end of the bandage – continue to
wrap until the wound is completely covered
• Tie or Tape in place
• Do not cover fingers or toes – Check after
wrapping for feeling, warmth, color, etc.
• Apply additional dressing if blood soaks through
Minor Wound Care
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Don’t forget your protection
Apply Direct Pressure and Elevate
Wash the wound, irrigate for about 5 minutes
Apply ointment to minor wounds when no
allergies or sensitivities
• Cover the wound with a sterile dressing /
bandage
Major Wound Care
• Protection
• Cover the wound with a dressing, press hard
and elevate
• DO NOT REMOVE A DRESSING. If blood soaks
through add more dressings
• Watch for Shock
Tourniquets
• VERY LAST RESORT
• Should only be used in delayed care situations
• If you have to apply one:
– Apply just above the wound
– If using a manufactured tourniquet follow those
directions
– Wrap , then insert stick or something straight and firm
and twist until the bright red bleeding stops
– Note the time it was applied for EMS
– DO NOT EVER REMOVE OR LOOSEN IN THE FIELD.
Injuries to Muscles, Bones and
Joints
SED 205 – First Aid & CPR
Background
• Our skeleton is made up of muscles, bones, tendons
and ligaments
• Muscles are soft tissues that can shorten and lengthen.
Connected to bones by tendons
• Bones are hard / dense, rich blood supply and a lot of
nerves. Connected to each other at joints by ligaments
• Children’s bones are harder to break – more flexible,
but if they damage the growth plate, it can have lasting
effects
• Elderly folks bones are more brittle and break easily
the older they get Osteoporosis
Our Muscles
Approx 640+
skeletal
muscles in
the human
body
Muscles
Bones
• 206 Bones in the
human body
• Key bones related to
life-threatening injury:
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Femur
Humerus
Pelvic Girdle
Ribs
Bones
Joints, Ligaments and Tendons
• Where two or more
bones come together =
joint
• Ligaments hold the
bones in the proper
place at the joint
• Specified range of
motion – beyond this
you get injury
• Tendons tie muscles to
bones
• Specified range of
motion and elasticity
• Susceptible to strains
especially in the back,
neck, and back of leg
Main bone and muscle injuries
• Fractures
• Dislocation
• Sprain
• Strain
Fractures
Complete break, chip, or crack in a bone. A fall, blow, or
even twisting can lead to a fracture
• Open Fracture:
– Open wound
– Bone tears through skin
surface
– Object entering skin that
breaks bone (bullet)
– Serious Injury
• Closed Fracture
– Does NOT break the skin
surface
– Still serious – Internal
bleeding, swelling, etc.
Dislocation
• More obvious than
fracture – forms bump,
ridge or hollow that
does not normally exist
• When a bone moves
away from another
bone at the joint –
tearing ligaments
• Joint no longer
functions
Sprain
• Tearing of the ligaments
at the joints.
– Mild – just swelling,
quick recovery
– Severe – Tearing of
ligament, can also
involve or be a part of a
fracture
– Most often occurs at
ankle, wrist and knee
Strain
• Stretching or tearing of
tendon
• Most often caused by
lifting a heavy object
• Usually occurs in neck,
back, and back of legs
What to look for…
• PAIN
• Significant bruising /
swelling
• Significant deformity
• Normal use is not
present
• Protruding bone
fragments
• Feel bones grinding, or
heard snap / pop
• Injured area is cold to
the touch, numb, or
tingly
• Mechanism of injury
– Falling in the floor versus
being hit by a bus
• Suspect possibility of
serious injury for any of
these signs
When to call
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When in doubt
Obvious deformity
Moderate / Severe swelling
Grinding Noise
Snap or Pop was heard
Open fracture
Cold / Numb
Head / Neck / Spine
Trouble Breathing
Unsafe to transport to
hospital without EMS
• While you wait…RICE
– Rest – No Moving
– Immobilize – Stabilize the
injured area without moving
it
– Cold – Apply ice to help with
swelling, Control ANY
bleeding
– Elevate – Only if this doesn’t
cause more pain. Get the
injured area higher than the
heart level to help with
swelling and bleeding
Splinting an Injury
• Anatomic Splint
– Using the person’s body
as a splint
• Soft Splint
– Folded blanket, towel,
pillow, etc.
• Rigid Splint
– Padded boards,
Magazines, etc.
• The Ground
– Injured leg or arm laying
on the ground for
support
• After you have splinted
the injury, you should
apply ice and elevate if
possible
Applying Anatomic Splint - SKILL
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Get Consent
Support the injured part
Check Circulation
Position Bandages
Align body parts
Tie Bandages
Recheck Circulation
Applying a soft splint
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Get Consent
Support the injured part
Check Circulation
Position Bandages
Wrap with Soft Object
Tie Bandages Securely
Recheck Circulation
Applying a rigid splint
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Get consent
Support the injured part
Check circulation
Place Splint
Secure Bandages
Recheck Circulation
Applying Sling & Binder
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Get Consent
Support injured part
Check circulation
Position Sling
Secure Sling
Bind with Bandage
Recheck Circulation
Head, Neck and Spinal Injuries
• Life threatening
• Permanent life-altering
damage
• 12,000 annually
• Mostly men over 40
• Car Crash, Falls,
Violence, Sports
• Head / Neck injuries:
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Paralysis
Speech Problems
Memory Problems
Can’t see these injuries,
so always suspect them
with violent accidents
Brain Injury
• Head injury can cause
blood vessels to rupture
in the brain, blood leaks
out and causes pressure
/ swelling, pressure on
brain = brain injury
• First sign is altered LOC
What to look for…
• Determine the
mechanism of injury
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Car crash
Fall
Diving
Fight
• If unconscious – always
treat for head / neck
injury
• If…
– Motor Vehicle Crash
– Fall from height greater
than standing
– Wearing safety helmet
that is cracked or broken
– Complains of head /
neck / back pain
– Not fully alert
– Tingling or Numbness
– Over 65 or Under 3
What to do…
• MINIMIZE Movement
• Control C-Spine with head
immobilization trick
• If wearing a helmet –
LEAVE IT ON
• If breathing stops or they
are bleeding this takes
precedent
• Concussion
– Temporary loss of brain
function
– Signs can appear quickly or
be delayed
– Mood changes
– Cognitive disturbance
– Sensitivity to light and
noise
– Headache
– Memory Loss
– Nausea Vomiting
What to do…
• Support the head and
neck
• Maintain an open airway
• Control bleeding
• Do NOT apply direct
pressure
• If clear fluid is leaking
from ears or a scalp
wound, cover it with
loose gauze
• Monitor
Chest Injuries
• Broken ribs are painful,
but rarely life
threatening
• Shallow breathing
• Try to support the area
with their hand or arm
• Serious injuries may
cause trouble breathing
• If trouble breathing
they may
– Have ashen or blue skin
– Cough up blood
– These are all serious and
should result in a call to
911 ASAP
When to call and What to do
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Call when in doubt
Trouble breathing
Coughing up blood
Numbness / Tingling
Spinal injury as well
• If they are standing,
DON’T TRY TO LAY
THEM DOWN. Keep
them still and support
the head / neck
• Monitor breathing and
LOC
Pelvic Injuries
• Risk of damage to major • Don’t move the person
arteries
• Try to keep them lying
• Signals include
flat or in the position
you find them
– Severe pain
– Nausea
• Watch for signs of shock
– Bruising
indicating internal
bleeding
– Weakness
– Tender Abdomen
– Loss of sensation in legs
– Altered LOC