Soft Tissue Injuries and Burns for EMT-Basic
Paul Vogt UT Southwestern Dallas, Texas
Structure and Function of Skin
Most durable and largest organ Three Layers
Epidermis, dermis, and subcutaneous layers
Roles
Protection from the environment
Body temperature regulation Receptor organ
Bacteria, viruses, and other micro-organisms
Heat, cold, touch pressure, and pain
Eliminates water and salts
BSI and Soft Tissue Injuries
Open soft tissue injuries Body fluids Exposure risk Protect your self
Closed Soft Tissue Injuries
A wound that is beneath unbroken skin
Skin is intact
Types
Contusions Hematomas Crush Injury
Closed Soft Tissue Injuries
Contusions
Damage in the dermis layer Swelling pain Ecchymosis
Closed Soft Tissue Injuries
Hematoma
Similar to contusion – Larger vessel, larger amount of tissue affected Goose egg Fist can be equal 10% of blood loss
Closed Soft Tissue Injuries
Crush Injuries
Blunt force trauma Soft tissue damage and internal bleeding Organ rupture possible
Open Soft Tissue Injuries
Continuity of skin is broken External bleeding Contamination
Types Abrasion Laceration
Penetrations/Punctu re
Amputations Crush
injuries
Open Soft Tissue Injuries
Abrasions
Scrapping, rubbing or shearing of the epidermis Painful – Nerve ending exposed Blood – Oozing in nature Contamination and infection
Open Soft Tissue Injuries
Laceration
Break in skin of varying depth Arteries can be involved
Open Soft Tissue Injuries
Avulsion
Loose flap of skin Partial or complete Significant bleeding can occur Scarring can be extensive
Open Soft Tissue Injuries
Amputations
Disruption of the continuity of the extremity or other body part Extensive bleeding possible (partial vs. complete)
Open Soft Tissue Injuries
Penetrations/Punct ures
Object being pushed into the body Wound can be deep Severity depends on location, depth, force of object
Open Soft Tissue Injuries
Blunt trauma or crushing forces
Suspect internal injuries Concern of when the object is removed Profuse bleeding
General Management of Open and Closed Soft Tissue Injuries
Closed
BSI precautions Ensure adequate airway and breathing
Treat for shock
Supply oxygen? Keep them warm, feet elevated?
Splint painful, swollen, deformed extremities
Additional soft tissue injury, if a fracture is involved
General Management of Open and Closed Soft Tissue Injuries Open
BSI precautions Ensure an adequate airway and breathing Provide oxygen? Expose he wound Control bleeding through direct pressure with elevation (when possible) Pressure point, tourniquet (last
Prevent further contamination Dress and bandage the wound
CMS checks – pre and post
Keep the patient calm and quiet Treat for shock Transport
General Management of Open and Closed Soft Tissue Injuries
Amputations
Take care of the patient first Search for missing body part
Do not delay transport while searching for body part if not immediately available
Part found
Wrap in dry or slightly moistened sterile dressing
Place part in a plastic bag Keep the body part cool
Do not immerse in water or saline
Ice, ice pack – do not allow the part to freeze
Transport the patient and part (if found)
General Management of Open and Closed Soft Tissue Injuries
Chest Injuries
Occlusive dressings
Abdominal injuries Do not touch or replace abdominal organs Cover the exposed organs
Sterile dressings large enough to cover all tissue Occlusive dressing
Flex the patient’s knees and hips, if not contraindicated
General Management of Open and Closed Soft Tissue Injuries
Impaled objects
Should never be removed
EXCEPT:
In the cheek or airway and creating an obstruction
Manually secure the object Expose the wound Control bleeding Use bulking dressings to stabilize the object
General Management of Open and Closed Soft Tissue Injuries Care
Neck Injuries Major vessels, airway structures, spinal cord Air embolism an issue to be considered Blood Flow – Arterial or Venous
Place a gloved hand over the wound to control bleeding Apply an occlusive dressing (tape on all sides) Cover the occlusive dressing with a regular dressing Apply only enough pressure to stop bleeding When bleeding is controlled, apply a pressure dressing Consider spinal
Burns
Burn Classifications
Superficial/1st degree
Partial Thickness/2nd degree
Epidermis
Epidermis and dermis
Full Thickness/ 3rd degree
Epidermis, dermis, fat and muscle
Burns
Superficial (1st)
Flash type burns, liquid, or sun S/S – Red skin, pain at site, tenderness, no blisters Days to heal
Burns
Partial Thickness (2nd)
Contact with fire, hot liquids or objects, chemical substances, severe sun burn S/S – Blisters, Intense pain, White or red skin, moist and mottled skin Damaged blood vessels leak plasma
Burns
Full Thickness (3rd)
Hot liquids or solids, flame, chemicals, and electricity Lathery appearance, charring (dark brown or white), skin is hard to the touch, no pain, pain in periphery Eschar Confined space?
Rule of Nines
Rule of Palm
Palm approximation 1%
Critical, Moderate, Minor burns
Respiratory tract involvement Other major trauma Full or partial thickness burn that involves:
Faces, eyes, ears, hands, feet, or genitalia
Any full thickness > 10% BSA
Any partial thickness >20% BSA Burn injuries with a suspected fractures extremity Any burn that encircles a body part Specialized burns – Electrical, chemical, inhalation Extreme of ages
Critical, Moderate, Minor burns
Full thickness burns with 2-10% BSA
Excluding the face, hands, feet, genitalia, or respiratory tract
Partial thickness burns with 15-20% BSA
Critical, Moderate, Minor burns
Full thickness involving less than 2% BSA Partial thickness less than 15% BSA Superficial burns less than 50% BSA
General Burn Care (Thermal)
Remove the patient from the source of the burn and stop the burning process Do not enter an unsafe environment Establish and maintain an effective airway Oxygen, BVM… Classify the severity of the burn
Remove jewelry, belts, shoes… Cover the burned area with dry sterile dressings Keep the patient warm and seek other injuries Transport to an appropriate facility
Inhalation Burns
Considered a Critical Burn Sources and S/S
Burns of the face, mouth, throat or history of an enclosed space entrapment, and/or smoke, toxic gas inhalation are all possible causes
Result = Possible laryngeal edema
Airway obstruction – Be prepared to aggressively manage
Inhalation Burns
Management – Ensure good oxygenation and ventilation Rapid transportation Other burn care May have a difficult airway to manage
Electrical Burns
Sources and Other Relevant Points
Electrical current or lightning Can injure soft tissue or the whole body Electricity seeks to be grounded, will take the path of least resistance to exit Exit and Entrance – Burns in between Heart – Electrical current can be disturbed
Electrical Burns
Management - Critical Burn
Ensure your safety first Ensure an adequate airway and good ventilation
Oxygen or BVM
Cardiac arrest? – AED & CPR Assess more muscle tenderness Assess Exit and Entrance wounds – Provide appropriate
Chemical Burns
Immediate care required
Skin contact = Continued burning Dry chemicals should be brushed off, then flushed for at least 15 minutes Protect yourself from exposure Remove patient’s clothing
Chemical Burns
Management
Protect yourself first
HazMat
Brush off dry chemicals – then flush with copious amounts of water (ensure water will not make matters worse) Flush for at least 20 minutes
Allow fluid to run away from wound
The End