Ch. 9 - Hemorrhage & Soft Tissue Trauma

Most of the human body is made of soft tissues, which is a general category that includes skin, fat, muscle, vital organs, and blood vessels, among others. Soft tissues are generally defined by what they are not: Essentially, soft tissues are all tissues other than bones. These tissues are more susceptible to injury than the denser tissue in the skeleton. Injuries to the soft tissues range from extremely minor (such as a scrape or bruise) to life-threatening (such as an impaled object or gunshot wound).

Transcript

1. Ch 9 – Pg 169
2. Infection • Protect against infection by cleansing open wounds to remove pathogens • Minor wounds that are not bleeding anymore should be washed with water (Non-RTC) • Hemorrhaging wounds require bleeding control and cleaning at a medical facility (RTC) • Avoid touching the wound • Use clean gloves • Avoid letting non-sterile material come into contact • Wipe away from the wound, not towards Ch 9 – Pg 170
3. Signs of Infection • Swollen and red • Warm to touch • Throb with pain • Some have a pus discharge • Systemic Infection: • Red streaks on skin • Flu-like symptoms Ch 9 – Pg 170
4. Open Wounds Ch 9 – Pg 178-180 Abrasion Laceration Avulsion Puncture
5. Dressings and Bandages Ch 9 – Pg 173
6. Controlling External Bleeding 1. Place patient in seated position 2. Place direct pressure on the wound 3. Apply sterile dressing, applying firm pressure 4. Apply bandage over dressing to maintain pressure 1. If blood soaks through, add additional dressing/bandage 2. Do not remove any blood-soaked dressings/bandages 5. If bleeding continues, apply a tourniquet Ch 9 – Pg 175-176
7. Tourniquets A tight band placed around an extremity to obstruct blood vessels and stop blood flow. Used to treat a hemorrhage when all other interventions are impossible or have been ineffective – only used if absolutely necessary. A bandage and dressing should be used in addition. Rapid Transport Category Ch 9 – Pg 174
8. Tourniquets 1. Apply 5-10cm above the injury (just above any joint in this range) 2. Tighten until the bleeding stops and secure in place 3. Continue to apply direct pressure to wound 4. Document the time it was applied 5. Ensure Rapid Transport Category Ch 9 – Pg 174-175
9. Impaled Objects Definition • Object that is still in the wound • Should be left in place unless they interfere with the patient’s airway or respiration Care • Stabilize with bulky dressings • Bandage in place to limit movement and control bleeding Ch 9 – Pg 181
10. Removing Fish Hooks Ch 9 – Pg 182
11. Ch 9 – Pg 183 Subungual Hematomas
12. Burns Burns affect the epidermis. They can progress to damage the dermis and other underlying tissues (ie. muscle, bone, etc.) Burns that break the skin can cause infection, fluid loss, and loss of temperature control. Ch 9 – Pg 184
13. Severity of Burns Ch 9 – Pg 184-185
14. Care for Burns 1. Prevent additional damage to tissue • Cooling, flushing, covered with moist, sterile dressings 2. Cover the burned area with dry dressings • Leave blisters intact • Use dry, non-stick, sterile dressing and loosely bandage • If burn covers large area, cover with clean, dry sheets 3. Take steps to manage shock • Manage temperature of the environment and patient Ch 9 – Pg 187
15. Chemical Burns - Care • Will continue to burn as long as it is on the skin • Remove from skin as quickly as possible • Flush continuously with large amounts of cool, running water, 20min • Brush powder or granules from skin before flushing • Have patient remove contaminated clothing • Rapid Transport Category Ch 9 – Pg 189-190 Chemical Burns To the Eye: • Flush affected eye from nose outward; angle the patient’s head to avoid washing chemical into the other eye
16. Electrical Burns • Electricity conducted through the entire body • Electrical burns along the path of the current • Entry and exit burns • Damage to underlying tissues • Respiratory or cardiac arrest? • Spinal injuries? • Rapid Transport Category Ch 9 – Pg 190
17. Amputations • A body part that is completely or partially severed • Initial bleeding is often heavy, but slows down • Usually Rapid Transport Category • To increase chance of successful reattachment: • Rinse the body part quickly with saline • Wrap in sterile gauze, place inside plastic bag • Place bag inside larger bag and cool with ice/cold pack • Label the bag clearly (name, date, time) Ch 9 – Pg 191
18. Internal Bleeding The escape of blood into spaces inside the body. Because it is more difficult to recognize than external bleeding, you should always suspect when the MOI indicates the potential for serious injury. S&S are not always obvious and may take time to appear. Signs and Symptoms: • Discolouration (bruising) • Soft tissues that are tender, swollen, or firm • Anxiety or restlessness • Rapid breathing • Skin that is cool, moist, pale, or bluish • Nausea and vomiting • Excessive thirst • DLOR • Rapid, weak pulse Ch 9 – Pg 177
19. Ch 9 – Pg 178 Care for Internal Bleeding Contusion (bruise) • Apply ice/cold pack (with gauze or towel between cold source and skin) Internal hemorrhage: • Obtain advanced medical care • Rapid Transport Category • Monitor for S&S of shock • More information on specific chest, abdominal and pelvic injuries will be covered in Ch. 11