Chapter 18 SoftTissue Injuries BRADY National Ski Patrol

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, 5 th 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. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Anatomy and Physiology of Skin l Physiology of Bleeding and Clotting l Types of Soft-Tissue Injuries l Assessment l Management l Chapter Summary BRADY National Ski Patrol, Outdoor Emergency Care, 5 th 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology of the Skin l Largest organ of the body l Multi purpose l Two layers ◦ Epidermis ◦ Dermis BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Anatomy and Physiology of the Skin BRADY National Ski Patrol, Outdoor Emergency Care, 5

Physiology of Bleeding and Clotting l Bleeding is a leak in a blood vessel ◦ Artery ◦ Vein ◦ Capillary l 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Physiology of Bleeding and Clotting BRADY National Ski Patrol, Outdoor Emergency Care, 5 th

Types of Soft-Tissue Injuries l Closed ◦ ◦ Injury: Skin remains intact Contusion Hematoma Crush injuries Compartment syndrome continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Types of Soft-Tissue Injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th

Types of Soft-Tissue Injuries l 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, 5 th 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Types of Soft-Tissue Injuries l Burns Injury: Exposure to excessive energy ◦ ◦ ◦ Thermal Friction Chemicals Electricity Nuclear radiation continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Update l What actions does the patroller take? l What injuries are found? l Are there any complications? BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment l Use PPE / Standard Precautions l Standard assessment procedures – ABCDs, SAMPLE, and vitals l Be aware of other potential injuries l Check for shock l Check CMS l Document findings BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Management l Direct Pressure l Pressure Bandage l Hemostatic Bandage l Tourniquet BRADY National

Management BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by

Treating for Specific Injuries l Contusions (closed injuries) ◦ Cold therapy ◦ R. I. C. E. S l Open Injuries ◦ ◦ ◦ BRADY Control bleeding Provide wound care Cover wound with a dressing Bandage Splint extremity wounds continued National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Treating for Specific Injuries continued Copyright Edward Mc. Namara BRADY National Ski Patrol, Outdoor

Treating for Specific Injuries l 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Treating for Specific Injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th

Treating for Specific Injuries l 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Dressing and Bandaging l Multiple materials may be used as dressings: ◦ ◦ ◦ BRADY Sterile Non-sterile Pressure Occlusive Stabilizing Hemostatic National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Dressings and Bandages l Different locations/injuries need different types of bandages: ◦ ◦ Joints Conical regions Head Hands and fingers l Check CMS before and after bandaging BRADY National Ski Patrol, Outdoor Emergency Care, 5 th 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, 5 th 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. l The three types of soft-tissue injuries are closed injuries, open injuries, and burns. l continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th 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. l When applying a dressing to control bleeding, do not remove it because doing so can disrupt clots and cause more bleeding. Instead, additional dressings. l Hemostatic bandages contain a substance that helps stop external bleeding. l continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Chapter Summary Do not use elastic bandages to secure dressings. l Splinting a soft-tissue injury helps decrease bleeding and reduces pain. l Applying an effective field dressing and bandage is an important skill for OEC Technicians. l BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ