Soft Tissue Injuries and Burns for EMT-Basic

Soft Tissue Injuries and Soft Tissue Injuries and Burns for EMT-BasicBurns for EMT-Basic

Paul VogtPaul VogtUT SouthwesternUT Southwestern

Dallas, TexasDallas, Texas

Structure and Function Structure and Function of Skinof Skin

Most durable and Most durable and largest organlargest organ

Three LayersThree Layers Epidermis, dermis, and Epidermis, dermis, and

subcutaneous layerssubcutaneous layers RolesRoles

Protection from the Protection from the environmentenvironment

Bacteria, viruses, and Bacteria, viruses, and other micro-organismsother micro-organisms

Body temperature Body temperature regulationregulation

Receptor organReceptor organ Heat, cold, touch Heat, cold, touch

pressure, and painpressure, and pain Eliminates water and Eliminates water and

saltssalts

BSI and Soft Tissue BSI and Soft Tissue InjuriesInjuries

Open soft tissue Open soft tissue injuriesinjuries

Body fluidsBody fluids Exposure riskExposure risk Protect your selfProtect your self

Closed Soft Tissue Closed Soft Tissue InjuriesInjuries

A wound that is A wound that is beneath unbroken beneath unbroken skinskin Skin is intactSkin is intact

TypesTypes ContusionsContusions HematomasHematomas Crush InjuryCrush Injury


ContusionsContusions Damage in the Damage in the

dermis layerdermis layer Swelling painSwelling pain EcchymosisEcchymosis


HematomaHematoma Similar to Similar to

contusion – Larger contusion – Larger vessel, larger vessel, larger amount of tissue amount of tissue affectedaffected

Goose eggGoose egg Fist can be equal Fist can be equal

10% of blood loss10% of blood loss


Crush InjuriesCrush Injuries Blunt force traumaBlunt force trauma Soft tissue damage Soft tissue damage

and internal and internal bleedingbleeding

Organ rupture Organ rupture possiblepossible

Open Soft Tissue InjuriesOpen Soft Tissue Injuries

Continuity of Continuity of skin is brokenskin is broken External External

bleedingbleeding ContaminationContamination

TypesTypes AbrasionAbrasion LacerationLaceration Penetrations/Penetrations/

PuncturePuncture

AmputationsAmputations Crush injuriesCrush injuries


AbrasionsAbrasions Scrapping, rubbing Scrapping, rubbing

or shearing of the or shearing of the epidermisepidermis

Painful – Nerve Painful – Nerve ending exposedending exposed

Blood – Oozing in Blood – Oozing in naturenature

Contamination and Contamination and infectioninfection


LacerationLaceration Break in skin of Break in skin of

varying depthvarying depth Arteries can be Arteries can be

involvedinvolved


AvulsionAvulsion Loose flap of skinLoose flap of skin Partial or completePartial or complete Significant bleeding Significant bleeding

can occurcan occur Scarring can be Scarring can be

extensiveextensive


AmputationsAmputations Disruption of the Disruption of the

continuity of the continuity of the extremity or other extremity or other body partbody part

Extensive bleeding Extensive bleeding possible (partial vs. possible (partial vs. complete)complete)


Penetrations/Penetrations/PuncturesPunctures Object being Object being

pushed into the pushed into the bodybody

Wound can be deepWound can be deep Severity depends Severity depends

on location, depth, on location, depth, force of objectforce of object


Blunt trauma or Blunt trauma or crushing forcescrushing forces Suspect internal Suspect internal

injuriesinjuries Concern of when Concern of when

the object is the object is removedremoved

Profuse bleedingProfuse bleeding

General Management of General Management of Open and Closed Soft Open and Closed Soft

Tissue InjuriesTissue Injuries Closed Closed

BSI precautionsBSI precautions Ensure adequate airway and breathingEnsure adequate airway and breathing

Supply oxygen?Supply oxygen? Treat for shockTreat for shock

Keep them warm, feet elevated?Keep them warm, feet elevated? Splint painful, swollen, deformed Splint painful, swollen, deformed

extremitiesextremities Additional soft tissue injury, if a fracture is Additional soft tissue injury, if a fracture is

involvedinvolved


Tissue InjuriesTissue Injuries OpenOpen

BSI precautionsBSI precautions Ensure an adequate Ensure an adequate

airway and breathingairway and breathing Provide oxygen?Provide oxygen?

Expose he woundExpose he wound Control bleeding Control bleeding

through direct through direct pressure with pressure with elevation (when elevation (when possible)possible)

Pressure point, Pressure point, tourniquet (last tourniquet (last resort)resort)

Prevent further Prevent further contaminationcontamination

Dress and bandage Dress and bandage the woundthe wound

CMS checks – pre CMS checks – pre and postand post

Keep the patient Keep the patient calm and quietcalm and quiet

Treat for shockTreat for shock TransportTransport


Tissue InjuriesTissue Injuries AmputationsAmputations

Take care of the patient firstTake care of the patient first Search for missing body part Search for missing body part

Do not delay transport while searching for body part Do not delay transport while searching for body part if not immediately availableif not immediately available

Part foundPart found Wrap in dry or slightly moistened sterile dressingWrap in dry or slightly moistened sterile dressing

Do not immerse in water or salineDo not immerse in water or saline Place part in a plastic bagPlace part in a plastic bag Keep the body part coolKeep the body part cool

Ice, ice pack – do not allow the part to freezeIce, ice pack – do not allow the part to freeze Transport the patient and part (if found)Transport the patient and part (if found)


Tissue InjuriesTissue Injuries Chest InjuriesChest Injuries

Occlusive dressingsOcclusive dressings Abdominal injuriesAbdominal injuries

Do not touch or replace abdominal organsDo not touch or replace abdominal organs Cover the exposed organsCover the exposed organs

Sterile dressings large enough to cover all Sterile dressings large enough to cover all tissuetissue

Occlusive dressingOcclusive dressing Flex the patient’s knees and hips, if not Flex the patient’s knees and hips, if not

contraindicated contraindicated


Tissue InjuriesTissue Injuries Impaled objectsImpaled objects

Should never be removed Should never be removed EXCEPT:EXCEPT:

In the cheek or airway and creating an In the cheek or airway and creating an obstructionobstruction

Manually secure the objectManually secure the object Expose the woundExpose the wound Control bleedingControl bleeding Use bulking dressings to stabilize the Use bulking dressings to stabilize the

objectobject


Tissue InjuriesTissue Injuries Neck InjuriesNeck Injuries

Major vessels, Major vessels, airway structures, airway structures, spinal cordspinal cord

Air embolism an Air embolism an issue to be issue to be consideredconsidered

Blood Flow – Blood Flow – Arterial or VenousArterial or Venous

CareCare Place a gloved hand over Place a gloved hand over

the wound to control the wound to control bleedingbleeding

Apply an occlusive Apply an occlusive dressing (tape on all dressing (tape on all sides)sides)

Cover the occlusive Cover the occlusive dressing with a regular dressing with a regular dressingdressing

Apply only enough Apply only enough pressure to stop bleedingpressure to stop bleeding

When bleeding is When bleeding is controlled, apply a controlled, apply a pressure dressingpressure dressing

Consider spinal Consider spinal immobilizationimmobilization

BurnsBurns

Burn ClassificationsBurn Classifications Superficial/1Superficial/1stst degree degree

EpidermisEpidermis Partial Thickness/2Partial Thickness/2ndnd

degreedegree Epidermis and dermisEpidermis and dermis

Full Thickness/ 3Full Thickness/ 3rdrd degree degree

Epidermis, dermis, fat Epidermis, dermis, fat and muscle and muscle

BurnsBurns

Superficial (1Superficial (1stst)) Flash type burns, Flash type burns,

liquid, or sunliquid, or sun S/S – Red skin, pain S/S – Red skin, pain

at site, tenderness, at site, tenderness, no blistersno blisters

Days to heal Days to heal

BurnsBurns

Partial Thickness Partial Thickness (2(2ndnd)) Contact with fire, hot Contact with fire, hot

liquids or objects, liquids or objects, chemical substances, chemical substances, severe sun burnsevere sun burn

S/S – Blisters, Intense S/S – Blisters, Intense pain, White or red pain, White or red skin, moist and skin, moist and mottled skinmottled skin

Damaged blood Damaged blood vessels leak plasma vessels leak plasma and form blistersand form blisters

BurnsBurns

Full Thickness (3Full Thickness (3rdrd)) Hot liquids or solids, Hot liquids or solids,

flame, chemicals, flame, chemicals, and electricityand electricity

Lathery appearance, Lathery appearance, charring (dark charring (dark brown or white), brown or white), skin is hard to the skin is hard to the touch, no pain, pain touch, no pain, pain in peripheryin periphery

EscharEschar Confined space? Confined space?

Rule of NinesRule of Nines

Rule of PalmRule of Palm

Palm Palm approximationapproximation

1%1%

CriticalCritical, Moderate, Minor , Moderate, Minor burns burns

Respiratory tract Respiratory tract involvementinvolvement

Other major traumaOther major trauma Full or partial Full or partial

thickness burn that thickness burn that involves:involves: Faces, eyes, ears, Faces, eyes, ears,

hands, feet, or genitaliahands, feet, or genitalia Any full thickness > Any full thickness >

10% BSA10% BSA

Any partial thickness Any partial thickness >20% BSA>20% BSA

Burn injuries with a Burn injuries with a suspected fractures suspected fractures extremityextremity

Any burn that Any burn that encircles a body partencircles a body part

Specialized burns – Specialized burns – Electrical, chemical, Electrical, chemical, inhalationinhalation

Extreme of agesExtreme of ages

Critical, Critical, ModerateModerate, Minor , Minor burnsburns

Full thickness burns with 2-10% BSAFull thickness burns with 2-10% BSA Excluding the face, hands, feet, Excluding the face, hands, feet,

genitalia, or respiratory tractgenitalia, or respiratory tract Partial thickness burns with 15-20% Partial thickness burns with 15-20%

BSABSA

Critical, Moderate, Critical, Moderate, Minor burnsMinor burns

Full thickness involving less than 2% Full thickness involving less than 2% BSABSA

Partial thickness less than 15% BSAPartial thickness less than 15% BSA Superficial burns less than 50% BSASuperficial burns less than 50% BSA

General Burn Care General Burn Care (Thermal)(Thermal)

Remove the patient Remove the patient from the source of the from the source of the burn and stop the burn and stop the burning processburning process Do not enter an Do not enter an

unsafe environmentunsafe environment Establish and Establish and

maintain an effective maintain an effective airwayairway Oxygen, BVM…Oxygen, BVM…

Classify the severity Classify the severity of the burn and of the burn and transport immediatelytransport immediately

Remove jewelry, Remove jewelry, belts, shoes…belts, shoes…

Cover the burned Cover the burned area with dry area with dry sterile dressingssterile dressings

Keep the patient Keep the patient warm and seek warm and seek other injuriesother injuries

Transport to an Transport to an appropriate facilityappropriate facility

Inhalation BurnsInhalation Burns Considered a Critical Considered a Critical

BurnBurn Sources and S/SSources and S/S

Burns of the face, mouth, Burns of the face, mouth, throat or history of an throat or history of an enclosed space enclosed space entrapment, and/or smoke, entrapment, and/or smoke, toxic gas inhalation are all toxic gas inhalation are all possible causespossible causes

Result = Possible Result = Possible laryngeal edemalaryngeal edema Airway obstruction – Be Airway obstruction – Be

prepared to aggressively prepared to aggressively managemanage

Inhalation BurnsInhalation Burns

Management – Management – Ensure good oxygenation and Ensure good oxygenation and

ventilationventilation Rapid transportationRapid transportation Other burn careOther burn care May have a difficult airway to manageMay have a difficult airway to manage

Electrical BurnsElectrical Burns Sources and Other Sources and Other

Relevant PointsRelevant Points Electrical current or Electrical current or

lightninglightning Can injure soft tissue or Can injure soft tissue or

the whole bodythe whole body Electricity seeks to be Electricity seeks to be

grounded, will take the grounded, will take the path of least resistance to path of least resistance to exitexit

Exit and Entrance – Exit and Entrance – Burns in betweenBurns in between

Heart – Electrical current Heart – Electrical current can be disturbed can be disturbed

Electrical BurnsElectrical Burns Management - Critical Management - Critical

BurnBurn Ensure your safety firstEnsure your safety first Ensure an adequate airway Ensure an adequate airway

and good ventilationand good ventilation Oxygen or BVMOxygen or BVM

Cardiac arrest? – AED & Cardiac arrest? – AED & CPRCPR

Assess more muscle Assess more muscle tendernesstenderness

Assess Exit and Entrance Assess Exit and Entrance wounds – Provide wounds – Provide appropriate burn careappropriate burn care

Transport Transport

Chemical BurnsChemical Burns

Immediate care Immediate care requiredrequired Skin contact = Skin contact =

Continued burningContinued burning Dry chemicals should Dry chemicals should

be brushed off, then be brushed off, then flushed for at least flushed for at least 15 minutes15 minutes

Protect yourself from Protect yourself from exposureexposure

Remove patient’s Remove patient’s clothingclothing

Chemical BurnsChemical Burns ManagementManagement

Protect yourself firstProtect yourself first HazMatHazMat

Brush off dry Brush off dry chemicals – then chemicals – then flush with copious flush with copious amounts of water amounts of water (ensure water will (ensure water will not make matters not make matters worse)worse)

Flush for at least 20 Flush for at least 20 minutes minutes

Allow fluid to run Allow fluid to run away from wound away from wound

The EndThe End

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Soft Tissue Injuries and Burns for EMT-Basic