Lecture #7

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Lecture #7
2013-04-16 14:56:21
Musculoskeletal Injuries Soft Tissure Burns

Thurston County EMT
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  1. What are they main functions of the skin?
    • barrier to the enviornment
    • prevents water loss
    • protects from UV
    • helps regulate temperature
  2. What are the three layers of the skins?
    • epidermis
    • dermis
    • subcutaneous
  3. What is the definition of a closed soft tissue injury?
    an injury to any type of soft tissue without a breakage of the skin
  4. Types of closed soft tissue injuries
    • contusion
    • hematoma
    • crush
  5. Define a contusion.
    • aka a bruise
    • when blood accumulation causes discoloration
    • swelling and pain are typically present
    • the epidermis remains intact
  6. Define a hematoma.
    a collection of blood underneath the skin that is larger than a contusion.
  7. List the different types of open soft tissue injuries.
    • puncture
    • abrasion
    • avulsion
    • laceration
    • amputation
    • crush
  8. Given two examples of a puncture wound.
    • stabbing
    • gunshot
  9. Define an abrasion.
    the outermost later of skin is damaged by shearing forces. (think road rash)
  10. Define an avulsion.
    a flap of skin or tissue torn loose or completely detached. (ex: scalping)
  11. Define a laceration.
    a break in the skin of varying depth; may be linear (regular) or stellate (irregular). caused by a forceful impact with a sharp object.
  12. List the steps of care for an open soft tissue injury.
    • expose the injury site (cut clothes, shoes, etc)
    • control bleeding
    • prevent further contamination (to prevent infection)
    • apply dry sterile dressing to wound and bandage securely in place
    • keep patient calm and quiet
    • treat for shock if signs, symptoms present
  13. List the steps to control bleeding.
    • Apply direct pressure
    • elevate
    • pressure point
    • apply dressing and bandage
    • LAST RESORT: bp cuff as tourniquet
  14. When would you use/need an occlusive dressing?
    an open wound to the chest or neck; anywhere the air could enter the pleural space and cause a collapsed lung
  15. List the three classifications of burns.
    • superficial
    • partial thickness
    • full thickness
  16. Define a superficial burn.
    involves only the epidermis; pain and reddened skin will be at the burn site
  17. List the steps when caring for a burn.
    • Stop the burning process with water or saline
    • remove any smoldering clothing and jewelery
    • BSI
    • continually monitor airway
    • prevent further contamination
    • cover burned area with a dry sterile dressing (if greater than 10%, BSA)
    • do not use ointment, lotion or antiseptic
    • do not break blisters
    • transport
  18. What is your greatest indicator that a burn is partial thickness and not just a superficial burn?
  19. Define a partial thickness burn.
    involves epidermis and dermis with intense pain; white to red skin that is moist and mottled with blisters
  20. Define a full thickness burn
    burn that extends through all dermal layers and may even involve muscle, bone, or organs. skin becomes dry and leathery, may appear white, dark brown, or charred with loss of sensation (hard to the touch)
  21. How do you classify burns?
    by the depth, location, and extent ("rule of nine" or "palm rule") of the burn. also take age and preexisting medical condition into account.
  22. What are critical burns?
    • full thickness burns to hands, feet, face, or genitalia
    • burns associated with respiratory injury
    • partial/full thickness or chemical burns over 10% BSA
    • burns complicated by painful, swollen, deformed extremity
    • moderate burns in children or elders
    • circumferential burns
    • burns from hydrofloric acid
  23. Define a moderate burn.
    • full thickness burn of 2-10% BSA (excluding hands, feet, face, genitalia & upper airway)
    • partial thickness burn of 15-30% BSA
    • superficial burn covering greater than 50% BSA
  24. What are the ALS upgrades for burns?
    • partial/full thickness or chemical burns to the face, or suspicion of airway involvement
    • partial/full thickness or chemical burn greater than 10% BSA
    • partial/full thickness or chemical burn if patient is less than 5y/o
    • electrical burns
    • hydrofluoric acid burns
  25. When should you use a water gel dressing?
    If the patient's burn area is less than the size of 2 4x4 inch gauze pads
  26. Define the "rule of nine" for burn victims in adults.
    used in the field to make a rough estimate of body surface; each of the following area is 9% of the entire body in an adult - head and neck, each entire arm, chest, abdomen, upper back, lower back and buttocks, each front of leg, each back of leg, with genitalia counting as the last 1%.
  27. Define the "rule of nine" for child burn victims
    • neck and head, entire back are 18% of BSA
    • each entire arm, the chest, and the abdomen are 9% of BSA
    • each entire leg is 14%
    • genitalia is 1% of BSA
  28. What is the purpose of a bandage? Provide examples.
    • Holds dressing in place
    • examples include gauze rolls, triangular bandages, adhesive tape, air splints
  29. What is the care for electrical burns?
    • administer O2 if indicated
    • monitor patient closely for respirator and cardiac arrest (consider the need for AED)
    • treat soft tissue injuries associated with the burn
    • look for an entrance or exit wound (and be concerned with what happened in between)
  30. What are the three types of muscle?
    • skeletal (functional)
    • smooth (organs)
    • cardiac (works on it's own)
  31. What are the functions of the skeletal system?
    • gives body form
    • protects structures underneath
    • allows for movement
  32. Ligaments connect ______ to ______.
    bone to bone
  33. Tendons connect ______ to ______.
    muscle to bone
  34. What are all the kinds of movement a joint can provide?
    • flexion and extension
    • adduction and abduction
    • rotation
    • circumduction
  35. What are the major bones of the thorax?
    • scapula
    • clavicle
    • sternum
    • manubrium
    • xiphoid
    • ribs
  36. What are the major bones of the upper extremities?
    • humerus
    • radius
    • ulna
    • carpals
    • metacarpals
    • phalanges
  37. What are the major bones of the lower extremities?
    • femur
    • tibia
    • fibula
    • tarsals
    • metatarsals
    • phalanges
  38. What are different types of bone/joint injuries?
    • open fracture
    • closed fracture
    • strain
    • sprain
    • dislocation
  39. What are the signs/symptoms of a bone/joint injury?
    • deformity or angulation (pointing in the wrong direction)
    • pain and tenderness
    • crepitus
    • swelling
    • bruising
    • exposed bone ends
    • joint locked into position
  40. When is an ALS upgrade required for bone/joint injury?
    when there is no distal pulse
  41. List the steps for care of a bone/joint injury
    • BSI/scene safe
    • administer O2 in indicated
    • after life threats controlled (ABCs), apply splint
    • apply cold pack
    • elevate the extremity
    • transport
  42. List the steps for splinting a long bone.
    • assess distal PMS
    • provide gross alignment unless resistance is encountered
    • consider ALS
    • measure, make, and apply splint (bracing joint above and joint below)
    • always splint hands and feet in a position of function
    • reassess PMS
  43. List the steps for splinting a joint.
    • Assess the distal PMS
    • splint the joint in position found unless no pulse is found; if no pulse, attempt to realign once
    • reassess PMS
    • cold pack as needed
  44. What are the reasons for splinting?
    • to prevent motion of jagged bone ends (causing more damage)
    • to minimize complications from bleeding and tears in tendons, ligaments, and/or muscles
  45. What are the general rules of splinting?
    • Assess PMS before and after splinting
    • immobilize the joint or bone above and below
    • remove or cut away clothing
    • cover open wounds with sterile dressing
  46. What are all the types of splints?
    • rigid splints
    • traction splints
    • vacuum splints
    • SAM splints
    • pneumatic splints (air)
    • improvised splints (pillow or towel)
    • PASG (personal anti-shock garment)
  47. What are the indications for traction splints?
    midshaft femur fracture
  48. What are the contraindications for a traction splint?
    • knee or hip involvement
    • pelvic fracture
    • knee, ankle, or lower leg injury
    • if traction would risk separation