Traumatic Injuries

Traumatic InjuriesTraumatic Injuries

May 2013 EMD CEMay 2013 EMD CE

Silver Cross EMSSSilver Cross EMSS

Our last CE covered Our last CE covered bleeding and shock. This bleeding and shock. This

month’s will continue month’s will continue the trauma theme and the trauma theme and focus on injuries to soft focus on injuries to soft

tissue, muscles and tissue, muscles and bones.bones.

WoundsWounds

A wound is an injury caused by any A wound is an injury caused by any physical means that leads to damage of a physical means that leads to damage of a body part.body part.– Wounds are classified as open or closed.Wounds are classified as open or closed.

WARNING!WARNING!

THIS POWERPOINT CONTAINS GRAPHIC THIS POWERPOINT CONTAINS GRAPHIC PICTURES OF TRAUMATIC INJURIES PICTURES OF TRAUMATIC INJURIES

AND OPEN WOUNDS.AND OPEN WOUNDS.

Closed WoundsClosed Wounds

The skin remains intact.The skin remains intact. The only closed wound is the bruise.The only closed wound is the bruise.

– Injury of the softInjury of the soft tissue beneath the skintissue beneath the skin

– Small blood vessels are broken.Small blood vessels are broken.

– The area becomes discolored and swells.The area becomes discolored and swells.

– A simple bruise heals quickly.A simple bruise heals quickly.

Bruising and swelling may be a sign of Bruising and swelling may be a sign of an underlying fracture.an underlying fracture.

SKINSKIN

The skin serves as a protective barrier The skin serves as a protective barrier that prevents foreign substances from that prevents foreign substances from entering the body.entering the body.

It is a sense organ and sends messages to It is a sense organ and sends messages to the brain.the brain.

It helps to regulate body temperature.It helps to regulate body temperature. It also prevents loss of body fluids.It also prevents loss of body fluids.

– When the skin is damaged, it can no longer When the skin is damaged, it can no longer perform these essential functions.perform these essential functions.

SKIN

Open Wounds Open Wounds

An open wound results in a break in An open wound results in a break in the skin. Bleeding and infection are the skin. Bleeding and infection are concerns with:concerns with:– AbrasionsAbrasions

– Penetrating WoundsPenetrating Wounds

– LacerationsLacerations

– AvulsionsAvulsions

– AmputationsAmputations

Open Wounds Open Wounds

AbrasionAbrasion– Also called a scrape, Also called a scrape,

road rash, or rug road rash, or rug burnburn

– Occurs when the skin Occurs when the skin is rubbed across a is rubbed across a rough surfacerough surface

– Affects the epidermis Affects the epidermis or outermost layer of or outermost layer of skin.skin.

Open Wounds Open Wounds Puncture or penetrating woundPuncture or penetrating wound

– Occurs when a sharp object penetrates the Occurs when a sharp object penetrates the skinskin

– May cause deep injury that is not May cause deep injury that is not immediately recognizedimmediately recognized

– Puncture wounds do not always bleed freelyPuncture wounds do not always bleed freely

– An impaled object may stick out of the skinAn impaled object may stick out of the skin

– A gunshot wound is a special type of A gunshot wound is a special type of puncture wound that may have an entrance puncture wound that may have an entrance and exit woundand exit wound

Open Wounds Open Wounds

Impaled objects Impaled objects are to be left in are to be left in place and place and stabilized. Control stabilized. Control bleeding around bleeding around them.them.

Open Wounds Open Wounds

Laceration or IncisionLaceration or Incision– Most common type of open woundMost common type of open wound

– Commonly called a cutCommonly called a cut

– Minor lacerations may require little Minor lacerations may require little carecare

– Large lacerations can cause extensive Large lacerations can cause extensive bleeding and even be life threateningbleeding and even be life threatening

Open Wounds Open Wounds

Open Wounds Open Wounds

Avulsions and amputationsAvulsions and amputations

– An avulsion is a tearing away of body tissue.An avulsion is a tearing away of body tissue.

– If an entire body part is torn away, the If an entire body part is torn away, the wound is called a traumatic amputation.wound is called a traumatic amputation.

– Amputated parts should be:Amputated parts should be: LocatedLocated Placed in a clean cloth or plastic bagPlaced in a clean cloth or plastic bag Kept cool but not put on iceKept cool but not put on ice Taken to the hospital for possible Taken to the hospital for possible

reattachmentreattachment

Open Wounds Open Wounds

Principles of Wound Principles of Wound TreatmentTreatment

Very minor bruises need no treatment.Very minor bruises need no treatment. Other closed wounds should be Other closed wounds should be

treated by:treated by:– Applying ice and gentle compressionApplying ice and gentle compression

– Elevating the injured part if no fractureElevating the injured part if no fracture

Splint all major contusionsSplint all major contusions Stop bleeding as quickly as possible Stop bleeding as quickly as possible

using the cleanest dressing available.using the cleanest dressing available.

Dressing and Bandaging Dressing and Bandaging Wounds Wounds

Dressings Dressings – If bleeding If bleeding

continues after continues after you have applied you have applied a dressing, put a dressing, put additional gauze additional gauze or clean cloth or clean cloth over the original over the original dressing.dressing.

Dressing and Bandaging Dressing and Bandaging WoundsWounds

Bandaging Bandaging

– A bandage is used to hold the dressing A bandage is used to hold the dressing in place.in place.

– Roller gauze and triangular bandages Roller gauze and triangular bandages are commonly used and found in are commonly used and found in most first aid kits.most first aid kits.

Burn Depth Burn Depth Superficial burns Superficial burns

(first-degree burns)(first-degree burns)– Reddened and Reddened and

painful skinpainful skin– The injury is The injury is

confined to the confined to the outermost layers outermost layers of the skin.of the skin.

– The patient The patient experiences minor experiences minor to moderate pain.to moderate pain.

Burn Depth Burn Depth Partial-thickness Partial-thickness

burns (second-burns (second-degree burns)degree burns)– Do not damage the Do not damage the

deepest layers of deepest layers of the skinthe skin

– BlisteringBlistering

– Fluid loss and Fluid loss and moderate to severe moderate to severe painpain

– Usually heal within 2 Usually heal within 2 to 3 weeksto 3 weeks

Burn Depth Burn Depth Full-thickness burns Full-thickness burns

(third-degree burns)(third-degree burns)– Damage all layers of Damage all layers of

the skinthe skin– Pain is absent Pain is absent

because the nerve because the nerve endings have been endings have been destroyed.destroyed.

– Patients lose large Patients lose large quantities of body quantities of body fluids and are fluids and are susceptible to shock susceptible to shock and infection.and infection.

Extent of Burns Extent of Burns

Rule of ninesRule of nines– Method for determining what percentage of Method for determining what percentage of

the body has been burnedthe body has been burned

– In an adult, the head and arms each equal In an adult, the head and arms each equal 9% of the total body surface.9% of the total body surface.

– The front and back of the trunk and each The front and back of the trunk and each leg are equal to 18% of the total body leg are equal to 18% of the total body surface.surface.

– This formulation is slightly modified for This formulation is slightly modified for children.children.

Extent of Burns Extent of Burns

Cause or Type of Burns Cause or Type of Burns

Thermal burnsThermal burns– Caused by heatCaused by heat

– Stop the burning process.Stop the burning process.

– Cover it with a dry, sterile dressing or a Cover it with a dry, sterile dressing or a burn sheet.burn sheet.

– Do not break blisters.Do not break blisters.

– Patients with large burns must be Patients with large burns must be treated for shock and transported to a treated for shock and transported to a hospital.hospital.

Cause or Type of Burns Cause or Type of Burns

Chemical burns Chemical burns – The longer the chemical remains in The longer the chemical remains in

contact with the skin or eyes, the more contact with the skin or eyes, the more damage it does.damage it does.

– Initial treatmentInitial treatment Remove as much of the chemical as possible.Remove as much of the chemical as possible. Brush away any dry chemical.Brush away any dry chemical. Flush with water.Flush with water. Cover the area with a dry, sterile dressing.Cover the area with a dry, sterile dressing. Arrange for prompt transport.Arrange for prompt transport.

Cause or Type of Burns Cause or Type of Burns

Electrical burnsElectrical burns– Occur when an electrical current enters Occur when an electrical current enters

the body at one point, travels through the the body at one point, travels through the body tissues and organs, and exits at the body tissues and organs, and exits at the point of ground contactpoint of ground contact

– Electricity causes major internal damage.Electricity causes major internal damage.

– Patients may experience irregularities of Patients may experience irregularities of cardiac rhythm or full cardiac arrest and cardiac rhythm or full cardiac arrest and death.death.

Cause or Type of Burns Cause or Type of Burns

Electrical burns Electrical burns – Be certain that a patient is not still in Be certain that a patient is not still in

contact with the electrical power source contact with the electrical power source before you touch or treat them.before you touch or treat them.

– Call for assistance from the power Call for assistance from the power company or from a qualified rescue squad.company or from a qualified rescue squad.

– Monitor the ABCs of electrical burn Monitor the ABCs of electrical burn patients and arrange for prompt transport.patients and arrange for prompt transport.

Injuries to Muscles or BonesInjuries to Muscles or Bones

Musculoskeletal injuries:Musculoskeletal injuries:– FracturesFractures

– DislocationsDislocations

– Sprains and strainsSprains and strains

– Head injuriesHead injuries

– Spinal cord injuriesSpinal cord injuries

– Chest injuriesChest injuries

Musculoskeletal SystemMusculoskeletal System Functions of the skeletal system:Functions of the skeletal system:

– To support the bodyTo support the body

– To protect vital structuresTo protect vital structures

– To assist in body movementTo assist in body movement

– To manufacture red blood cellsTo manufacture red blood cells The muscles of the body provide support and movementThe muscles of the body provide support and movement

– Muscles are attached to bones by tendons and cause Muscles are attached to bones by tendons and cause movement by alternately contacting and relaxing.movement by alternately contacting and relaxing.

– Movement occurs at joints, where two bones come Movement occurs at joints, where two bones come together.together.

– The bones are held together by ligaments.The bones are held together by ligaments.

Types of Injuries Types of Injuries

FracturesFractures– A fracture is a broken A fracture is a broken

bone.bone.

– It most often occurs as a It most often occurs as a result of a significant result of a significant force.force.

– In a closed fracture, the In a closed fracture, the bone is broken but there is bone is broken but there is no break in the skin.no break in the skin.

– In an open fracture, the In an open fracture, the bone is broken and the bone is broken and the overlying skin is lacerated.overlying skin is lacerated.

– Both result in bleeding at Both result in bleeding at the fracture site.the fracture site.

Types of Injuries Types of Injuries

DislocationsDislocations– A dislocation is a A dislocation is a

disruption that tears the disruption that tears the supporting ligaments of supporting ligaments of the joint.the joint.

– The bone ends separate The bone ends separate completely from each completely from each other and can lock in other and can lock in one position.one position.

– Any attempt to move a Any attempt to move a dislocated joint is very dislocated joint is very painful.painful.

– A dislocation can A dislocation can damage nearby nerves damage nearby nerves and blood vessels.and blood vessels.

Types of InjuriesTypes of Injuries

Sprains and strainsSprains and strains– A sprain is a joint A sprain is a joint

injury caused by injury caused by excessive excessive stretching of the stretching of the supporting supporting ligaments.ligaments.

– A strain is caused A strain is caused by stretching or by stretching or tearing of a muscle.tearing of a muscle.

Signs and Symptoms of Extremity Injuries

– Pain at the injury site

– An open wound

– Swelling and discoloration

– The patient’s inability or unwillingness to move the extremity

– Deformity or angulation

– Tenderness at the injury site

Anything that is painful, swollen, deformed or discolored should be considered a fracture, until it is x-rayed.

Treatment of Musculoskeletal Injuries

All limb injuries are treated the same way:– Cover open wounds with dry, sterile

dressings.

– Apply firm but gentle pressure to control bleeding.

– Apply a cold pack to painful, swollen, or deformed extremities.

– Stabilize to keep it from moving.

Injuries to the Head (Skull and Brain)

Head and spinal cord injuries are common causes of death.– Can also lead to irreversible paralysis and

permanent brain damage

– In a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to brain damage and death.

– An open head injury usually bleeds profusely

Injuries of the Spine

Mechanisms of Injury – Injury to the spinal cord high in the neck

paralyzes the diaphragm and results in death.

– Gunshot wounds to the chest or abdomen may produce spinal cord injury at that level.

– Falls, motor vehicle crashes, and stabbings are other common MOIs.

– Suspect a spinal injury if the patient has sustained high-energy trauma.

Injuries of the Chest Fractures of the ribs

– Even a simple fracture produces pain at the site and difficulty breathing.

– Rib fractures may be associated with injury to the underlying organs.

General Treatment for Traumatic Injuries

Keep the trauma patient from moving so they won’t aggravate any injuries they may have.

Monitor A – B - C’s and treat for shock.

Control external bleeding with direct pressure.

Refer to the proper protocol for additional information.

Sources

AAOS Emergency Medical Responder, 5th edition

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