WOUNDS - ptrp2014.weebly.com · Rapid Trauma Assessment If no life-threatening injuries are present, perform a complete head-to-toe rapid trauma assessment Focus on DCAP-BTLS Deformities

WOUNDS Emergency Procedures in PT

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Types of Wounds

Abrasions – uppermost layer scraped

away, minor capillary bleeding occurs,

nerve endings exposed

Lacerations – skin tear with edges jagged

and uneven

Incisions – made by a knife, edges are

straight


Types of Wounds

Punctures – an incision made by a sharp,

pointed object

Avulsions – forceful separation of a limb

from the body because of trauma

Amputations – clean removal of a limb

from the body


ASSESSMENT •Scene Size-Up •Primary Assessment •Rapid Trauma Assessment


Scene Size-Up

Assess for the MOI

Standard precautions against blood should

be taken if bleeding is present.


Primary Assessment

Assess for signs of hypoperfusion e.g.

tachycardia and tachypnea.


Rapid Trauma Assessment

If no life-threatening injuries are present,

perform a complete head-to-toe rapid trauma

assessment

Focus on DCAP-BTLS ◦ Deformities

◦ Contusions

◦ Abrasions

◦ Penetrations

◦ Burns

◦ Tenderness

◦ Lacerations

◦ Swelling

http://en.wikipedia.org/wiki/Deformity

http://en.wikipedia.org/wiki/Bruise

http://en.wikipedia.org/wiki/Abrasion_(medical)

http://en.wikipedia.org/wiki/Penetrating_trauma

http://en.wikipedia.org/wiki/Burn

http://en.wikipedia.org/wiki/Tenderness_(medicine)

http://en.wikipedia.org/wiki/Wound

http://en.wikipedia.org/wiki/Swelling_(medical)


MANAGEMENT •Wound bandaging


Bandaging

GOAL: protect the wound from further

injury and contamination

Roller bandage, military compress,

triangular bandage


TRANSPORTATION


Ongoing Assessment

Carefully monitor all bandages.

Often it becomes slack and loose or acts

like a tourniquet when swelling is present


THERMAL BURNS


Management

Stop burning

Cool the area with sterile water and wash

away excess debris

Remove any jewerly

Never apply ointments or antiseptic

lotions

Apply appropriate dressings


Management

Less than 10% TBSA

◦ Use a wet dressing, excess water squeeze out

◦ Secure with dry sterile bandage

More than 10% TBSA

◦ Use a dry dressing

◦ Consider risk for hypothermia - cover the

patient


CHEMICAL BURNS


Management

Dry Chemicals

◦ Brush off the patient

◦ Remove clothing

◦ Wait for MSD authority decision

◦ Flush the chemicals with water*

* Some chemicals can react violently upon

contact with water


Management

Wet Chemicals

◦ Wash off the patient

◦ Remove clothing

◦ Wait for MSD authority decision

◦ 20-30 minutes of flushing, continuous

irrigation (gentle rather than forceful)


Management

Eye Injury

◦ Irrigation of the eyes continuously for 20-30

minutes

◦ Water is running away from the unaffected

eye


ELECTRICAL BURNS


Management

Should be treated like any trauma, spinal

precautions

Check ABC, start CPR immediately

Use AED, as indicated

Assist breathing

Rapid transport


WOUND CARE


Initial Wound Care

Isolation or universal precautions

Clean wounds; blisters debrided

Shave hair for prevention of infection


Daily Wound Care

Pain medications, as needed

Dressings soaked off

Remove old topical and gently wash

wounds. Debride loose tissue.

Reapply topicals and dressings as ordered


Debridement

Remove dead tissue to get between dead

and viable tissue

Not so aggressive as to cause bleeding

Some removed with coarse mesh gauze

Debrided with sedation / analgesic /

conscious sedation or general anesthesia


Debridement

Sharp debridement

Scalpel or scissors to remove devitalized

tissue

Indications

Removing adherent eschar

Devitalized tissue in extensive ulcer

Urgent debridement in advanced Cellulitis

or Sepsis

http://www.fpnotebook.com/DER/Bacteria/Clts.htm

http://www.fpnotebook.com/ID/Fever/Sps1.htm


Debridement

Sharp debridement

Follow-up sharp debridement

Apply clean, dry dressings for 8-24 hours

Restart wet-to-moist (or wet-to-dry) dressings

Debridement under Anesthesia Indications

Indicated for extensive stage 4 Decubitus Ulcers

Consider bone biopsy to assess for Osteomyelitis

http://www.fpnotebook.com/Surgery/DER/DcbtsUlcr.htm



http://www.fpnotebook.com/Ortho/ID/Ostmylts.htm


Debridement

Mechanical debridement

• Wet-to-Dry Dressing

• Hydrotherapy (Occlusive Wound

Dressing)

•Transparent Film Dressing

• Wound irrigation

http://www.fpnotebook.com/Surgery/Pharm/SlnGzDrsng.htm





http://www.fpnotebook.com/Surgery/Pharm/WndDrsng.htm

http://www.fpnotebook.com/Surgery/Pharm/WndDrsng.htm

http://www.fpnotebook.com/Surgery/Pharm/TrnsprntFlmDrsng.htm

http://www.fpnotebook.com/Surgery/DER/Wnd.htm

http://www.fpnotebook.com/Surgery/DER/Wnd.htm


Debridement

Enzymatic debridement (chemical)

• Indicated where surgical debridement is not possible and wound infected or dead tissue

• Enzymatic debridement is more specific in targeting dead tissue

• Enzymatic debridement ointments were previously FDA approved: Santyl, Panafil, and Accuzyme.


Debridement

Autolytic debridement

• In vivo enzymes self-digest devitalized tissue

• Contraindicated for infected wounds

• Synthetic dressing applied to cover wound

• Mildly draining wounds: Hydrogel

Dressing, Hydrocolloid Dressing

• Moderately to strongly draining

wounds: Alginate Dressing

http://www.fpnotebook.com/Surgery/Pharm/HydrglDrsng.htm



http://www.fpnotebook.com/Surgery/Pharm/HydrcldDrsng.htm

http://www.fpnotebook.com/Surgery/Pharm/AlgntDrsng.htm


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WOUNDS - ptrp2014.weebly.com · Rapid Trauma Assessment If no life-threatening injuries are present, perform a complete head-to-toe rapid trauma assessment Focus on DCAP-BTLS Deformities

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