Professional Documents
Culture Documents
L. ARIES FAHROZI
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Closed Wounds
More Common Contusions, Sprains, Strains
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Dermis
Upper Layer (Papillary Layer)
Loose connective tissue, capillaries and nerves
Subcutaneous
Adipose tissue Heat retention Free Powerpoint Templates
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Skin Layers
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Skin Injuries
Tension Lines
Natural patterns in the surface of the skin revealing tension within
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Inflammation
Local biochemical process that attracts WBCs
Epithelialization
Migration of epithelial cells over wound surface
(continued)
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Collagen Synthesis
Fibroblasts: Cells that form collagen Collagen: Tough, strong protein that comprises connective tissue
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Infection Management
Antibiotics & keep wound clean Gangrene
Deep space infection of anerobic bacteria Bacterial Gas and Odor
Tetanus
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Lockjaw
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Re-Bleeding Delayed Healing Compartment Syndrome Abnormal Scar Formation Pressure Injuries
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Open Wounds
Abrasions Lacerations Incisions Punctures Avulsions Amputations
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Closed Injuries/wound
In which soft tissue damage occurs beneath the skin, but the surface remains intact.
Typically caused by blunt trauma or crushing injury Examples: contusion (bruise), hematoma
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Closed Wounds
If small blood vessels are damaged, ecchymosis will cover the area. If large blood vessels are torn, a hematoma will appear.
Courtesy of Rhonda Beck
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Open Injuries
There is a break in the surface of the skin exposing deeper tissue to contamination 4 Types: -Abrasions -Lacerations -Avulsions -Punctures/ Penetrations
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Abrasions
Wound of the superficial layer of the skin caused by friction across a hard surface blood and plasma may ooze from surface capillaries Ex: Road rash, rug burn
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Lacerations
Smooth or jagged cut caused by a sharp object or a blunt force that tears the tissue Depth can vary, may sever arteries or veins
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Avulsions
An injury that separates layers of soft tissue so that they are either completely unattached or hanging by a flap
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Amputations
An avulsion involving the complete loss of a body part
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Amputations
Assessment and management
Be aware of sharp bone protrusions. The body part may be completely detached or soft tissues may remain attached. Degloving injury: unraveling of skin from the hand
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Amputations
Assessment and management (contd)
If a body part is completed amputated, try to preserve it in optimal condition.
Rinse off any debris. Wrap it loosely in saline-moistened sterile gauze. Seal it in a plastic bag; place it in a cool container. Never warm it or place it in water. Never place it directly on ice or use dry ice.
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Amputations
Assessment and management (contd)
Transport as soon as possible. If the amputated part is a limb or part of one, notify ED staff of:
Type of amputation Estimated arrival time
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Bite Wounds
Animals bites can be serious.
Cat and dog mouths are contaminated with virulent bacteria.
Courtesy of Moose Jaw Police Service Chuck Stewart, MD
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Bite Wounds
Assessment and management
Place a sterile dressing and transport promptly. Splint an arm or leg if it is injured. Determine and document:
When the bite occurred Type of animal What led to the biting incident
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Bite Wounds
Assessment and management (contd)
Rabies is a major concern with dog bites.
Once signs appear, it is almost always fatal. Spread by bites or licking an open wound Can be prevented by a series of vaccine injections
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Bite Wounds
Human bites usually occur on the hand.
Human mouths contain a wide variety of virulent pathogens.
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Bite Wounds
Assessment and management (contd)
Emergency treatment for human bites includes:
Control all bleeding and apply a sterile dressing. Immobilize the area with splint or bandage. Provide transport.
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Associated Injury
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Crush Injuries
An injury to the underlying soft tissues and bones Caused by a body part being crushed between two solid objects
Mark C. Ide
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Crush Injuries
May lead to compartment syndrome May lead to rupture of internal organs External appearance may not represent level of internal damage.
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Crush Injuries
Bodys first responses to vessel injury is localized vasoconstriction.
If vessels are damaged, they may not be able to constrict.
Crush injuries often result in difficult-tocontrol hemorrhage.
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Crush Injury
Crush Syndrome
Body is entrapped for >4 hours Crushed muscle tissue becomes necrotic
Traumatic Rhabdomyolysis Skeletal Muscle Degradation Release of toxins
Myoglobin Phosphate Potassium Lactic Acid Uric Acid
When tissue is released, toxins move RAPIDLY into systemic circulation Impacts Cardiac Function Impacts Kidney Function Free Powerpoint Templates Page 41
Blast Injury
Explosions can result in:
Soft-tissue trauma Abdominal trauma Skeletal trauma Blast lung
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Compartment Syndrome
Develops when edema and swelling cause increased pressure within a closed soft-tissue compartment
Leads to compromised circulation Commonly develops in extremities Can cause tissue necrosis
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Compartment Syndrome
Assessment and management
Presents with six Ps:
Pain Paresthesia Paresis Pressure Passive stretch pain Pulselessness
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Compartment Syndrome
Assessment and management (contd)
Many signs may be delayed or nonspecific. Can cause death of local tissues Risk of sepsis In-hospital intervention includes fasciotomy.
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Absorbent/Non-absorbent
Absorbent: soak up blood or fluids
Wet/Dry Dressings
Wet: Burns, postoperative wounds (Sterile NS) Dry: Most common Free Powerpoint Templates Page 48
Gauze bandage
Single ply, non-stretch: 1-3
Donts
Use unless you can not control the bleeding via other means Use rope or wire. Release it once applied.
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Immobilization
Prevents movement and aggravation of wound ( Do not use an elastic bandage: TQ effect Free Powerpoint Templates Page 52 Monitor distal pulse, motor, and
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Sprain / Strain
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SPRAIN
stretch and/or tear of a ligament caused by a sudden pull one or more ligaments can be injured at the same time severity of injury extent of injury and number of ligaments involved
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STRAIN
injury to either a muscle or a tendon as a result of suddenlly pulling them too far simple overstretch of muscle or tendon, or result of a partial or complete tear
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frequently occur at the wrist sprain to the thumb common in skiing and other sports
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Rest Ice
Compression Elevation
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Do stretching exercises daily. Be in proper physical condition to play a sport. Warm up and stretch before participating in any sports or exercise. Wear protective equipment when playing. Run on even surfaces.
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Splints
Splints Devices that can be used to immobilize injured parts when fractures, dislocations and other similar injuries are present or suspected Many commercial splints are available
Inflatable or air splints Padded boards Traction splints (used for fractured femur)
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