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127 Cards in this Set

  • Front
  • Back
What are the five main functions of the skin?
1) Protection

2) Water balance

3) Temperature regulation

4) Excretion

5) Impact absorption
Define "epidermis"
The outer layer of the skin
Define "dermis"
The inner (second) layer of the sin found beneath the epidermis. Rich in blood vessels and nerves.
Define "subcutaneous layers"
The layers of fat and soft tissues found below the dermis.
Define "closed wound"
An internal injury with no open pathway from the outside
What's a crush injury?
An injury caused when force is transmitted from the body's exterior to its internal structures. Bones, muscles, nerves, tissues, and organs can all be damaged, causing internal bleeding.
What are the "rule of 9's" percentage numbers for a child?
Head: 18%

One side of each arm: 4.5%

One side of each leg: 7%

Front torso: 18%

Back torso: 18%

Genitals 1%
Why are children more endangered by burns?
Body surface area differences

Higher risk of shock

Higher risk of airway problems

Higher risk of hypothermia
What must you always consider when responding to a call with burns on a child?
Child abuse
Why are geriatric patients more endangered by burns?
Ability to heal is lessened

Time to heal is increased

Other illnesses and injuries may complicate things
How do you treat thermal burns?
Apply dry sterile dressings

Contact medical direction
Define "closed wound."
An internal injury with no open pathway from the outside. Usually due to blunt object impact.
What are the three types of closed wounds?
Contusions
Hematomas
Crush injuries
Define "contusion."
A bruise
Define "hematoma."
A swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel
What is the most common type of closed wound?
Contusions.
Define "dressing."
Material applied to a wound in an effort to control bleeding and prevent further contamination
Define "occlusive dressing."
A dressing used to form an airtight seal on open wounds.
Define "pressure dressing."
Self-adherent roller bandage wrapped tightly over a dressing
Define "bandage"
Material used to hold a dressing in place.
What steps are taken to dress an open wound?
Expose the wound

Cover the entire wound

Control bleeding

DO NOT REMOVE DRESSINGS
What five guidelines should you always follow when dressing an open wound?
Do not bandage too tightly or loosely -- check capillary refill

Do not leave loose ends

Do not cover tips of fingers and toes

Cover all edges of dressing

Always use sterile or very clean materials
What steps do you take to treat a patient with closed wounds?
1) Manage airway, breathing, circulation -- apply oxygen

2) Assume internal bleeding and treat for shock if you believe there is ANY possibility of internal injuries

3) Splint extremities that are painful, swollen, or deformed

4) Stay alert for the patient to vomit

5) Monitor patient for shock and transport ASAP
Define "open wound"
an injury in which the skin is interrupted, exposing the tissue beneath
Define "abrasion"
a scratch or scrape
Define "laceration"
A cut
Define "puncture wound."
An open wound that tears through the skin and destroys underlying tissues. A penetrating puncture wound can be shallow or deep. A perforating puncture wound has both an entrance wound and an exit wound.
What's the difference between a perforating puncture wound and a penetrating puncture wound?
A perforating puncture wound has both an entrance and an exit wound.
What kind of bleeding results from abrasions?
Capillary bleeding
Define "avulsion"
The tearing away or tearing off of a piece or flap of the skin or other soft tissue. This term may also be used for an eye pulled from its socket or a tooth dislodged from its socket.
What kind of wound is an eyeball torn from its socket --- an avulsion, a perforating puncture wound, or a laceration?
Avulsion
What kind of wound is the tip of the nose being torn off?
Avulsion
Define "amputation"
The surgical removal or traumatic severing of a body part, usually an extremity.
Is blood loss from an amputation generally severe?
It can be -- however, often the blood vessels at the site of amputation collapse or constrict, limiting bleeding
Is a crush injury an open injury or a closed injury?
trick question -- it can be either, depending on whether or not underlying tissue is exposed.
Why must you take special care in treating puncture wounds?
Because the extent of damage can't be effectively determined at a glance. A puncture wound can cause severe internal injury.
What steps do you take to care for the patient with a moderate or serious puncture wound?
1) Reassure the patient -- these wounds can be scary

2) Search for an exit wound.

3) Control bleeding on both entrance and exit wounds

4) Immobilize the spine if head, neck, or torso is involved

5) Transport
What do you do if you respond to a call and the patient is the victim of an impaling wound that makes transport impossible?
Contact medical direction immediately.
What is the cardinal rule when dealing with impaled objects?
Don't remove the object!
What steps do you take to care for the patient impaled by an object?
1) Expose the wound area, taking great care not to disturb it. Stabilize object if necessary.

2) Control profuse bleeding

3) Have another rescuer place several layers of bulky dressing around the injury site, surrounding the object on all sides. MAINTAIN MANUAL STABILIZATION UNTIL OBJECT IS SUFFICIENTLY STABILIZED. Secure dressings in place.

4) Care for shock

5) Keep patient at rest

6) Transport. If this is impossible, contact medical direction

7) Reassure the patient
How do you treat an object impaled in the cheek?
1) Examine wound site inside and out

2) Remove the object IF you find perforation AND you can see both ends of the object. If not easily done, leave it in place.

3) If the object is impaled AND lodged into a deeper structure like the palate, leave it in place!

4) Position the patient -- stabilize if necessary, and put in recovery position due to need for drainage and possible vomiting

5) Monitor airway, and suction as necessary

6) Dress the outside of the wound using a pressure dressing, and if patient is alert, put gauze inside the cheek and apply pressure

7) Provide oxygen and care for shock
How do you care for an object impaled in the eye?
1) Stabilize the object

2) Apply rigid protection

3) Have another rescuer stabilize the dressings while you secure them with bandage

4) Dress and bandage the other eye (actually, follow local protocol on this step)

5) Provide oxygen and care for shock

6) Reassure the patient
How do you treat avulsions?
1) Clean the wound surface

2) Fold the skin back to its normal position as gently as possible

3) Control bleeding and dress the wound using bulky pressure dressings

4) Find and take any avulsed parts! Transport them with the patient. Keep it cool, and LABEL IT.

5) Observe local protocol -- contact medical direction if necessary
How do you treat an amputation?
1) Apply pressure dressing over stump

2) Use pressure points

3) Care for the amputated part
How do you care for an amputated body part?
Wrap in sterile dressing and secure it with self-adhesive gauze bandage. Wrap or bag the part in a plastic bag and place the bag in a pan with water kept cool by cold packs.
Define "air embolus."
A bubble of air in the bloodstream.
How do you care for an open neck wound?
1) Ensure an open airway

2) Place gloved hand over wound and apply pressure

3) Apply an occlusive dressing to the wound. Must extend 2" past the wound and be thick enough that it doesn't get sucked in

4) Place dressing over occlusive dressing

5) Apply pressure as needed to stop the bleeding

6) Once bleeding has stopped, bandage the dressing in place

7) Immobilize spine
What are the three general ways a chest injury can occur?
1) Blunt trauma

2) Penetrating objects

3) Compression
Define "flail chest"
Fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment
Define "paradoxical motion"
Movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity
Is flail chest an early or late sign of a severe chest injury?
It's a late sign. Early on, the chest muscles will naturally splint the segment. As fatigue sets in, the section will move more freely.
How do you treat flail chest?
1) Administer oxygen

2) Use a bulky dressing to stabilize the segment. Tape the dressing into place. The tape or bandage used should not encircle the chest or interfere with chest expansion

3) Monitor patient carefully
Define "open chest wound."
A chest wound in which the chest wall is penetrated.
You must consider all open wounds to the chest to be ___ ______
Life threatening
Define "sucking chest wound"
An open chest wound in which air is sucked into the chest cavity
What are signs of an open, or "sucking" chest wound?
1) There's a visible chest wound

2) There may or may not be a sucking sound

3) The patient may be gasping for air
How do you care for a patient with an open chest wound?
1) Maintain airway

2) Seal the chest wound ASAP with gloved hand, and have somebody get an occlusive dressing -- secure the dressing at least 2" away and all around the wound. Leave one corner unsealed so that air can escape.

3) Administer oxygen, care for shock, transport
Define "pneumothorax"
Air in the chest cavity
Define "tension pneumothorax"
A type of pneumothorax in which air that enters the chest cavity is prevented from escaping
What's a flutter-valve dressing?
An occlusive dressing applied to an open chest wound with one side or corner open to allow for air to escape
What do you do if you find that blood or tissue has accumulated under a flutter-valve dressing and is interfering with airflow?
Remove the dressing, wipe away accumulation, and reseal on three sides.
When transporting a patient with a sucking chest wound, what must you keep an eye out for?
Always make sure that the flutter valve is working
How much blood can the chest cavity hold?
3 liters
How does a pneumothorax occur?
Either a punctured lung, an open chest wound, or both allow air into the chest.
What is a tension pneumothorax?
A pneumothorax in which air cannot escape the chest cavity and exerts pressure on the lungs.
What are some signs of a pneumothorax?
Diminished or absent lung sounds

Shock

Late sign -- trachea shifts to one side
What is hemothorax?
A condition in which the chest cavity begins to fill with blood.
What's a hemopneumothorax?
A condition in which the chest cavity fills with both blood and air
What causes a hemothorax?
When lacerations within the chest cavity are produced by penetrating objects or fractured ribs
What are the most significant effects of pneumothorax and hemothorax?
1) Collapsed lung

2) In the case of hemothorax, shock.
Define "traumatic asphyxia"
Caused by sudden compression of the chest, traumatic asphyxia results when blood is forced backward out of the right atrium and into the jugular veins. Causes swelling and bruising in neck and head. Face will be darker in color.
What is a "cardiac tamponade?"
When an injury to the heart causes blood flow into the pericardial sac. Pressure exerted on the heart causes insufficient blood flow and blood backing up into the body.
What are signs of a cardiac tamponade?
Distended neck veins

Shock

Narrowed pulse pressure
Define "aortic dissection."
A condition in which degeneration of the aorta causes the aorta to begin to tear. An aneurysm is produced, and it may rupture and probably kill the patient.
What are signs of an aortic injury?
Pain in chest, abdomen, or back

Signs of shock

Differences in pulse or BP between right and left arms or legs

A pulsating mass palpating in the abdomen
What are the main signs of a pneumothorax or tension pneumothorax?
Increasing respiratory difficulty

Indications of developing shock

Distended neck veins

Tracheal deviation to the uninjured side (late sign)

uneven chest wall movement

Reduction of breath sounds in affected side.
What are signs of a hemothorax or hemopneumothorax?
Coughing up frothy red blood, as well as signs of a pneumothorax, including:

Increasing respiratory difficulty

Indications of shock

Distended neck veins

Tracheal deviation to uninjured side (late sign)

Uneven chest wall movement

Reduction of breath sounds
What are the signs of traumatic asphyxia?
Distended neck veins

Head, neck, and shoulders are dark blue or purple

Eyes may be bloodshot and bulging

Tongue and lips may appear swollen and blue

Chest deformity may be present
What are the signs of a cardiac tamponade?
Distended neck veins

Weak pulse

Low BP

Steadily decreasing pulse pressure
Define "evisceration."
An intestine or other internal organ protruding through a wound in the abdomen.
What are signs and symptoms of abdominal injury?
Increasing pain

Cramps

Nausea

Weakness

Thirst

Lacerations or puncture wounds to the abdomen

Indications of blunt trauma

Signs of shock

Vomiting blood, including partially digested blood that resembles coffee grounds

Rigid or tender abdomen

Abdomen guarding

Distended abdomen

Patient lying still in fetal position
How do you care for a closed abdominal injury?
1) Monitor for vomiting and keep airway open

2) Position patient on back, legs flexed at knees (or in recovery position)

3) Administer oxygen

4) Care for shock

5) Apply antishock garments if local protocols recommend

6) Give patient nothing by mouth

7) Transport
How do you care for an open abdominal injury?
1) Monitor for vomiting and keep airway open

2) Position patient on back, legs flexed at knees (or in recovery position)

3) Administer oxygen

4) Care for shock

5) Apply antishock garments if local protocols recommend

6) Give patient nothing by mouth

7) Transport

8) Control bleeding and dress all wounds

9) Do not touch or try to replace eviscerated organs. Apply saline-moistened dressing and then apply an occlusive dressing, then place layers of bulky dressing over the occlusive dressing

10) Don't remove impaled objects
Should you ever use foil as an occlusive dressing when eviscerated organs are present?
NO! It may lacerate the organs.
What three ways must you classify a burn?
1) By agent and source

2) By depth

3) By severity
Define "superficial burn"
A burn that involves only the epidermis, the outer layer of the skin. Characterized by reddening of the skin and perhaps swelling. Sunburn is an example.

Also called "first degree"
What are the three depth classifications of a burn?
Superficial

Partial thickness

Full thickness
Define "partial thickness burn"
A burn in which the epidermis is burned through and the dermis is damaged. Reddening, blistering, and a mottled appearance result. "second degree."
Define "full thickness burn"
A burn in which all the layers of the skin are damaged. Usually some areas are charred black or dry and white. Also called "third-degree."
What factors must you keep in mind in order to determine the severity of a burn?
Agent or source

Body regions burned

Depth of burn

Extent of burn

Age of patient

Other illnesses and/or injuries
Define the "rule of nines" in an adult
Each of these regions make up 9 percent of body surface:

Head and neck
Each upper extremity
Chest
Abdomen
Upper back
Lower back
Buttocks
Front of each leg
Back of each leg

Genitals make up one percent of body surface
Define "rule of palm"
A method for estimating the extent of a burn. The palm of a patient's hand equals about 1 percent of body surface area
How does the rule of nines differ in a child
head is 18 percent

each lower extremity is 14 percent
What age groups are particularly endangered by burns?
under 5, over 55
Patient fell asleep by the pool and is sunburned on back of both legs, back, and back of both arms. What percentage of body is burned, and to what degree?
45%

First-degree/superficial
Patient had hot grease splashed on her, covering anterior portion of left forearm and entire right hand. Skin is red and blistered. What percentage of body is burned, and to what degree?
About 3.25%

Second-degree/partial thickness
Patient fell asleep while smoking. Has burns all around both legs and entire right arm. Legs are red and blistered, and right arm is charred and peeling. What percentage of body is burned, and to what degree?
Legs = 36% partial thickness/second-degree

Arm= 9% full thickness/third-degree
When burns are accompanied by other injuries or medical problems, treat the burns as if they are ___ _____.
More serious
Burns considered moderate in teenage to middle-aged adults are considered ______ in adults over 55 years of age.
Critical
Why do burns pose a greater threat to children?
1) High body surface area

2) Higher risk of shock

3) Higher risk of hypothermia

4) Higher risk of airway problems
When a child has been burned, consider the possibility of ___ ____.
Child abuse
Define minor, moderate, and critical burns in terms of body surface area, thickness, and complicating factors.
1) MINOR:
a) Full-thickness burns 2 percent or less (excluding genitals, face, hands, feet, or respiratory tract)
b) Partial-thickness burns of less than 15 percent
c) Superficial burns of 50 percent or less

2) MODERATE:
a) Full thickness burns of 2-10 percent (excluding face, etc.)
b) Partial thickness burns of 15-30 percent
c) Superficial burns involving 50 percent or more

3) CRITICAL
a) All burns involving respiratory tract, other soft-tissue injuries, and injuries of bones
b) Partial or full-thickness burns of face, hands, feet, genitals, or respiratory tract
c) Full thickness burns 10 percent or more
d) Partial thickness burns 30 percent or more
e) Burns complicated by musculoskeletal injuries
f) Circumferential burns
Define minor, moderate, and critical burns when dealing with children 5 yrs or younger
Minor: partial thickness burns 10 percent or less

Moderate: Partial thickness burns of 10-20 percent

Critical: Full thickness to any extent, or partial thickness of 20 percent or more
What are the steps in caring for thermal burns?
1) Stop the burning process w/ water

2) Ensure open airway and assess breathing

3) Look for signs of airway injury

4) Complete the initial assessment

5) Treat for shock

6) Treat serious injuries

7) Evaluate burn by depth, extent, and severity

8) Do not clear debris, but remove clothes and jewelry

9) Wrap with sterile dressing

10) Observe local protocol
How do you care for chemical burns?
1) Wash or brush away the burning agent, and flush with water for 20 minutes -- continue process en route to hospital

2) Apply sterile dressing or burn sheet

3) Treat for shock

4) Transport
How do you care for a burn to the eye?
Continuously flush from nasal side of eye -- flush on the scene, and flush en route to hospital, for 20 minutes
How do you care for carbolic acid burns?
Clean with alcohol before flushing with water
What are signs of electrical injuries?
Burns where energy enters and exits body

Disrupted nerve pathways and paralysis

Muscle tenderness or twitching

Respiratory or cardiac distress or arrest

Irregular heartbeat

Elevated BP or low BP with signs of shock

Restlessness

Unconsciousness

Visual difficulties

Fractured bones and dislocations from severe muscle contractions or falling

Seizures
What additional steps must you take in order to care for electrical injuries?
1) Care for spine injuries, neck fractures, etc. Always assume spinal injury.

2) Make sure everybody's safe!

3) Cool the burn areas
Define "dressing"
Any material used to cover a wound to help control bleeding and contamination
Define "bandage"
A material used to hold dressing in place.
How do you dress forehead and ear injuries with no skull injury?
Place dressing and secure with self-adherent roller bandage around teh head
How do you dress elbow or knee injuries?
Place dressing and secure with cravat or roller bandage. Apply roller in figure-eight pattern
How do you dress a forearm or leg injury?
Apply dressing and secure with roller bandage, distal to proximal. Better protection is offered if palm or sole is wrapped.
How do you dress a hand injury?
Place dressing, wrap with roller bandages, and secure at wrist.
How do you dress a shoulder?
Place dressing and secure with figure-eight of cravat or roller dressing.
How do you dress a hip?
Place bandage and large dressing to cover hip. Secure with first cravat around waist and second cravat around thigh on injured side.
Define "universal dressing"
A bulky dressing
Define "pressure dressing"
A dressing applied tightly to control bleeding
Define "occlusive dressing"
A dressing that serves as an air tight seal
Should elastic bandages used to care for sprains be used as a bandage to hold dressings in place?
No! They will form a constricting band.
When should you remove dressings?
ONLY when a bulky dressing has become blood soaked beyond effectiveness.

Prevent this mishap by applying several gauze pads before applying bulky dressings.
What guidelines must you follow when bandaging wounds?
1) Do not bandage too tightly

2) Do not bandage too loosely

3) Do not leave loose ends.

4) Don't cover tips of fingers or toes --- you have to be able to continue to assess distal circulation

5) Cover all edges of dressing
Is cartilage considered "soft tissue?"
No
Why are circumferential burns so serious?
Because they cause the skin to constrict, hampering circulation to distal extremities.
What is the least important problem in the case of an electrical injury?
The burn
Can you be burned by infrared light?
No. Unless you are shot by the MIRACL laser developed by the US Navy. That is an extremely unlikely circumstance. And it would blow you up.