Trauma - Soft Tissue Injuries

Front 1

What is death from soft tissue injury related to?

Back 1

Uncontrolled hemorrhage and infection.

Front 2

What are the five stages of wound healing?

Back 2

Hemostasis - clotting and the cessation of bleeding

Inflammation - Cells move to the injured area to help with healing, combat pathogens etc. Histamines cause vasodilation

Epithelialization - New epithelial cells move into position

Neovascularization - New capillaries form budding from intact capillaries.

Collagen synthesis - helps to bind the edges of wounds together. This will not be as strong as the original tissue

Front 3

How can anatomical factors delay healing?

Back 3

Areas of the body subject to motion heal more slowly, may need to be splinted.

Some medications can delay healing.

Front 4

What medical conditions can interfere with healing?

Back 4

Advanced age, severe alcoholism, acute uremia, diabetes, hypoxia, severe anemia, peripheral vascular disease, malnutrition, advanced cancer, hepatic failure and cardiovascular disease.

Front 5

What are high risk wounds?

Back 5

Human and animal bites contain a high risk of infection.

Foreign bodies or or organic matter becoming embedded in a wound.

Injection wounds, crush wounds, wounds in immunocompromised patients and injuries to patients with poor peripheral circulation.

Front 6

What is abnormal scar formation?

Back 6

Excessive collagen formation can occur if the healing is not balanced between building up and breaking down.

Hypertrophic scars form in areas subject to high stress such as the elbow or knee

Keloid scars grow over the wound edges and typically develop in those with dark skin

Front 7

What are pressure injuries?

Back 7

Typically form when a patient is bedridden for a long time or immobilized on a back board.

Tissues are deprived of oxygen which leads to local hypoxia and cell deterioration.

Front 8

What are some points to note about infection?

Back 8

The skin serves as the initial barrier against infection therefore any break can lead to infection.

Infection can cause a delay in healing and lead to systemic infection.

Front 9

What are visible clues of an infection?

Back 9

Erythema, pus, warmth, edema and local discomfort.

Front 10

What are clues to a systemic infection?

Back 10

Red streaks indicate lymphangitis, an inflammation of the lymph channels

Systemic = fever, shaking, chills, joint pain and hypotension

Front 11

What is gangrene?

Back 11

Caused by the anaerobic, toxin producing bacterium clostridium perfringens.

25% mortality rate, untreated the skin will become necrotic and infection can lead to sepsis.

Front 12

What is tetanus?

Back 12

Caused by infection with an anaerobic bacterium Clostridium tetani. The body produces a toxin which causes painful muscle contraction that can fracture bones.

Stiffness can be first noted in the jaw.

Front 13

What is an abrasion?

Back 13

A superficial wound that is caused when the skin is rubbed or scrapped over a rough surface causing the loss of part of the epidermis.

There can be contamination and debris and can ooze small amounts of blood.

Cover with a clean sterile dressing.

Front 14

What is a laceration?

Back 14

A cut inflicted by a sharp object or knife producing a clean or jagged incision through the skin and underlying structures.

Front 15

What determines the seriousness of a laceration?

Back 15

The depth and the structures that are involved.

Front 16

What are the first priorities in treating a laceration?

Back 16

Control bleeding by applying direct manual pressure. A laceration involving a major artery can be fatal due to the bleeding involved.

Front 17

What is a puncture wound?

Back 17

A stab from a pointed object. Most often they do not cause much external bleeding but can produce extensive or even fatal internal bleeding.

If the object remains embedded it should be stabilized in place and transported with the patient.

Front 18

What is an avulsion?

Back 18

Occurs when a flap of skin is torn loose either partially or completely. This can be accompanied with profuse bleeding.

The principle danger is the blood supply to the avulsed part being lost by a kinked or folded back section.

Front 19

What is amputation?

Back 19

An avulsion involving the complete loss of a body part. Blood loss is often relative to how clean the amputation was.

Front 20

What is a crush injury?

Back 20

Occurs when a body part is crushed between two solid objects.

Front 21

What problems do crush injuries cause with regards to hemorrhage?

Back 21

They can lead to hemorrhage that cannot be easily controlled. The vessels involved often loose their ability to constrict resulting in a free flow of blood from any unnatural opening.

Front 22

When does crush syndrome occur?

Back 22

Occurs when an area of the body is trapped for longer than four hours and arterial blood flow is compromised.

Front 23

What happens?

Back 23

Tissue necrosis develops leading to the release of harmful producs a process called rhabdomyolysis.

Front 24

What happens when the body part is freed?

Back 24

The products are released into general circulation this can lead to life threatening arrhythmias and renal failure.

The kidneys can be damaged by acids and free radicals can damage cells.

Front 25

What is compartment syndrome?

Back 25

Edema and swelling results in increased pressure within soft tissues.

The pressure is contained within an enclosed space in a muscle leading to compromised circulation and damage to nerves.

The longer this goes on the greater the chance of necrosis

Front 26

What happens in the primary phase of a blast injury?

Back 26

The pressure wave - Can damage air filled cavities such as the ears and lungs, burns may occur.

Front 27

What happens in the secondary phase?

Back 27

The blast wind - projectiles and debris can cause a range or blunt and penetrating injures.

Front 28

What happens in the tertiary phase?

Back 28

Victims may be thrown by the blast or injured by collapsing structures. There is a risk of long term entrapment.

Front 29

What happens in the quaternary phase?

Back 29

Injuries can come from the heat generated, may cause burns ranging from superficial to full thickness.

Front 30

What is general treatment of closed wounds?

Back 30

I - Apply ice or cold packs to the affected area (not directly on the skin)
C - Apply firm compression over the injured area to decrease bleeding
E - Elevate the injured part to a level above the heart
S - Apply a splint to decrease movement. An air splint gives both compression and decreases bleeding

Front 31

What is general treatment of open wounds?

Back 31

Control bleeding by the most effective method

Keep the wound as clean as possible wash away loose dirt or debris

For healing wounds look for signs of infection!

Front 32

What are complications of improperly applied dressings?

Back 32

Wound contamination leading to infection

Do not remove a dressing once applied as it can disrupt clot formation

Blood vessels, nerves, tendons, muscles, skin and internal organs can be damaged if dressings are excessively tight

Front 33

What should always be checked with extremity wounds and dressings?

Back 33

Distal pulses before and after the application of a dressing

Front 34

How should direct pressure be applied to a wound?

Back 34

Apply a dry sterile dressing over the entire wound and apply pressure with a gloved hand.

Maintain the pressure and secure the dressing with a roller bandage.

If bleeding continues leave the original dressing and applu a second one and secure with another roller bandage.

Splint the extremity to stabilize the injury and further control the bleeding

Front 35

What can help with pain control?

Back 35

A cold compress will help reduce the pain and diminish blood flow to an open wound.

Front 36

How is preservation of amputated parts best performed?

Back 36

Rinse the amputated part free of debris with cool sterile saline

Wrap the part loosely in saline moistened sterile gauze

Seal inside a plastic bag and place inside a cool container, keep cold but do not allow to freeze

Front 37

How should impaled objects be managed?

Back 37

Do not try to remove

Control hemorrhage by direct compression

Do not try to shorten unless it is extremely cumbersome

Stabilize the object with a bulky dressing

Front 38

How are scalp wounds dressed?

Back 38

Application of direct pressure is often effective due to the scalp lying over the hard skull.

Take care as there may be skull damage. In this case apply pressure around the edges and use a bulky dressing if bleeding must be controlled.

Front 39

What are some considerations for facial dressings?

Back 39

Assess for airway compromise and position and use suctioning where needed

Application of direct pressure is an effective means to control bleeding

If an avulsed piece of tissue is present attempt to replace to its normal anatomical position

Front 40

What are some considerations for ear or mastoid dressings?

Back 40

Never put dressing in the ear canal but place loosely along the length of the external ear.

Gauze sponges work well to stop blood loss but do not attempt to control it directly due to risk of CSF and IICP

Front 41

What are some considerations for neck dressings?

Back 41

There are large vessels, the spine and the airway present and little room for error

A minor neck laceration can lead to an air embolism

Open injuries to the neck require the use of an occlusive dressing.

Ensure dressings do not occlude blood flow or movement or air through the trachea

Front 42

What are some considerations for shoulder dressings?

Back 42

Apply direct pressure and if immobilization is indicated a sling and swathe will prevent motion of the shoulder girdle.

Front 43

What are some considerations for truncal dressings?

Back 43

Cover open wounds with an occlusive dressing that is taped on three sides

Assessment of breath sounds becomes a high priority

The best choice for securing a truncal dressing is medical tape.

Front 44

What are some considerations for groin and hip dressings?

Back 44

Dressing and bandage in combination with direct pressure work well to control blood loss in this region

Work with the patient to preserve modesty.

Front 45

What are some considerations for hand, wrist and finger dressings?

Back 45

Dressing applied over any open wound and bandage wrapped completely around the affected area.

When possible the hand should be placed in the position of function

The hand and wrist can be splinted to limit motion

Front 46

What are some considerations for elbow and knee dressings?

Back 46

Good practice to provide immobilization of the elbow or knee when a larger wound is present.

Very important to assess distal neurovascular status.

Front 47

What are some considerations for ankle and foot dressings?

Back 47

Control of bleeding by direct pressure augmented by elevation and pressure points in cases involving significant bleeding.

Ensure bandage not so tight as to interfere with circulation or sensation

Alway assess distal neurovascular function before and after caring for the wound