Traumatic Injuries

1. Traumatic Injuries May 2013 EMD CE Silver Cross EMSS

2. Our last CE covered bleeding and shock. This month’s will continue the trauma theme and focus on injuries to soft tissue, muscles and bones.

3. Wounds A wound is an injury caused by any physical means that leads to damage of a body part. Wounds are classified as open or closed. WARNING! THIS POWERPOINT CONTAINS GRAPHIC PICTURES OF TRAUMATIC INJURIES AND OPEN WOUNDS.

4. Closed Wounds The skin remains intact. The only closed wound is the bruise. Injury of the softtissue beneath the skin Small blood vessels are broken. The area becomes discolored and swells. A simple bruise heals quickly. Bruising and swelling may be a sign of an underlying fracture.

5. SKIN The skin serves as a protective barrier that prevents foreign substances from entering the body. It is a sense organ and sends messages to the brain. It helps to regulate body temperature. It also prevents loss of body fluids. When the skin is damaged, it can no longer perform these essential functions.

6. SKIN

7. Open Wounds An open wound results in a break in the skin. Bleeding and infection are concerns with: Abrasions Penetrating Wounds Lacerations Avulsions Amputations

8. Open Wounds Abrasion Also called a scrape, road rash, or rug burn Occurs when the skin is rubbed across a rough surface Affects the epidermis or outermost layer of skin.

9. Open Wounds Puncture or penetrating wound Occurs when a sharp object penetrates the skin May cause deep injury that is not immediately recognized Puncture wounds do not always bleed freely An impaled object may stick out of the skin A gunshot wound is a special type of puncture wound that may have an entrance and exit wound

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

11. Open Wounds Laceration or Incision Most common type of open wound Commonly called a cut Minor lacerations may require little care Large lacerations can cause extensive bleeding and even be life threatening

12. Open Wounds

13. Open Wounds Avulsions and amputations An avulsion is a tearing away of body tissue. If an entire body part is torn away, the wound is called a traumatic amputation. Amputated parts should be: Located Placed in a clean cloth or plastic bag Kept cool but not put on ice Taken to the hospital for possible reattachment

14. Open Wounds

15. Principles of Wound Treatment Very minor bruises need no treatment. Other closed wounds should be treated by: Applying ice and gentle compression Elevating the injured part if no fracture Splint all major contusions Stop bleeding as quickly as possible using the cleanest dressing available.

16. Dressing and Bandaging Wounds Dressings If bleeding continues after you have applied a dressing, put additional gauze or clean cloth over the original dressing.

17. Dressing and Bandaging Wounds Bandaging A bandage is used to hold the dressing in place. Roller gauze and triangular bandages are commonly used and found in most first aid kits.

18. Burn Depth • Superficial burns (first-degree burns) • Reddened and painful skin • The injury is confined to the outermost layers of the skin. • The patient experiences minor to moderate pain.

19. Burn Depth • Partial-thickness burns (second-degree burns) • Do not damage the deepest layers of the skin • Blistering • Fluid loss and moderate to severe pain • Usually heal within 2 to 3 weeks

20. Burn Depth • Full-thickness burns (third-degree burns) • Damage all layers of the skin • Pain is absent because the nerve endings have been destroyed. • Patients lose large quantities of body fluids and are susceptible to shock and infection.

21. Extent of Burns • Rule of nines • Method for determining what percentage of the body has been burned • In an adult, the head and arms each equal 9% of the total body surface. • The front and back of the trunk and each leg are equal to 18% of the total body surface. • This formulation is slightly modified for children.

22. Extent of Burns

23. Cause or Type of Burns • Thermal burns • Caused by heat • Stop the burning process. • Cover it with a dry, sterile dressing or a burn sheet. • Do not break blisters. • Patients with large burns must be treated for shock and transported to a hospital.

24. Cause or Type of Burns • Chemical burns • The longer the chemical remains in contact with the skin or eyes, the more damage it does. • Initial treatment • Remove as much of the chemical as possible. • Brush away any dry chemical. • Flush with water. • Cover the area with a dry, sterile dressing. • Arrange for prompt transport.

25. Cause or Type of Burns • Electrical burns • Occur when an electrical current enters the body at one point, travels through the body tissues and organs, and exits at the point of ground contact • Electricity causes major internal damage. • Patients may experience irregularities of cardiac rhythm or full cardiac arrest and death.

26. Cause or Type of Burns • Electrical burns • Be certain that a patient is not still in contact with the electrical power source before you touch or treat them. • Call for assistance from the power company or from a qualified rescue squad. • Monitor the ABCs of electrical burn patients and arrange for prompt transport.

27. Injuries to Muscles or Bones • Musculoskeletal injuries: • Fractures • Dislocations • Sprains and strains • Head injuries • Spinal cord injuries • Chest injuries

28. Musculoskeletal System • Functions of the skeletal system: • To support the body • To protect vital structures • To assist in body movement • To manufacture red blood cells • The muscles of the body provide support and movement • Muscles are attached to bones by tendons and cause movement by alternately contacting and relaxing. • Movement occurs at joints, where two bones come together. • The bones are held together by ligaments.

29. Types of Injuries Fractures A fracture is a broken bone. It most often occurs as a result of a significant force. In a closed fracture, the bone is broken but there is no break in the skin. In an open fracture, the bone is broken and the overlying skin is lacerated. Both result in bleeding at the fracture site.

30. Dislocations A dislocation is a disruption that tears the supporting ligaments of the joint. The bone ends separate completely from each other and can lock in one position. Any attempt to move a dislocated joint is very painful. A dislocation can damage nearby nerves and blood vessels. Types of Injuries

31. Types of Injuries • Sprains and strains • A sprain is a joint injury caused by excessive stretching of the supporting ligaments. • A strain is caused by stretching or tearing of a muscle.

32. 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.

33. 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.

34. 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

35. 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.

36. 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.

37. 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.

38. Sources • AAOS Emergency Medical Responder, 5th edition • Google and Bing Images • Will County 9-1-1 EMDPRS