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Class 8 (Skin A&P, Soft Tissue Injuries & Vitals & S.A.M.P.L.E.) Ch 4 (Partial) , Ch24 & Ch 5 PowerPoint PPT Presentation


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Class 8 (Skin A&P, Soft Tissue Injuries & Vitals & S.A.M.P.L.E.) Ch 4 (Partial) , Ch24 & Ch 5. The Skin (1 of 2). The Skin (2 of 2). Protects the body from the environment Regulates body temperature Transmits information from environment to the brain. Functions of Dressing and Bandaging.

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Class 8 (Skin A&P, Soft Tissue Injuries & Vitals & S.A.M.P.L.E.) Ch 4 (Partial) , Ch24 & Ch 5

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Class 8 (Skin A&P, Soft Tissue Injuries & Vitals & S.A.M.P.L.E.)Ch 4 (Partial), Ch24 & Ch 5


The Skin (1 of 2)


The Skin (2 of 2)

  • Protects the body from the environment

  • Regulates body temperature

  • Transmits information from environment to the brain


Functions of Dressingand Bandaging

  • Control bleeding.

  • Protect wound.

  • Prevent contamination.


Dressings and Bandages

  • Sterile dressings

    • Used to cover wounds

  • Bandaging

    • Used to keep dressing in place


Soft-Tissue Injuries

  • Closed injuries

    • Soft-tissue damage beneath the skin

  • Open injuries

    • Break in the surface of the skin

  • Burns

    • Soft tissue receives more energy than it can absorb


Contusion

  • Results from blunt force striking the body


Hematoma

  • Pool of blood that has collected in the body


Crushing Injury

  • Occurs when a great amount of force is applied to the body


Mechanism of Injury

  • Underlying organ damage

  • Hidden injury

  • Shock from internal bleeding


Interventions

  • Provide complete spinal immobilization early if spinal injuries are suspected.

  • Provide high-flow oxygen.

  • Treat aggressively for shock.

  • Request ALS if necessary.

  • Do not delay transport.


RICES

  • Rest—keep patient quiet and comfortable as possible.

  • Ice slows bleeding.

  • Compression over an injury slows bleeding.

  • Elevation above the level of the heart reduces swelling.

  • Splinting decreases bleeding and reduces pain.


Transport Decision

  • If patient has signs of shock or airway or breathing problem, consider quickly transporting or requesting ALS.

  • Do not delay transport of closed-injury patient who may have more serious deeper injury.


Open Soft Tissue Injury

  • Protective skin is damaged and open

  • Contaminated

  • Possible heavy bleeding

  • 4 Types

    • Abrasion

    • Laceration

    • Avulsion

    • Penetrating


Abrasions

  • Caused by friction


Laceration

  • Jagged cut


Avulsion

  • Separation of various layers of the skin


Penetrating Wound

  • Results from a sharp pointed object


Gunshot Wounds

  • Gunshot wounds have unique characteristics


Crushing Open Wound

  • May involve damaged internal organs or broken bones


Interventions

  • Control bleeding.

  • If bleeding is not significant, control later in assessment.

  • Stabilize spine and assist breathing.

  • Splint painful, swollen, deformed extremities.


Emergency Medical Care (1 of 3)

  • Use proper BSI precautions.

  • Administer oxygen if needed.

  • Treatment priority is ABCs—including controlling bleeding.


Emergency Medical Care (2 of 3)

  • Apply dry, sterile dressing over entire wound.

  • Maintain pressure and secure dressing with a roller bandage.


Emergency Medical Care (3 of 3)

  • Leave original dressing in place if bleeding continues.

  • Apply a second dressing on top of first and secure.

  • Splint the extremity.


Abdominal Wounds

  • Open wound in abdomen may expose organs.

  • Organ protruding through abdomen is called an evisceration.


Abdominal Wound Management

  • Do not touch exposed organs.

  • Cover organs with a moist sterile dressing.

  • Transport immediately.


Impaled Objects (1 of 2)

  • Do not attempt to move or remove object.


Impaled Objects (2 of 2)

  • Control bleeding and stabilize object.

  • Tape a rigid item over object to prevent movement.

  • Transport to hospital carefully.


Amputations

  • Immobilize partial amputation with bulky dressings and splint.

  • Wrap complete amputation in dry sterile dressing and place in plastic bag.

  • Put bag in cool container filled with ice. Do not let object freeze!

  • Transport severed part with patient.


Neck Injuries (1 of 2)

  • An open neck injury can be life threatening.

  • Air can get into the veins and cause an air embolism.


Neck Injuries (2 of 2)

  • Cover the wound with an occlusive dressing.

  • Apply manual pressure.

  • Secure a pressure dressing loosely over the neck and firmly through the opposite axilla.


Transport Decision

  • Consider quick transport if patient has airway or breathing problem or significant bleeding.

  • Stay focused on problems at hand.

  • Patients with significant bleeding or internal bleeding may quickly become unstable.

  • Watch for signs of shock.


Burns

  • Burns account for over 10,000 deaths/year.

  • Burns are the most serious and painful injuries.

  • Remember to perform a complete assessment on burn patients for other injuries.


Determining Burn Severity

  • What is the depth of the burn?

  • What is the extent of the burn?

  • Are any critical areas involved?

  • Are there any preexisting medical conditions or other injuries?

  • Is the patient younger than 5 years or older than 55 years of age?


Depth of Burns


Extent of Burns


Critical Burns (1 of 2)

  • Full-thickness burns involving hands, feet, face, upper airway, genitalia, or circumferential burns of other areas

  • Full-thickness burns covering more than 10% of total body surface area

  • Partial-thickness burns covering more than 30% of total body surface area

  • Burns associated with respiratory injury


Critical Burns (2 of 2)

  • Burns complicated by fractures

  • Burns on patients younger than 5 years old or older than 55 years old that would be classified as moderate on young adults


Moderate Burns

  • Full-thickness burns involving 2% to 10% of total body surface area excluding hands, feet, face, upper airway, or genitalia

  • Partial-thickness burns covering 15% to 30% of total body surface area

  • Superficial burns covering more than 50% of total body surface area


Minor Burns

  • Full-thickness burns involving less than 2% of the total body surface area

  • Partial-thickness burns covering less than 15% of the total body surface area

  • Superficial burns covering less than 50% of the total body surface area


Critical Burns in Infantsand Children

  • Full-thickness burns covering more than 20% of total body surface area

  • Burns involving hands, feet, face, upper airway, genitalia


Moderate Burns in Infantsand Children

  • Partial-thickness burns covering 10% to 20% of total body surface area


Minor Burns in Infants and Children

  • Partial-thickness burns covering less than 10% of total body surface area


Pediatric Needs

  • Burns to children are considered more serious than burns to adults.

  • Children have more surface area relative to body mass than adults.

  • Many burns result from abuse.

  • Report all suspect cases of abuse to the authorities.


Emergency Care for Burns (1 of 3)

  • Follow proper BSI precautions.

  • Move patient away from burning area.

  • Immerse affected area in cool sterile water or saline solution to stop burning

  • Cover with dry dressing.


Emergency Care for Burns (2 of 3)

  • Provide high-flow oxygen.

  • Prevent body heat loss.

  • Rapidly estimate the burn’s severity.

  • Check for traumatic injuries.


Emergency Care for Burns (3 of 3)

  • Treat the patient for shock.

  • Provide prompt transport.


Chemical Burns

  • Occur whenever a toxic substance contacts the body

  • Eyes are particularly vulnerable.

  • Fumes can cause burns.

  • To prevent exposure, wear appropriate gloves and eye protection.


Care for Chemical Burns (1 of 2)

  • Remove the chemical from the patient.

  • If it is a powder chemical, brush off first.

  • Remove all contaminated clothing.


Care for Chemical Burns (2 of 2)

  • Flush burned area with large amounts of water for about 15 to 20 minutes.

  • Transport quickly.


Chemical Burn to the Eye

  • Hold open eyelid while flooding eye with a gentle stream of water.

  • Continue flushing en route to hospital.


Electrical Burns

  • Make sure power is off before touching patient.

  • There will be two wounds (an entrance and an exit wound) to bandage.

  • Transport patient and be prepared to administer CPR.


Small Animal Bites

  • All small animal bites should be considered potentially infected.

  • Occasionally bites require surgical repair.

  • Apply a dry, sterile dressing and transport.


Rabies

  • Potentially fatal viral infection

  • May be transmitted through biting or licking an infected wound

  • Some commons carriers are bats, squirrels, skunks, foxes, raccoons, and stray dogs.

  • Refer to local resources for identification and capture.

  • All patients with bites need medical attention.


Human Bites

  • Very serious injury

  • Promptly immobilize with a splint or bandage.

  • Apply a dry, sterile dressing.

  • Provide transport.


5: Baseline Vital Signs and SAMPLE History


Baseline Vital Signs and SAMPLE History

  • Assessment is the most complex skill EMT-Bs learn.

  • During assessment you will:

    • Gather key information.

    • Evaluate the patient.

    • Learn the history.

    • Learn about the patient’s overall health.


Gathering Key Patient Information

  • Obtain the patient’s name.

  • Note the age, gender, and race.

  • Look for identification if the patient is unconscious.


Chief Complaint

  • The major sign and/or symptom reported by the patient

  • Symptoms

    • Problems or feelings a patient reports

  • Signs

    • Conditions that can be seen, heard, felt, smelled, or measured


Obtaining a SAMPLE History (1 of 2)

  • S—Signs and Symptoms

    • What signs and symptoms occurred at onset?

  • A—Allergies

    • Is the patient allergic to medications, foods, or other?

  • M—Medications

    • What medications is the patient taking?


Obtaining a SAMPLE History (2 of 2)

  • P—Pertinent past history

    • Does the patient have any medical history?

  • L—Last oral intake

    • When did the patient last eat or drink?

  • E—Events leading to injury or illness

    • What events led to this incident?


OPQRST (1 of 2)

  • O—Onset

    • When did the problem first start?

  • P—Provoking factors

    • What creates or makes the problem worse?

  • Q—Quality of pain

    • Description of the pain


OPQRST (2 of 2)

  • R—Radiation of pain or discomfort

    • Does the pain radiate anywhere?

  • S—Severity

    • Intensity of pain on 1-to-10 scale

  • T—Time & Treatment

    • How long has the patient had this problem?

    • What has the patient done about it?


Baseline Vital Signs (1 of 3)

  • Key signs used to evaluate a patient’s condition

  • First set is known as baseline vitals.

  • Repeated vital signs compared to the baseline


Baseline Vital Signs (2 of 3)

  • Vital signs always include:

    • Respirations

    • Pulse

    • Blood pressure


Baseline Vital Signs (3 of 3)

  • Other key indicators include:

    • Skin temperature and condition in adults

    • Capillary refill time in children

    • Pupils

    • Level of consciousness


Rate

Number of breaths in 30 seconds ´ 2

Quality

Character of breathing

Rhythm

Regular or irregular

Effort

Normal or labored

Noisy respiration

Normal, stridor, wheezing, snoring, gurgling

Depth

Shallow or deep

Respirations


Adults 12 to 20 breaths/min

Children 15 to 30 breaths/min

Infants25 to 50 breaths/min

Respiratory Rates


Pulse Oximetry

  • Evaluates the effectiveness of oxygenation

  • Probe is placed on finger or earlobe.

  • Pulse oximetry is a tool.

  • Does not replace good patient assessment


Pulse (1 of 3)


Pulse (2 of 3)


Pulse (3 of 3)

  • Rate

    • Number of beats in 30 seconds ´ 2

  • Strength

    • Bounding, strong, or weak (thready)

  • Regularity

    • Regular or irregular


Normal Ranges for Pulse Rate

Adults 60 to 100 beats/min

Children70 to 150 beats/min

Infants 100 to 160 beats/min


Drill Time

  • Break up into groups of two.

  • Take each others respirations and pulse.

  • On person in each group do as many jumping jacks or pushups as you can safety do or do a wind sprint.

  • Other person now takes your pulse and respirations.

  • Switch role and repeat.

  • ONLY DO SO IF SAFE FOR YOU TO DO SO

  • Any one for the stepmill?


The Skin

  • Color

    • Pink, pale, blue, red, or yellow

  • Temperature

    • Warm, hot, or cool

  • Moisture

    • Dry, moist, or wet


Capillary Refill

  • Evaluates the ability of the circulatory system to restore blood to the capillary system (perfusion)

  • Tested by depressing the patient’s fingertip and looking for return of blood


Blood Pressure

  • Blood pressure is a vital sign.

  • A drop in blood pressure may indicate:

    • Loss of blood

    • Loss of vascular tone

    • Cardiac pumping problem

  • Blood pressure should be measured in all patients older than 3 years.


Measuring Blood Pressure

  • Diastolic

    • Pressure during relaxing phase of the heart’s cycle

  • Systolic

    • Pressure during contraction

  • Measured as millimeters of mercury (mm Hg)

  • Recorded as systolic/diastolic


Blood Pressure Equipment


Palpation of Blood Pressure

  • Secure cuff.

  • Locate radial pulse.

  • Inflate to 200 mm Hg.

  • Release air until pulse is felt.

  • Method only obtains systolic pressure.


Auscultation of Blood Pressure (1 of 2)

  • Place cuff on patient’s arm.

  • Palpate brachial artery and place stethoscope.

  • Inflate cuff until you no longer hear pulse sounds.

  • Continue pumping to increase pressure by an additional 20 mm Hg.


Auscultation of Blood Pressure (2 of 2)

  • Note the systolic and diastolic pressures as you let air escape slowly.

  • As soon as pulse sounds stop, open the valve and release the air quickly.


Normal Ranges of Blood Pressure


Level of Consciousness

A – Alert

V – Responsive to Verbal stimulus

P – Responsive to Pain

U – Unresponsive


Pupil Assessment

  • P - Pupils

  • E - Equal

  • A - And

  • R - Round

  • R - Regular in size

  • L - React to Light


Abnormal Pupil Reactions

  • Fixed with no reaction to light

  • Dilate with light and constrict without light

  • React sluggishly

  • Unequal in size

  • Unequal with light or when light is removed


Pupillary Reactions


Reassessment of Vital Signs

  • Reassess stable patients every 15 minutes.

  • Reassess unstable patients every 5 minutes.


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