Lecture Mosby's paramedic textbook (4th ed) - Chapter 38: Bleeding and soft tissue trauma

9/11/2012 1 Chapter 38 Bleeding and Soft Tissue Trauma 2 Learning Objectives • Describe the normal structure and function of the skin. • Describe the pathophysiological responses to soft tissue injury. • Discuss pathophysiology as a basis for key signs and symptoms, and describe the mechanism of injury and signs and symptoms of specific soft tissue injuries. 3 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 1 9/11/2012 Learning Objectives • Outline management principles for prehospital care of soft tissue injuries. • Describe, in the correct sequence, patient management techniques for control of hemorrhage. • Identify the characteristics of general categories of dressings and bandages. 4 Learning Objectives • Describe prehospital management of specific soft tissue injuries not requiring closure. • Discuss factors that increase the potential for wound infection. • Describe the prehospital management of selected soft tissue injuries. 5 Hemorrhage • Hemorrhage – Occurs when disruption, or “leak,” occurs in vascular system – Sources can be external or internal 6 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 2 9/11/2012 External Hemorrhage • Results from soft tissue injury • Accounts for about 2.3 million emergency department visits in U.S. each year • Most soft tissue trauma is accompanied by mild hemorrhage – Usually does not pose threat to life – Can carry major risks of morbidity and disfigurement 7 External Hemorrhage • Seriousness of injury depends on three factors – Anatomical source of hemorrhage • Arterial • Venous • Capillary – Degree of vascular disruption – Amount of blood loss patient can tolerate 8 Internal Hemorrhage • Can result from – Blunt or penetrating trauma – Acute or chronic illnesses • Insufficient amount of circulating blood can occur in – Chest – Abdomen – Pelvis – Retroperitoneum 9 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 3 9/11/2012 Internal Hemorrhage • Intracranial hemorrhage can cause grave hemodynamic instability from loss of blood – Associated with higher morbidity and mortality rates than external hemorrhage 10 Internal Hemorrhage • Signs and symptoms – Bright red blood from mouth, rectum, or other orifice – Coffee‐ground appearance of vomitus – Melena (black, tarry stools) – Hematochezia (passage of red blood through rectum) – Dizziness or syncope on sitting or standing – Orthostatic hypotension 11 Why do you think internal hemorrhage is associated with an increase in morbidity and mortality rates? 12 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 4 9/11/2012 Skin Anatomy and Physiology • Skin – Tough, supple membrane that covers entire body – Largest and most dynamic organ of body – Covers more than 20 sq. ft., makes up 16 percent of total body weight – Two distinct layers of tissue • Outer layer (epidermis) • Inner layer (dermis) 13 14 Epidermis • Thin, nonvascular epithelial tissue – Derives nourishment from capillaries of dermis – Epidermis composed of five layers • Stratum basale • Innermost layer; stratum spinosum • Stratum granulosum • Stratum lucidum • Stratum corneum, most superficial layer, composed of about 20 layers of dead skin cells that are filled with waterproofing protein keratin 15 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 5 ... - tailieumienphi.vn