Continues with the information taught in Bleeding and Shock, discussing the anatomy of the skin and the management of soft tissue injuries and the management of burns. Techniques of dressing and bandaging wounds will also be taught in this lesson. Lesson meets or exceeds USDOT NHTSA EMT/EMR 2009 training requirements. Presentation is over 100 slides in length. Recommended classroom time is 3 hours & 2 hours lab time.

1. PREVIEW OF
EMT/EMR SOFT TISSUE INJURIES
POWERPOINT TRAINING
PRESENTATION

2. FUNCTION OF THE SKIN
The skin provides
Protection from the environment
Extreme temperature
Pathogens (Bacteria, viruses)
Blunt trauma
Helps regulate temperature
Feeling of sense
Helps maintain body fluid balance

3. CLOSED SOFT TISSURE INJURY
Injury injury with no pathway from outside the
injured area
Types of injury
Signs and Symptoms
Assessment
Management

4. Outermost layer of
skin is scraped off
Painful
Superficial
No bleeding or small amount of blood oozes
from wound
ABRASION

5. AVULSION
Flaps of skin or
tissue are torn
loose or pulled
completely off

6. IMPALED OBJECT
Object that creates the puncture wound
remains embedded
Leave in place unless it is in the cheek with
uncontrolled bleeding
Apply pressure around the object and secure in
place
Avoid movement

7. AMPUTATION
Involves the
extremities and
other body parts
Massive bleeding
may be present or
bleeding may be
limited

8. BLAST INJURY/HIGH PRESSURE
Often seen in WMD attacks
Be careful of secondary explosions
These injuries are compounded when the
explosion occurs in a confined space

10. CONTUSION (Bruise)
Epidermis remains
intact
Cells are damaged &
blood vessels torn
from dermis
Swelling & pain

11. HEMATOMA
Collection of blood
beneath the skin
Larger amount of
tissue damage as
compared to
contusion
Larger vessels are
damaged
May lose one or more
liters of blood

12. COMPLICATIONS OF
SOFT TISSUE INJURY
Bleeding – shock
Pain
Infection
Mechanisms of infection
Risk factors

13. GENERAL ASSESSMENT
Safety of Environment / Standard Precautions
Airway Patency
Respiratory Distress
Concepts of Open Wound Dressings/Bandaging
Hemorrhage Control
Associated Injuries

14. CONCEPTS OF OPEN WOUND
DRESSING/BANDAGING
Sterile
Non-sterile
Occlusive
Non-occlusive
Wet
Dry
Tourniquet
Complications of dressings/bandages

15. DRESSING & BANDAGING
Used to
Stop bleeding
Protect the wound from further
damage
Prevent further contamination and
infection
Dressing
Bandage

16. DRESSINGS
Usually sterile
Types
Sterile gauze pads
Non-stick gauze pads
Occlusive dressings
Trauma dressings

17. BANDAGES
Hold dressings in place
Types
Adhesive bandages
Roller gauze
Elastic
Non-elastic
Tape

18. MANAGEMENT
Appropriate PPE
Airway management
Expose the wound
Control hemorrhage
Dress/bandage open wounds with dry sterile
dressing
Prevention of shock
Prevent infection
Transport to the appropriate facility

19. THERMAL
Types
Severity related to
Exposure time
Temperature
Enclosed space versus open
Scalds with unusual history patterns may be
abuse

20. CHEMICAL
Severity related to
Type of chemical
Concentration of chemical
Duration of exposure
Solutions and powders are different

21. DEPTH CLASIFICATION OF BURNS
Superficial
Partial-thickness
Full-thickness

22. SUPERFICIAL
1st DEGREE
Involves only the epidermis
Reddened skin
Pain at the site

23. Head & Neck
9%
Posterior
Trunk
18%
Anterior
Trunk 18%
Each Upper
Extremity
9%
External
Genitalia 1%
Each Lower
Extremity
18%
RULE OF 9‘s
ADULT

24. RULE OF ONES
The patient's palm can serve a reference point
roughly equivalent to 1% of the body surface
area

25. DEPTH
Full thickness extends through all layers of the
skin
White, yellow, tan, brown or charred
appearance
Leathery feel
No pain in those areas
Usually there is pain in surrounding
areas with other depth of burns

26. RESPIRATORY BURNS
Facial burns are an
indication of respiratory
burns
Patient may have burns
to airway & lungs
Respiratory burns have
double the mortality
rate

27. PART OF BODY BURNED
Severity should be increased with certain body
parts including
Fingers
Face
Genitals
Feet

28. INFANTS & CHILDREN
Greater surface area in relationship to the
total body size
Results in greater fluid and heat loss
Any full thickness burn or partial thickness
burn greater than 20%, or burn
involving the hands, feet, face , airway
or genitalia is considered to be a critical
burn in a child

29. GERIATRIC PATIENTS
Severity of burn should be increased for patients
over 55 years old

30. THERMAL
Complete general management
May be associated with an inhalation injury
Large burns may cause hypovolemia and
hypothermia
Cool small burns or those remaining hot (patient
who has just been rescued from fire)
Dry dressing help prevent infection and provide
comfort
Time in contact with heat increases damage

31. COMPLICATIONS ARE RELATED TO
TOXIC CHEMICALS WITHIN INHALED
AIR
Carbon monoxide
Cyanide
Other toxic gasses

32. INHALATION
Edema of mucosa of airway can be rapid
Consider ALS backup if signs and symptoms of
edema are present, such as:
Hoarseness
Singed nasal or facial hair
Burns of face
Carbon in sputum
Burns in enclosed spaces without ventilation cause
inhalation injuries

33. ELECTRICAL
Scene safety - never touch a patient in contact
with an electric source
Often internal damage more severe than
external injuries appear
Sometimes electric current crosses the chest
and causes cardiac arrest or arrhythmias
Patient may be in cardiac arrest when EMT
arrives (probably V-fib or asystole)

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