WOUNDS. Emergency Procedures in PT

Transcription

1 WOUNDS Emergency Procedures in PT

2 Types of Wounds Abrasions uppermost layer scraped away, minor capillary bleeding occurs, nerve endings exposed Lacerations skin tear with edges jagged and uneven Incisions made by a knife, edges are straight

3 Types of Wounds Punctures an incision made by a sharp, pointed object Avulsions forceful separation of a limb from the body because of trauma Amputations clean removal of a limb from the body

4 ASSESSMENT Scene Size-Up Primary Assessment Rapid Trauma Assessment

5 Scene Size-Up Assess for the MOI Standard precautions against blood should be taken if bleeding is present.

6 Primary Assessment Assess for signs of hypoperfusion e.g. tachycardia and tachypnea.

7 Rapid Trauma Assessment If no life-threatening injuries are present, perform a complete head-to-toe rapid trauma assessment Focus on DCAP-BTLS Deformities Contusions Abrasions Penetrations Burns Tenderness Lacerations Swelling

8 MANAGEMENT Wound bandaging

9 Bandaging GOAL: protect the wound from further injury and contamination Roller bandage, military compress, triangular bandage

10 TRANSPORTATION

11 Ongoing Assessment Carefully monitor all bandages. Often it becomes slack and loose or acts like a tourniquet when swelling is present

12 THERMAL BURNS

13 Management Stop burning Cool the area with sterile water and wash away excess debris Remove any jewerly Never apply ointments or antiseptic lotions Apply appropriate dressings

14 Management Less than 10% TBSA Use a wet dressing, excess water squeeze out Secure with dry sterile bandage More than 10% TBSA Use a dry dressing Consider risk for hypothermia - cover the patient

15 CHEMICAL BURNS

16 Management Dry Chemicals Brush off the patient Remove clothing Wait for MSD authority decision Flush the chemicals with water* * Some chemicals can react violently upon contact with water

17 Management Wet Chemicals Wash off the patient Remove clothing Wait for MSD authority decision minutes of flushing, continuous irrigation (gentle rather than forceful)

18 Management Eye Injury Irrigation of the eyes continuously for minutes Water is running away from the unaffected eye

19 ELECTRICAL BURNS

20 Management Should be treated like any trauma, spinal precautions Check ABC, start CPR immediately Use AED, as indicated Assist breathing Rapid transport

21 WOUND CARE

22 Initial Wound Care Isolation or universal precautions Clean wounds; blisters debrided Shave hair for prevention of infection

23 Daily Wound Care Pain medications, as needed Dressings soaked off Remove old topical and gently wash wounds. Debride loose tissue. Reapply topicals and dressings as ordered

24 Debridement Remove dead tissue to get between dead and viable tissue Not so aggressive as to cause bleeding Some removed with coarse mesh gauze Debrided with sedation / analgesic / conscious sedation or general anesthesia

25 Debridement Sharp debridement Scalpel or scissors to remove devitalized tissue Indications Removing adherent eschar Devitalized tissue in extensive ulcer Urgent debridement in advanced Cellulitis or Sepsis

26 Debridement Sharp debridement Follow-up sharp debridement Apply clean, dry dressings for 8-24 hours Restart wet-to-moist (or wet-to-dry) dressings Debridement under Anesthesia Indications Indicated for extensive stage 4 Decubitus Ulcers Consider bone biopsy to assess for Osteomyelitis

27 Debridement Mechanical debridement Wet-to-Dry Dressing Hydrotherapy (Occlusive Wound Dressing) Transparent Film Dressing Wound irrigation

28 Debridement Enzymatic debridement (chemical) Indicated where surgical debridement is not possible and wound infected or dead tissue Enzymatic debridement is more specific in targeting dead tissue Enzymatic debridement ointments were previously FDA approved: Santyl, Panafil, and Accuzyme.

29 Debridement Autolytic debridement In vivo enzymes self-digest devitalized tissue Contraindicated for infected wounds Synthetic dressing applied to cover wound Mildly draining wounds: Hydrogel Dressing, Hydrocolloid Dressing Moderately to strongly draining wounds: Alginate Dressing

30 THANK YOU FOR LISTENING!