Skin Anatomy and Physiology

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Mervin Carpenter
6 years ago
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Skin Anatomy and Physiology Body s largest organ Three layers: Epidermis Dermis Subcutaneous tissue 1 2 Skin Anatomy and Physiology Complex system, variety of functions Sensation Control of water

1 Skin Anatomy and Physiology Body s largest organ Three layers: Epidermis Dermis Subcutaneous tissue 1 2 Skin Anatomy and Physiology Complex system, variety of functions Sensation Control of water loss Protection against microbes Temperature control 3 4 Scene Size up Wear BSI. Do not touch equipment with bloody gloves; change often Beware of contaminating one patient with another patient s blood. Wear eye protection. Consider MOI. Initial Assessment How does the patient look? Decide SICK/NOT SICK. There may be internal underlying injuries. Injuries can affect airway and breathing. Provide spinal immobilization. Open chest wound? Evaluate for bubbling or sucking sounds Occlusive dressing. Provide high flow oxygen. Assess pulse and skin for shock. Control significant bleeding

2 Focused Exam Focused physical exam Focus on isolated injury, complaint, and affected body region. Look for DCAP BTLS. Rapid physical exam Perform if there is significant trauma affecting multiple systems. Look for DCAP BTLS. Be sure that spine is stabilized. Baseline Vitals/SAMPLE Baseline vital signs Will help determine if patient is going into shock SAMPLE history Critical Findings Anemia and hemophilia Medications that thin the blood (aspirin, prescribed blood thinners) 7 8 Detailed Exam Perform if patient is stable and time allows. Ongoing Assessment Reassess all bandaging/splinting Assess PMS Reassess ABCs. Communication o and documentation o Include description of MOI and patient s position. Describe location, size, depth of injury. Provide accurate account of how you treated injuries Soft Tissue Injuries Closed OpenO Burns Closed Injury Associated with blunt trauma Skin remains intact Damage occurs below skin surface Types: Contusions Hematomas

Contusion Blunt force damages dermal structures Blood, fluid leak into injury area (pain/swelling) Ecchymosis Hematoma Larger vessel damage with mass of blood collecting at injury site Fist

What could the force that caused the soft tissue trauma have done to underlying organs?

3 Contusion Blunt force damages dermal structures Blood, fluid leak into injury area (pain/swelling) Ecchymosis Hematoma Larger vessel damage with mass of blood collecting at injury site Fist sized = 10% volume loss Closed Soft Tissue Injury Considerations: How much blood is tied up in that injury rather than circulating in the vessels? What could the force that caused the soft tissue trauma have done to underlying organs? BLS Care Request ALS if indicated O2, assist ventilations Maintain airway, breathing, c spine RICES Maintain body temperature Monitor vital signs Calm and reasssure Transport Closed Injury Management Rest Ice Compression Elevation Splint Open Injury Skin broken Protective function lost External bleeding, infection become problems

Open Injury Types Abrasions Lacerations Punctures Avulsions Amputations

Abrasion Laceration Cut by sharp object Typically longer than it is deep

Types Linear Stellate 21 22 Lacerations Punctures Result from stabbing

4 Open Injury Types Abrasions Lacerations Punctures Avulsions Amputations Abrasion Loss of portions of epidermis, upper dermis by rubbing or scraping force. Usually associated with capillary oozing, leaking of fluid Road rash Abrasion Laceration Cut by sharp object Typically longer than it is deep May be associated with severe blood loss, damage to underlying tissues Types Linear Stellate Lacerations Punctures Result from stabbing force Wound is deeper than it is long Difficult to assess injury extent GSW especially difficult Object producing puncture may remain impaled in wound

Puncture Wounds Avulsions Piece of skin torn

Result from accidents with machinery and

position before bandaging Treat completely

Part should be wrapped in sterile gauze,

cold pack Do NOT pack part directly in ice Do

Wound Management Manage ABCs first Position

contamination, but do not worry about trying

5 Puncture Wounds Avulsions Piece of skin torn loose as a flap or completely torn from body Result from accidents with machinery and motor vehicles Replace flap into normal position before bandaging Treat completely avulsed tissue like amputated part Avulsions Amputations Disruption of continuity of extremity or other body part Part should be wrapped in sterile gauze, placed in plastic bag, transported on top of cold pack Do NOT pack part directly in ice Do NOT let part freeze Amputations Open Wound Management Manage ABCs first Position of comfort Control bleeding Prevent further contamination, but do not worry about trying to clean wound Immobilize injured part Mange hypoperfusion if present (O2)

Dressing and Bandaging Dressings Applied directly to wound Should be sterile Occlusive Bandaging Should be

Bandaging A step between bandaging and tourniquet, should not effect distal pulses Special Considerations

dress inside and outside mouth 33 34 Eviscerations Internal organs exposed through wound Cover organs with

6 Dressing and Bandaging Dressings Applied directly to wound Should be sterile Occlusive Bandaging Should be done after bleeding controlled Used to hold dressings in place Should be clean, if not sterile Pressure Bandaging A step between bandaging and tourniquet, should not effect distal pulses Special Considerations Impaled objects Eviscerations Open chest wounds Neck wounds Gunshot wounds Crush Injuries Injection Injuries Improvise, adapt, overcome! Impaled Objects Impaled Objects Do NOT remove Stabilize in place Exception: Object in cheek Remove, dress inside and outside mouth Eviscerations Internal organs exposed through wound Cover organs with large saline moistened dressing, then with occlusive or dry multi trauma dressing Do NOT use individual 4 x 4 or material that may stick ik to wound Do NOT attempt to replace organs Eviscerations

Open Chest Wound May prevent adequate ventilation Cover with occlusive dressing Monitor patient for

develops lift dressing corner to relieve pressure Open Chest Wounds 37 38 Gunshot Wounds Special

direction, tumble Impossible to assess severity in field or ER Patient must go to OR Gunshot Wounds

injury Beware of crush syndrome Injection Injuries Serious tissue injury caused by high pressure

7 Open Chest Wound May prevent adequate ventilation Cover with occlusive dressing Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax) If tension pneumo develops lift dressing corner to relieve pressure Open Chest Wounds Gunshot Wounds Special type of puncture wound Transmitted energy can cause injury remote from bullet track Bullets change direction, tumble Impossible to assess severity in field or ER Patient must go to OR Gunshot Wounds Crush Injuries MOI will determine severity of injury Do not be fooled by signs of minimal injury Beware of crush syndrome Injection Injuries Serious tissue injury caused by high pressure injections External injury may look minor but internal injury may be very severe Treat like a puncture injury

8 BLS Care Request ALS if indicated O2, assist with ventilations Maintain airway, breathing, c spine Control bleeding Maintain body temperature Monitor vital signs Calm and reassure Transport BLS Indicators Conscious and alert Stable vital signs Soft tissue injuries limited to the superficial layer of skin Single digit amputations Controlled bleeding by direct pressure and/or elevation ALS Indicators Significant head injury Signs/symptoms of shock Airway compromise Excessive, uncontrolled bleeding Altered LOC High index of suspicion based on MOI 45 8

Face and Throat Injuries. Chapter 26

Face and Throat Injuries. Chapter 26 Face and Throat Injuries Chapter 26 Anatomy of the Head Landmarks of the Neck Injuries to the Face Injuries around the face can lead to upper airway obstructions. Bleeding from the face can be profuse.