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Chapter 12

Bleeding, Shock, and Soft-Tissue Injuries

Body Substance Isolation


Most soft-tissue injuries involve bleeding. Take appropriate measures to prevent contact with patients body fluids. Gloves must be worn to avoid contact with patients blood. You may also need a mask and eye protection.

Shock
Collapse of the cardiovascular system State of inadequate delivery of blood to the organs Three main causes: Pump failure Pipe failure Fluid loss

Signs and Symptoms of Shock


Confusion, restlessness, anxiety Cold, clammy, pale skin Rapid, weak pulse Increased capillary refill time Rapid breathing Thirst, nausea, vomiting Weakness or fainting

General Treatment for Shock


Position patient correctly. Maintain patients ABCs. Control bleeding. Maintain body temperature. Do not give anything to eat or drink. Provide oxygen, if available. Arrange for immediate and prompt transport.

Controlling External Blood Loss


Use proper BSI. Apply direct pressure using sterile dressing, if available. Elevate extremity if you do not suspect a fracture. Locate and apply pressure to brachial, femoral pressure points.

Open vs. Closed Wounds


Open: Abrasion Puncture Laceration Avulsion Closed: Bruiseinjured area becomes discolored and swollen. Skin remains intact.

Principles of Wound Treatment


Control bleeding. Prevent further contamination of wound. Immobilize injured part. Stabilize impaled object.

Face and Scalp Wounds


Cause large amounts of bleeding. Most bleeding can be controlled by applying pressure.

Eye Injuries
For lacerations, cover entire eye. For impaled objects: Cover injured eye with a dressing. Place a paper cup over injured eye. Bandage both eyes.

Chest and Back Wounds


May affect lungs, large vessels, and heart. Any wound involving organs is lifethreatening. Use an occlusive dressing to secure wound. Place patient in a comfortable position. Administer oxygen.

Occlusive Dressings

Closed Abdominal Wounds


Usually result from a direct blow with a blunt object. Abdomen may be swollen, rigid, or boardlike. Give patient nothing by mouth. Arrange for prompt transport.

Open Abdominal Wounds


Apply dry, sterile dressing to wound. Maintain patients body temperature. Place patient on back with legs elevated. If patient is having difficulty breathing, place in semi-reclining position. Administer oxygen. To bandage, apply sterile dressing and wrap bandage.

Genital Wounds
Both male and female genitals have a rich blood supply. Apply direct pressure with a dry, sterile dressing. Patient can suffer critical blood loss.

Extremity Wounds
Apply dry, sterile dressing and bandage. Elevate area to decrease bleeding and swelling. Splint injured area if fracture is suspected.

Gunshot Wounds
Establish ABCs. Control any external bleeding. Examine for entrance and exit wounds. Treat for shock. Arrange for prompt transport. Be prepared to perform CPR.

Burns
Rule of nines: Method to determine percentage of body that is burned. Burn depth: Superficial (first-degree): Skin is reddened and painful. Partial-thickness (second-degree): Blisters are present. Full-thickness (third-degree): Destroys underlying muscle and other tissues.

Heat (Thermal) Burn


Cool burned area. Cover with a dry, sterile dressing. Do not remove clothing. Arrange for transport.

Respiratory Burns
Signs and symptoms: Singed nose hairs Soot in mouth and nose Difficulty breathing Pain while breathing Burns around face Unconsciousness

Care for Respiratory Burns


Watch patient carefully. Monitor the ABCs. Administer oxygen if available. Arrange for prompt transport.

Chemical Burns
Chemicals are extremely dangerous to eyes. Remove patient from exposure. Brush off dry chemicals. Flush contaminated skin for 10 minutes. Cover area with dry, sterile dressing. Flush chemical burns to eyes for at least 20 minutes.

Electrical Burns
Make sure there is no contact with power sources. Unplug, disconnect, or turn off power. Examine patient. Assess ABCs. Arrange for prompt transport.

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