WOUNDS - Filesptrp2014.weebly.com/uploads/1/3/6/2/13623509/wounds.pdf · Emergency Procedures in PT...

Preview:

Citation preview

WOUNDS Emergency Procedures in PT

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

ASSESSMENT •Scene Size-Up •Primary Assessment •Rapid Trauma Assessment

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Scene Size-Up

Assess for the MOI

Standard precautions against blood should

be taken if bleeding is present.

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Primary Assessment

Assess for signs of hypoperfusion e.g.

tachycardia and tachypnea.

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

MANAGEMENT •Wound bandaging

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Bandaging

GOAL: protect the wound from further

injury and contamination

Roller bandage, military compress,

triangular bandage

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

TRANSPORTATION

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Ongoing Assessment

Carefully monitor all bandages.

Often it becomes slack and loose or acts

like a tourniquet when swelling is present

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

THERMAL BURNS

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

CHEMICAL BURNS

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Management

Wet Chemicals

◦ Wash off the patient

◦ Remove clothing

◦ Wait for MSD authority decision

◦ 20-30 minutes of flushing, continuous

irrigation (gentle rather than forceful)

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Management

Eye Injury

◦ Irrigation of the eyes continuously for 20-30

minutes

◦ Water is running away from the unaffected

eye

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

ELECTRICAL BURNS

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Management

Should be treated like any trauma, spinal

precautions

Check ABC, start CPR immediately

Use AED, as indicated

Assist breathing

Rapid transport

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

WOUND CARE

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

Initial Wound Care

Isolation or universal precautions

Clean wounds; blisters debrided

Shave hair for prevention of infection

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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.

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

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

Emergency Procedures in PT © 2012 | Prepared by MJChalan, PTRP, MSPT

THANK YOU FOR LISTENING!

Recommended