Introduction to Emergency

Medical Care
1

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 CORE CONCEPTS

• Understanding closed wounds and

emergency care for closed wounds
• Understanding open wounds and
emergency care for open wounds
• Understanding burns and emergency care
for burns

continued
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 CORE CONCEPTS

• Understanding electrical injuries and

emergency care for electrical injuries
• How to dress and bandage wounds

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 Topics
• Soft Tissues
• Closed Wounds
• Open Wounds
• Treating Specific Types of Open Wounds
• Burns
• Electrical Injuries
• Dressing and Bandaging

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 Soft Tissues

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 Soft Tissues
• Skin
• Fatty tissues
• Muscles
• Blood vessels
• Fibrous tissues
• Membranes
• Glands
• Nerves

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 Skin
• Protection
• Water balance
• Temperature
regulation
• Excretion
• Shock absorption

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 Integumentary Anatomy Video

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 Closed Wounds

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 Closed Wounds
• Contusion
– Bruise
• Hematoma
– Similar to contusion
– More tissue
damage
– Involves larger
blood vessels

continued
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 Closed Wounds
• Closed crush injury
– Excessive force
crushing or rupturing
internal (generally
solid) organs

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 Assessment:
Closed Wounds
• Bruising may be
internal injury or
bleeding
• Consider
mechanism of
injury
• Crush injuries are
difficult to identify

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 Treatment:
Closed Wounds
• Take appropriate Standard Precautions
• Manage airway, breathing, and circulation
• Always manage for internal bleeding and
shock if there is a possibility of internal
injuries

continued
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 Treatment:
Closed Wounds
• Splint extremities that are painful, swollen,
or deformed
• Stay alert for vomiting
• Continuously monitor for changes and
transport

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 Open Wounds

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 Open Wounds
• Abrasion
• Laceration
• Puncture
• Avulsion
• Amputation
• Crush injury
• Blast injury

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 Think About It
• Does an open wound necessitate using
more than just gloves as standard
precautions?
• Can an open injury affect the patient’s
airway or breathing?

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 Treatment: Open Injuries
• Expose wound
• Clean surface of wound
• Control bleeding
• Provide care for shock
• Prevent further contamination

continued
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 Treatment: Open Injuries
• Bandage dressings in place after bleeding
is controlled
• Keep patient still
• Reassure patient

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 Treating Specific Types of
Open Wounds

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 Treatment:
Abrasions and Lacerations
• Reduce wound contamination
• Hold direct pressure to control bleeding
• Always check pulse, motor, and sensory
function distal to injury to assure function
• Never open edges of laceration to see
inside or further clean wound

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 Treatment:
Puncture Wounds
• Use caution—objects may be embedded
deeper than they appear
• Check for exit wounds
– May require immediate care
• Bullets can fracture bones as they enter
• Stab wounds are considered serious if in a
vital area of body

continued
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 Treatment:
Puncture Wounds
• Reassure patient
• Search for exit
wound
• Assess need for
shock care
• Follow local
protocols regarding
spinal immobilization
• Transport patient
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 Treatment:
Impaled Objects
• Do not remove object; may cause severe
bleeding
• Expose wound area
• Control profuse bleeding by direct
pressure
• Apply several layers of bulky dressing to
“splint” object in place

continued
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 Treatment:
Impaled Objects
• Secure dressings
• Treat for shock
• Provide rapid transport

continued
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 Treatment:
Impaled Objects

Splint object Secure dressings

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 Impaled Object in Cheek
• Take care that object does not enter oral
cavity, causing airway obstruction
• If cheek wall is perforated, profuse
bleeding into mouth and throat can cause
nausea and vomiting
• External wound care will not stop the flow
of blood into the mouth

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 Treatment:
Impaled Object in Cheek
• Examine wound site, both inside and
outside mouth
• If you find the perforation and can see
both ends, remove
object
• If object is impaled
into another structure,
stabilize in place
continued
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 Treatment:
Impaled Object in Cheek
• Position patient to allow for drainage
• Monitor patient’s airway
• Dress outside of wound
• Provide oxygen
• Provide care for shock

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 Treatment: Avulsions
• Clean wound surface
• Fold skin back into normal position
• Control bleeding and dress with bulky
dressings
• If avulsed parts are completely torn away,
save in sterile dressing and keep moist
with sterile saline

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 Treatment: Amputations
• Apply pressure dressing over stump
• Use pressure points to control bleeding;
use tourniquet only if all other methods fail

continued
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 Treatment: Amputations
• Wrap amputated part in sterile dressing
and place in plastic bag; put bag in pan
with water and cold packs
• Do not immerse amputated part directly in
icy cold water

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 Treatment: Genital Injuries
• Control bleeding
• Preserve avulsed parts
• Consider if injury suggests another,
possibly more serious, injury
• Calm, professional manner
• Maintain patient’s dignity
• Dress and bandage wound

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 Burns

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 Burns
• May involve more than just skin-level
structures
• If respiratory structures are affected,
swelling may occur, causing life-
threatening obstruction
• Don’t let burn distract from spinal damage
or fractures

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 Assessment: Burns
• Classifying burns
– Agent and source
– Depth
– Severity

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 Burns: Depth
• Superficial (1st Degree)
– Involves only epidermis
– Reddening with minor swelling
• Partial Thickness (2nd Degree)
– Epidermis burned through, dermis damaged
– Deep, intense pain
– Blisters and mottling

continued
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 Burns: Depth
• Full Thickness (3rd Degree)
– All layers of skin burned
– Blackened areas surrounded by dry and white
patches

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 Burns: Severity
• Rule of Nines
– Helps estimate extent of burn area
– Adult body is divided into 11 main areas
– Each represents 9 percent of body surface

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 Burns:
Geriatrics and Pediatrics
• “Minor” burn area in a young adult can be
fatal to a geriatric adult
• Infants and children have a much greater
relationship of body surface area to total
body size, resulting in greater fluid and
heat loss from burned skin

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 Treatment: Thermal Burns
• Use sterile dressings
• Never apply ointments, sprays, or butters
• Do not break blisters

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 Treatment: Chemical Burns
• Wash away
chemical with
copious amounts
of flowing water
• If dry chemical,
brush away, then
flush with water

continued
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 Treatment: Chemical Burns
• Remove contaminated clothing
• Apply sterile dressings
• Treat for shock

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 Electrical Injuries

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 Electrical Injuries
• Severe damage through body by
disrupting nerve pathways
• Entry and exit burns are possible
• Respiratory/cardiac arrest are possible
• Bones may fracture from violent muscle
contractions

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 Treatment: Electrical Injuries
• Provide airway care
• Be alert and prepared for cardiac rhythm
changes; be ready to defibrillate
• Treat for shock and provide oxygen

continued
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 Treatment: Electrical Injuries
• Care for spinal and head injuries as well
as extremity fractures
• Evaluate burn sites
• Cool burning areas and apply sterile
dressings

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 Electrical Injuries Video

Click here to view a video on the subject of injuries

caused by electricity.
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 Dressing and Bandaging

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 Dressing and Bandaging
• Dressing: any
material applied to
wound to control
bleeding and Pressure Dressing
prevent
contamination

Occlusive Dressing
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 Dressing and Bandaging
• Bandage: any
material used to
hold dressing in
place

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 Dressing Open Wounds
• Expose wound
• Completely cover wound area
• Dressings should not be removed unless
bulky dressing is blood soaked and new
one must be applied to maintain direct
pressure
• Control bleeding by direct pressure or
pressure dressings

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 Bandaging Open Wounds
• Do not bandage too
tightly or too loosely
• Do not leave loose
ends
• Do not cover tips of
fingers or toes—must
observe distal skin
color changes
• Cover all edges of
dressings
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 Chapter Review

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 Chapter Review
• Soft-tissue injuries may be closed or open.
• Closed injuries include contusions,
hematomas, and crush injuries. Open
wounds include abrasions, lacerations,
avulsions, amputations, and crush injuries.

continued
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 Chapter Review
• For open wounds, expose the wound,
control bleeding, and prevent further
contamination.
• For both open and closed injuries, take
appropriate Standard Precautions.

continued
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 Chapter Review
• Burn severity is determined by considering
the source, the region affected, depth of
burn, extent of burn, age of the patient,
and other patient illnesses or injuries.

continued
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 Chapter Review
• Care for burns includes stopping the
burning, covering a thermal burn with a dry
sterile dressing, flushing a chemical burn
with sterile water, protection of the airway,
administration of oxygen, treatment for
shock, and transport.

continued
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 Chapter Review
• For treatment of electrical injuries, be sure
that you and the patient are in a safe zone
away from possible contact with electrical
sources. Protect airway, breathing, and
circulation. Be prepared to care for
respiratory or cardiac arrest. Treat for
shock, care for burns, and transport.

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 Remember
• The soft tissue of the body is made up of
skin, fatty tissues, muscles, blood vessels,
fibrous tissues, membranes, glands, and
nerves.
• The skin provides protection, water
balance, temperature regulation,
excretion, and shock absorption.

continued
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 Remember
• Open or closed in reference to a soft-
tissue injury is dictated by whether or not
the skin is still intact.
• Closed injuries must be evaluated with
consideration to underlying anatomy and
mechanism of injury.

continued
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 Remember
• Open injuries typically are easier to
visualize, but they often can mask
underlying injuries.
• Burns involve immediate destruction of
tissue but also can have a long-term
effect, both physically and emotionally.

continued
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 Remember
• Safety must be a key concern when
treating a patient with a burn or an
electrical injury.
• The goal of dressing and bandaging
wounds is to control bleeding and to
prevent infection.

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 Questions to Consider
• Does the patient have a patent airway and
is breathing adequate?
• If the wound is penetrating, is there an exit
wound?
• What is the best way to immobilize an
impaled object?

continued
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 Questions to Consider
• Is there respiratory involvement with the
burn?
• Have we irrigated the chemical burn
sufficiently?
• Does the electrical burn have an exit
wound?
• Is the bandage securely fastened to hold
the dressing?

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 Critical Thinking
• A 21-year-old male lacerated his anterior
elbow when he fell through a window.
There is a lot of blood around the patient.
Bystanders have applied numerous towels
and washcloths over the wound (at least 3
inches thick).

continued
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 Critical Thinking
• There are so many dressings on the
wound that you can’t tell if it is still
bleeding. The patient is alert, but pale and
anxious. The radial pulse on his uninjured
arm is weak and rapid. How much
assessment of the wound should you do
and how do you do it without making
things worse?

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