Mechanical injury

Open injury
Open one in which there is disruption in the continuity of the skin and therefore susceptibility to external hemorrhage and contamination
An abrasion: caused by rubbing or scraping, where in part of the skin surface has been lost Laceration: a cut inflicted by a sharp instrument, such as a knife or razor blade, producing a clean or jagged incision through the skin surface and underlying structures A puncture wound(impaled foreign object): is a stab from a pointed object, such as a nail; advent of the refrigerator has made the ice pick nearly obsolete, but occasionally one still sees puncture wound inflicted by this instrument An avulsion: involve tearing lose of flap of skin, which may either remain hanging or be torn off altogether

 Closed injury
Bruise or Contusion(marked by local pain and swelling, there is damage to soft tissues beneath the skin but no break in the continuity of the epidermis) Ecchymosis (black-and-blue mark), if small blood vessel or vessels beneath the skin have been disruption Hematoma, if large blood vessel have been torn beneath the contusion area

Treatments
Open wound
Control hemorrhage Keep the wound as clean as possible Immobilize If there is impaled object:
Do not remove impaled object Control hemorrhage by direct compression, but do not applied pressure on the impaled object itself Stabilize the impaled object with bulky dressing

Closed wound
Should be treated with cold application to minimize edema but otherwise require no specific treatments

Burns
Critical burn - Burn complicated by respiratory injury - Burn (all degrees) involving more than thirty percent of boy surface - Third degree burn of more than ten percent of body surface - Almost all burn of the face, hands, feet, or genitalia - Burn complicated by fracture or major of soft tissue injury - Deep acid and electric burn - Burn occurring in patient with serious underlying disease

 Thermal burn - First degree o Limited to the most superficial layer of the skin o Producing redness and pain o Usually heal in 1 week - Second degree o Penetrate the skin deeper o Producing pain and blistering as well as some subcutaneous edema o Usually heal in about 2-3 weeks - Third degree o Involve damage to or destruction of the full thickness of the skin o Involve underlying muscles, bone and other structures as well o The skin may appear charred and leathery or may be dry and pale o No pain o Usually heal in very long time

 Chemical burn Occur when the skin comes in contact with strong acid, alkalis, or other corrosive material; the burn will progress so long as the corrosive substance remains in contact with the skin. Electric burn May produce devastating internal injury with he little external evidence. The hand is the area most prone to electric injury since it is the means by the which with touch and grabs. Electricity can cause three types of burn - Contact burn Lesion characteristic resembles a bulls eye, with a central, charred zone of third degrees burn, a middle zone of cold, gray, dry tissue and an outer, red zone of coagulation necrosis - Flash burn Occurs when an extremity is close to an electric flash - Arcing injury Occurs when a current jumps from surface to surface In addition to burns, electricity can cause respiratory or cardiac arrest.

 Lightning injuries
Lightning is Strikes when there is a massive discharge of electricity between two bodies that have different charges Lightning injury is an injury/ burn caused by lightning

 Thermal burn
first-degree:

Management Care

first hour: immerse the burned area in cold water or applied cold compress to the burn, but sometime continue for up to the first 24hours of hospitalization Do not use salves, ointments, butter, cream, spray, or any other covering on any type of burns Never put goo on a burn

Second-degree
immerse the burned area in cold water or applied cold compress to the burn Do not attempt to rupture blister over the burn Start IV fluid

Third-degree
Put out the fire As in any critical injury, the airway is the most important initial consideration every patient exposed to smoke inhalation of any degree should receive oxygen Complete the primary survey (record vital signs, and retake them frequently) Do the secondary survey, check pulse in all extremities; edema from circumferential burns can acting as tourniquet, leading to arrest circulation to the limb and consequent ischemia of that limb If more than 10 percent start IV fluid Do not waste time trying to pick debris off the skin Remove rings, bracelet and other potentially constricting items

 Chemical burn
Removal of the chemical from contact with the patients body Begin flushing the area immediately with water Rapidly remove the patients clothing, especially shoes and socks do not waste time initially looking for specific anti dotes; copious flushing with water is more effective and more immediately available After finish, give of finally rinse dilute vinegar for alkali burn with baking soda (1 tsp per pint of water) for acid burn Never use any chemical antidotes in the eyes

 Electric Burn
Determine whether he/she is still in contact with current sources, if so he/she must be removed from contact beware of touching the patients or any conducting substance (wires, meta object, water, wet ground) with which he may be in contact Use rubber gloves and gloves protector if it is necessary to touch a patient who is still in contact in current sources Otherwise use a wooden pole, lasso or any other non conductive object Immediately check the patients airway, respiration, and pulse, and begin resuscitation if necessary If the patient have adequate vital signs, proceed with the secondary survey

 Lightning Injuries
Treatment
Triage Establish an airway If the patients is not breathing, begin artificial ventilation Check for pulse if absence, begin external cardiac compression Control external bleeding Start an IV fluid Monitor cardiac rhythm Cover opened wound with sterile dressing Immobilize patients on a long backboard

Prevention
Stay low in the outdoor Stay away from object that project from the ground; do not stand along side such things as trees, poles, or high building do not hold on to fishing pole, golf club, or other potential lightning rods If in a car, keep the windows tightly shut