injury and trauma

• The definition of injury is physical damage to the body caused by external force or over exertion.
• Thermal - including flame, radiation, or excessive heat from fire, steam, and hot liquids and hot objects.

  Chemical - including various acids, bases, and caustics.

  Electrical - including electrical current and lightning.

  Light - burns caused by intense light sources or ultraviolet light, which includes sunlight.

  Radiation - such as from nuclear sources. Ultraviolet light is also a source of radiation burns.
• Wallace's Rule of Nines estimates an adult’s burns using multiples of 9 representing different areas of the body.

  Head and neck represent 9%.

  Each lower extremity is 18%.

  Each upper extremity is 9%.

  Anterior and posterior torso are 18% each.

  For scattered burns, the palmar surface of the person's hand represents approximately 1%
• Different calculations are used for children and infants.
• First degree burns are superficial injuries that involve only the epidermis or outer layer of skin. The skin is reddened and extremely painful. 

  For example,

  • Mild sunburn
  • Mild steam burn
  • Straighteners contact no blister
• First degree burns will heal on its own without scarring within two to five days
• Second degree burns occur when the first layer of skin is burned through and the second layer, the dermal layer, is damaged but the burn does not pass through to underlying tissues.

  Second degree burns are considered minor if they involve less than 15 percent of the body surface in adults and less than 10 percent in children.
• Third degree burns involve all the layers of the skin. (B2.13) 

  They are referred to as full thickness burns and are the most serious of all burns. 

  This type of burn may require skin grafting. As third-degree burns heal, dense scars form.

  Skin grafts are taken from the thigh more often than not in an operation
• The body reacts as a response to injury with Inflammation 

  This is the immune system's response as a primary way to removing injurious stimuli and initiating the healing process.

  The defence response is the immune system's initial reaction
•  An injury and the inflammatory response is about increasing blood flow, vasodilation which causes redness. The blood carries mechanism to start clotting, healing and immunity.
• The metabolic                              response is                                    directly related to the supply of energy and protein substrates in order to protect tissue damage repair and critical organ functions. 

  The increased body oxygen consumption and metabolic rate are among these responses.

  Shock initially takes energy, an immune response does and then there is repair.
• Pain is a personal, individual and subjective (a matter of opinion/perception) experience. 

  The complex and dynamic nature of pain makes its assessment and management challenging for healthcare professionals.

  Various pain scales are available that can assist in identifying the patient’s experience of pain; however, these tend to reduce this experience to a measure of pain intensity.
• Healthcare providers have at least 11 types of pain scales to choose from. They generally fall into one of three categories:

  Numerical rating scales (NRS): Use numbers to rate pain eg. 1 to 10

  Visual analog scales (VAS): Ask you to select a picture that best matches your pain level 

  Categorical scales: Primarily use words, possibly along with numbers, colours, or location(s) on the body

  The scales may provide quantitative measurements, qualitative measurements, or both.
• non-verbal signs

  Signs and symptoms that a person may exhibit if they are in pain:

  • Facial grimacing or a frown
  • Writhing or constant shifting in bed
  • Moaning, groaning, or whimpering
  • Restlessness and agitation
  • Appearing uneasy and tense, perhaps drawing their legs up or kicking
  • Guarding the area of pain or withdrawing from touch to that area
• Swelling is the result of the increased movement of fluid and white blood cells into the injured area. 

  Some swelling will speed up healing but too much swelling slows down the healing process and can cause secondary problems as the injured person moves differently and can cause a strain elsewhere.
• The Triangle of Wound Assessment is a tool.

  It divides assessment of the wound into three areas: the wound bed, the wound edge, and the periwound skin, which is 4cm around the wound.
• The proliferative phase of wound healing is when the wound is ‘rebuilt’ with new tissue made up of collagen and extracellular matrix. 

  In the proliferative phase, the wound contracts as new tissues are built