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Soft Tissue Injuries

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Skin Functions• Protection

– Barrier to keep out microorganisms, debris and chemicals.

– Tissues & organs are protected from environment

• Water Balance– Prevents water loss & stops

environmental water from entering body

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Skin Functions• Temperature Regulation

– Blood vessels dilate to carry more blood to skin allowing heat to radiate from the body – constrict to prevent heat loss

• Excretion– Salts and excess water can be released

through the skin

• Shock (impact/absorption)– Skin and its layers of fat help protect the

underlying organs

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Skin Anatomy and Physiology• Body’s largest organ• Three layers

– Epidermis – Outer layer of skin (composed of 4 layers) consisting of dead cells constantly being rubbed off and replaced.

– Dermis – layer of skin below the epidermis. Rich in blood vessels and special structures such as sweat glands, oil glands, hair follicles, blood vessels. Specialized nerve endings allow for sense of touch, feeling heat/cold and pain

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– Subcutaneous tissue – layers of fat and soft tissue. Acts as shock absorption and as a body insulator

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Soft Tissue InjuriesCLOSED

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Contusion (Bruise)• Produced when blunt force damages

dermal structures

• Blood leaks into damaged area causing swelling & pain

• Presence of blood causes skin discoloration called ecchymosis (bruise)

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Hematoma• Collection of blood beneath the

skin

• Larger amount of tissue damage as compared to contusion

• Larger vessels are damaged

• Patient may lose one or more liters of blood

• Fist-sized hematoma = 10% volume loss

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Crush Injuries• Crushing forces cause damage to soft tissue

and internal organs

• May cause painful, swollen, deformed extremities

• External bleeding may be minimal or absent

• Can cause internal organ rupture

• Internal bleeding may be severe with shock (hypoperfusion)

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Emergency Medical Care

• PPE for BSI• Maintain airway and provide oxygen

as needed• If shock or internal bleeding is

suspected, treat for shock• Splint a painful, swollen deformed

extremity• Transport

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Closed Injury Management• Rest

• Ice

• Compression

• Elevate

• Splint

When in doubt assume underlying fractures are

present

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Soft Tissue InjuriesOPEN

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Open Injury Types

• Abrasions

• Lacerations

• Punctures

• Avulsions

• Amputations

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Abrasion• Outermost layer of the skin is damaged by

rubbing or scraping force. “Road rash”

• Can be a painful injury, even though superficial

• There is very little or no oozing of blood. Usually associated with capillary oozing, leaking of fluid

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Laceration• Break in skin of varying depth

• Typically longer than it is deep

• Caused by forceful impact with sharp object

• Bleeding may be severe

• Types

– Linear (regular)

– Stellate (jagged/irregular)

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Avulsions

• Piece of skin torn loose as a flap or completely torn from body

• Result from accidents with machinery and motor vehicles

• Replace flap into normal position before bandaging

• Treat completely avulsed tissue like amputated part

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Penetration/PuncturesA. Penetrating puncture

Can be shallow or deep Only entrance wound

B. Perforating puncture Has both an entrance and exit wound

• Caused by a sharp pointed object• Wound is deeper than it is long• Difficult to assess extent of injury – may not be

external bleeding• Examples

– Gun Shot Wound– Stab Wound

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Gunshot Wounds

• Gunshot wounds have unique characteristics – entrance/exit wounds

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Open Wound Management

1. PPE for BSI

2. Manage ABCs first – consider oxygen

3. Expose wound

4. Control bleeding

5. Prevent further contamination

6. Apply dry sterile dressing to the wound and bandage securely in place

7. Keep the patient calm & quiet

8. Manage hypoperfusion if present

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Special Considerations

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Chest Injuries• Pneumothorax

– occurs when the lung collapses as a result of air entering the chest cavity (SUCKING CHEST WOUND)

• Tension pneumothorax– found in closed chest injuries or when

the chest is sealed with an occlusive dressing.

– Pressure builds & puts pressure on the heart, lungs, and vessels

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Chest Injuries• Hemothorax

– occurs when the chest fills with blood. May lead to shock

• Hemopneumothorax– when the chest fills with blood and air. May

also lead to shock

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Chest Tube – releases air and allows lung to re-inflate

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Chest Injuries• Traumatic Asphyxia

– sudden compression of the chest, sternum and ribs

– exerts severe pressure on the heart and lungs, forcing blood out of the right atrium and up into the jugular veins

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Chest Injuries• Cardiac Tamponade

– Injury to the heart – Causes blood to flow into the

surrounding pericardial sac– Unyielding sac fills with blood &

compresses the chambers of the heart to the point they no longer fill adequately, backing up blood into the veins

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Care for Chest Wounds• Administer oxygen

• Cover with occlusive dressing – secure only on 3 sides

• Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax)

• If tension pneumo develops lift corner of dressing to relieve pressure

• Treat for shock

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Flutter Valve – InspirationFlutter Valve – Inspiration

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Flutter Valve – ExhalationFlutter Valve – Exhalation

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Eviscerations• Internal organs exposed through wound in the

abdomen

• Do NOT touch or attempt to replace organs

• Cover exposed organs with large moistened sterile dressing

• Flex the patient’s hips and knees, if uninjured

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Impaled Objects• Do NOT remove; unless it is through

the facial cheek, would interfere with chest compressions, or interferes with transport

• Manually secure & stabilize in place using bulky dressings

• Control bleeding

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Amputations• Part should be wrapped in sterile gauze

• Wrap or bag the amputated part in plastic

and keep COOL• Transport amputated part with the patient

• Do NOT pack part directly in ice

• Do NOT let part freeze

• Do NOT complete partial amputations

• Immobilize to prevent further injury

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Neck Wounds• Risk of air entering vein and moving

through heart to lungs (air embolism)

• Cover with occlusive dressing

• Do NOT occlude airway or blood flow to brain

• Compress carotid artery ONLY if necessary to control bleeding

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BurnsClassification – according to depth

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First Degree (Superficial)– Involves only

epidermis

– Red

– Painful

– Possible swelling, no blisters

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Second Degree (Partial Thickness)– Extends through

epidermis into dermis

– Salmon pink

– Moist, shiny

– INTENSE PAIN

– Blisters may be present

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Third Degree (Full Thickness)– Through epidermis,

dermis into muscle, bone or organs

– Skin dry and leathery and may appear white, dark brown or charred

– May bleed from vessel damage

– Painless

– Require grafting

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Severity

Based on depth or degree of the burn:

a. Superficial

b. Partial thickness

c. Full thickness

Percentage of body area burned – size of the patient’s hand is equal to 1%

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Rule of NinesAdult

a. Head & Neck – 9%

b. Each upper ext. – 9%

c. Anterior trunk – 18%

d. Posterior trunk – 18%

e. Each lower ext. – 18%

f. Genitalia – 1%

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Infanta. Head & Neck – 18%b. Each upper ext. – 9%c. Anterior trunk – 18%d. Posterior trunk – 18%e. Each lower ext. – 14%f. Genitalia – 1%

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Location of Burn – Special Concern1. Face & Upper airway – respiratory

system2. Hands & Feet3. Genitalia

Infants/Elderly or preexisting medical problems may be of concern

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Determine Severity of Burns

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Critical Burns• Full thickness burns of the hands, feet, face or

genitalia• Burns associated with respiratory injury• Full thickness burns covering more than 10% of

the body surface• Partial thickness burns covering more than 30%

of body surface• Burns complicated by painful, swollen deformed

extremity• Moderate burns in young children and elderly

patients• Burns encompassing any body part (ex. Arm, leg

or chest)

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Moderate Burns• Full thickness burns of 2% to 10% of the

body surface (excluding hands, feet, face, genitalia & upper airway)

• Partial thickness burns of 15% to 30% of body surface

• Superficial burns of greater than 50% of body surface

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Mild Burns• Full thickness burns of less than 2% of

body surface

• Partial thickness burns of less than 15% of body surface

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Emergency Care for Burns1. Stop the burning process, initially with water

or saline2. Remove smoldering clothing & jewelry3. PPE for BSI4. Continually monitor the airway for evidence

of closing5. Prevent further contamination6. Cover burned area with dry, sterile dressing7. Do not use any type of ointment, lotion or

antiseptic8. Do not break blisters9. Transport to appropriate facility

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Infants and Children

1. Greater surface area in relationship to total body size

2. Results in greater fluid and heat loss3. Any full or partial thickness burn greater than

20% or burns involving hands, feet, face, airway or genitalia

4. Any partial thickness burn of 10% to 20% is moderate burn

5. Any partial thickness burn less that 10% is a minor burn

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Infants and ChildrenAre at higher risk for shock, airway problems, or

hypothermia.

Consider the possibility of child abuse

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Chemical Burns

Take necessary scene safety precautions to protect yourself

Wear gloves and eye protection

Phosphorous Burns

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Emergency Medical Care

• Remove chemical from skin

• Liquids

– Flush with large amounts of water

• Dry chemicals

– Brush away

– Flush what remains with water

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Electrical Burns

Scene Safety

1. DO NOT ATTEMPT TO REMOVE PATIENT FROM THE ELECTRICAL SOURCE unless trained to do so

2. If the patient is still in contact with electrical source or you are unsure, DO NOT touch the patient

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Electrical Burns Emergency Care

• ABC’s & oxygen• Monitor patient for respiratory & cardiac

arrest (consider need for AED)• Massive internal tissue damage that may

not be easily seen• Treat soft tissue injuries associated with

burn. Look for both entrance and exit wounds

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