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Soft Tissue Injuries


Dressing v Bandages

Dressings Function Stop bleeding Protect the wound from further injury Prevent further contamination/infection Types Universal dressings 4X4 gauze pads Adhesive-type Occlusive Bandages Function Holds dressings in place Types Self adherent Gauze rolls Triangular bandages/Cravats Adhesive Tape Air splint

Soft Tissue Injuries the Skin

Integumentary System Skin


Largest organ system in the body Protection from environment Temperature regulation Senses Heat, Cold, Touch, Pressure, Pain, etc. Vitamin D synthesis Storage



Outermost layer No blood vessels Protection, absorption of nutrients homeostasis Deeper layer Contains sweat/sebaceous glands, hair folicles, blood vessels, nerve endings Gives skin its flexibility


Subcutaneous layer

Fat layer Insulation, protective padding, energy storage

Soft Tissue Injuries Types


Skin is not broken Underlying tissue damage Leaky vessels = Edema Contusion/Hematoma


Any wound that breaks the skin Slight scrapping of skin --- amputation

Closed Injuries

Contusion (Bruise)

Epidermis remains intact Cells and vessels are damaged in dermis Swelling and pain Blood accumulated Collection of blood beneath the skin Larger tissue damage than contusion Larger vessels are damaged 1 + Liter of blood loss Crushing force applied to body Internal organ rupture Internal bleeding may be severe = Shock


Crush injuries

Soft Tissue Injuries Closed Injuries

Hematoma Hematoma Crush Injury

Care of Closed Injuries



Airway control Ventilation If shock or internal bleeding suspected

Treat for shock

Splint painful, deformed, swollen extremities Transport

Soft Tissue Injuries Open Injuries


Outermost layer of skin is sheered off Painful even though superficial No/very little oozing of blood Break in skin of varying depth May be linear or non linear Caused by forceful impact with sharp object Bleeding may be severe Flap of skin/tissue is torn loose or torn off



Soft Tissue Injuries Open Injuries

Abrasion Laceration

Soft Tissue Injuries Open Injuries


Caused by sharp pointed object May be no external bleeding Internal bleeding may be severe Exit wound may/may not be present

I.e. Gunshot wound, Stab wound


Cutting away from the body of a limb/protruding structure Extremities and other body parts Massive bleeding may be present OR Bleeding may be controlled Damage to soft tissue and internal organs May cause painful, swollen, deformed extremities External bleeding may be present of absent Internal bleeding may be severe

Crush Injury

Soft Tissue Injuries Open Injuries



Crush Injury

Care of Open Injuries


Gloves Gowns Eye protection

Maintain airway/Ventilation Expose the wound Control bleeding Prevent further contamination Apply dry sterile bandage to wound Secure in place Keep pt calm/quiet Treat for shock if S/S present

Special Cases: Chest/Abdomen/Impalement

Penetrating Chest Injury GSW

Evisceration Evisceration

Impaled Object

Chest Injuries

Flail Segment Traumatic Asphyxia Pneumothorax

Open- Sucking Chest Wound Closed

Hemothorax Pericardial Tamponade

Flail Segment

Definition: 4 or more ribs broken in 2 or more places Results in an unstable chest Presentation: Paradoxical motion Movement of flail segment inward with inspiration and outward with exhalation Splinting Patient reduces motion of the chest wall Dyspnea Pain Complications Hemothorax Pneumothorax Abdominal organ laceration/rupture Treatment O2 Apply bulky trauma dressing to injured area and secure in place OR Place patient with injured side down OR Place padded board splint over injured area and secure to adjacent ribs Assisted ventilations

Traumatic Asphyxia


Severe compression of the thorax Blood within the veins are drive into:

Upper Thorax, Neck, Brain


Sever swelling and ecchymosis of the face Air hunger DCAP-BTLS to chest Underlying injury O2 Positive pressure ventilation Rapid transport





Collection of air in the pleural space Results in a collapsed lung Open


Penetration of the chest Sucking Chest Wound Pneumothorax without an open wound to the chest Air entering the chest becomes trapped Increases intrathoracic pressure Collapses lung and shifts thoracic contents away from injury Closed and open pneumothorax can present



Normal Anatomy

Injury resulting in pneumothorax

Pneumothorax S/S, Treatment


SOB Chest pain Absent/diminished lung sounds on injured side Subcutaneous emphysema Cyanosis Tracheal deviation Profound shock JVD


Reduced surface area of lung =Hypoxia Kinking of vena cavae = Reduced blood volume = Shock


O2 Ventilatory assistance if needed See next slide for Sucking Chest Wounds if Open pneumothorax Rapid transport

Sucking Chest Wound: Treatment

Cover with gloved hand initially Ask patient to forcefully exhale Place an occlusive dressing over the wound Tape on 3 sides

Occlusive Dressing

Complete Seal with an Occlusive Dressing



Injured blood vessel in thorax Blood accumulates in pleural space Pneumothorax S/S Shock Flat neck veins Diminishes/distant lung sounds Tachypnea Shock Cardiac collapse/arrest O2 Treatment for shock Rapid transport




Pericardial Tamponade


Collection of blood/fluid in the pericardium Becks Triad Muffled heart sounds Narrowing pulse pressures Systolic BP- Diastolic BP 40mmHg or less Shock Pulsus Paradoxus A BP drop of 1OmmHg on inhalation



Decreased stroke volume Shock Cardiac collapse/arrest

O2 Prepare for arrest Rapid transport


Abdominal Injuries: Evisceration


Organs protruding through wound DO NOT TOUCH OR REPLACE the organ Cover with a sterile dressing moistened with sterile water Cover with a dry sterile dressing and tape in place Cover with plastic wrap Tape completely around the border of the dressing Flex the pts hips and knees, if uninjured


Impaled Objects


It is in the cheek

Bleeding control inside and outside of cheek Keep suction ready

Would interfere with chest compressions Interferes with transport Manually secure the object Expose the wound area Control bleeding Use a bulky dressing to help stabilize the object


Soft Tissue Injuries Amputations/Neck Wounds

Open neck wound
Air embolism

Amputations/Neck Wounds Treatment


Concerns for reattachment Wrap the part in a sterile dressing Wrap or bag the part in plastic and keep cool Transport part with the pt DO NOT COMPLETE PARTIAL AMPUTATIONS Immobilize to prevent further injury May cause air embolism Cover with an occlusive dressing Compress carotid artery ONLY if NECESSARY to control bleeding

Large open neck injuries

Eye Injuries

Impaled Objects:

NEVER REMOVE Stabilize object with several 4X4s Cover with paper cup/cardboard cone Have patient close other eye OR dress it as well.


Sources Thermal Electrical - Chemical Types Superficial (1st degree) Upper level of the skin (epidermis) Redness and pain Sunburn Partial Thickness (2nd degree) Upper and lower level of skin (Epidermis/Dermis) Does not involve underlying tissue White to red skin Moist to mottled BLISTERS VERY painful Full Thickness (3rd degree) Extension through upper and lower layers of skin May involve subcutaneous layers, muscles, or bone Black/charred red, Yellow/Brown, Dark red, White/Translucent Hard to touch Little pain, pain from associated 1st and 2nd degree burns

Burn Severity Rule of 9s

Depth of burn

Superficial Partial thickness Full thickness

Percentage of body surface burned

Rule of 9s Pt palm = 1% Adult


Head and neck = 9% Each upper extremity= 9% Anterior trunk = 18% Posterior trunk = 18% Each lower extremity = 18% Genitalia= 1 %....\

Head and neck = 18% Each upper extremity= 9% Anterior trunk = 18% Posterior trunk = 18% Each lower extremity = 14%

Burn Severity Contd


Face Upper airway Hands Feet Genitalia

Pre existing medical conditions Age of pt

Less than 5 y/o Greater than 55 y/o

Criticality of Burns

CRITICAL BURNS Body Surface Area

Moderate Burns Body Surface Area

Full thickness 10% Partial thickness- 30%

Full thickness- 2-10%


Excludes: - Hands Feet Face Genitalia Respiratory tract

Full thickness Hands/Feet Burns assoc with resp. injury

Burns encompassing any body part

Partial Thickness- 15-30% Superficial burn Greater than 50%


Minor Burns Body Surface Area

i.e. Leg, -Arm, -Chest

Full thickness- 2-10%

Painful, swollen, deformed extremity Moderate burns of

Excludes: - Hands Feet Face Genitalia Respiratory tract


Partial Thickness- 15-30% Superficial burn Greater than 50%

Young Children Elderly pts

Burn Care

Stop the burning process, initially with water/saline Remove smoldering clothing/jewelry BSI CONTINUALLY monitor airway for compromise Prevent further contamination Cover the burned area with a DRY sterile dressing Do no use any lotion, ointment, or antiseptic Do not break blisters Transport Refer to local protocols for transport decision

Electrical Burns

SCENE SAFE Do not remove pt from source unless trained to do so If pt still in contact with source or you are unsure DONT touch the pt Emergency Care O2 Monitor CLOSELY for respiratory and/or cardiac arrest Often more severe than external indications Treat associated soft tissue injuries Note entrance and exit wounds

Chemical Burns Care


Dry Powders = Brush off Flush with large amounts of water

20 minutes

Continue flushing area while en route Do not contaminate uninjured areas

Soft Tissue Injuries Infant/Child Considerations


Greater surface area v body size Greater fluid/heat loss Higher risk of

Shock Hypothermia Airway compromise

Consider possibility of child abuse Critical

Critical Burn Values

Full Thickness OR Partial thickness greater than 20% Hands, feet, face, genitalia, or airway Partial thickness greater than 10-20%


Minor Partial thickness less than10%

Now go and treat soft tissue injuries.

Reason #1 why youre supposed to wear a helmet!