1. Soft Tissue Injuries: Cuts, Scrapes & Bruises Soft tissues are the layers of skin and the fat and muscle beneath the skin’s outer layer.

2. Soft Tissue Injuries Any time the soft tissues are damaged or torn, the body is threatened. Injuries may damage the soft tissues at or near the skin’s surface or deep in the body. Severe bleeding can occur at the skin’s surface and under it, where it is harder to detect.

3. Soft Tissue Injuries Germs can get into the body through a scrape, cut or puncture and cause infection. Burns are a special kind of soft tissue injury. Wounds: *closed wounds *open wounds

4. Wounds An injury to the soft tissue is considered a wound. In a closed-wound, the skin’s surface is not broken and the damage happens below the surface, where bleeding sometimes occurs. In an open-wound, the skin’s surface is broken and blood may come through the tear in the skin.

5. Signals of Internal Bleeding Tender,swollen, bruised or hard areas of the body, such as the abdomen Rapid, weak pulse Skin that feels cool or moist or looks pale or bluish Vomiting blood or coughing up blood Excessive thirst Confused, faint, drowsy, unconscious

6. Closed Wounds Simplest closed wound – bruise Caused by force of a blow to the body damaging soft tissue layers beneath the skin, causing internal bleeding Area tends to swell and change color

7. Caring for Closed Wounds Many closed wounds do not require special medical care. Apply direct pressure on the area to decrease bleeding beneath the skin. Apply cold compress to help control pain and swelling. (Place thin barrier between ice and bare skin) – Apply for 20 minutes, remove for 20 minutes.

8. Caring for Closed Wounds Elevating the injured part may help reduce swelling – however, do not elevate if it causes more pain! Call 9-1-1 if: – A person complains of severe pain or cannot move a body part without pain – You think the force that caused the injury was great enough to cause serious damage – An injured extremity is blue or extremely pale

9. Closed Wounds Help the person rest in the most comfortable position Keep the person from getting chilled or overheated Reassure that a person with an injured lower extremity does not bare weight until advised by a medical professional

10. Infection Best defense: clean area For minor wounds, wash with soap and water Do not wash wounds that require medical attention – more important to control bleeding Maintain up-to-date immunizations *example: tetanus – needed every 10 years

11. Infection Recognizing early signals – Swollen – Red – Warm – Throbbing with pain – Discharging of pus – Fever – Red streaks

12. Infection If see signs of infection – Keep area clean – Soak in warm water – Apply triple-antibiotic ointment – Change bandage daily

13. Open Wounds Four main types: Abrasions Lacerations Avulsions Punctures

14. Open Wounds Abrasions Most common Caused by something rubbing against skin Do not bleed very much Important to clean thoroughly with soap and water to prevent infection Also called a scrape, rug burn, road rash, strawberry Usually painful because nerve endings are exposed

15. Open Wounds Lacerations Cut in the skin Commonly caused by sharp object Can happen with blunt force – splits skin If deep, can cut layers of fat and muscle, damage nerves and blood vessels Can bleed heavily or not at all Not always painful (if nerve damage) Easily infected if not cared for properly

16. Open Wounds Avulsions Injury in which a portion of skin and other soft tissue is partially or completely torn away Caused by violent force (amputation) Damages deeper tissues Bleeding significant Easier to control bleeding if completely torn away, tissues close around vessels at injury site

17. Open Wounds Punctures Caused by pointed object, piercing skin Do not bleed very much unless blood vessel is injured Can carry germs deep into body causing infection If object remains in wound - embedded object

18. Caring for Open Wounds All open wounds need some type of covering to help control bleeding and prevent infection Referred to as dressing and bandages Dressings are pads placed directly on the wound to absorb blood and other fluids and to prevent infection Dressings should be sterile Most dressings are porous, allowing air circulation to promote healing

19. Caring for Open Wounds Standard dressings include various sizes of cotton gauze Larger dressings are used to cover very large wounds and multiple wounds in one body area Some have nonstick surfaces

20. Caring for Open Wounds An occlusive dressing is a bandage or dressing that closes a wound or damaged area preventing air exposure Help prevent infection Keep medication on wound Keep in heat, body fluids and moisture Example: plastic wrap Used for certain chest and abdominal injuries

21. Bandages Any material that is used to wrap or cover any part of the body Used to hold dressings in place Used to apply pressure to control bleeding Used to protect wound from dirt and infection Used to provide support to an injured limb or body part

22. Bandages Any bandage applied snuggly to create pressure on a wound or an injury is called a pressure bandage

23. Bandages Types – Adhesive compresses – Bandage compresses – Roller bandages

24. Stitches Are needed when edges of skin do not fall together Are needed if on face Are needed if wound is over ¼ inch long

25. Stitches Speed healing process Lessen chances of infection Improve appearance of scars Should be done within first few hours of injury

26. Stitches Required when: – Bleeding from an artery or uncontrolled bleeding – Wounds that show muscle or bone, involve joints, gape widely or involve hands or feet – Wounds from large or deeply embedded objects – Wounds from human or animal bites – Wounds that, if left unattended, could leave conspicuous scars (especially on face)

27. Stitches Once applied, stitches are easily cared for by gently applying a triple-antibiotic ointment to the skin around them, once or twice daily If wound gets red or swollen or if pus begins to form, notify a health-care provider Often removed in 6 to 10 days Some dissolve naturally

28. Bandaging Read pages 115 -117 in Red Cross Book Note how to apply various bandages

29. Bandaging Practical quiz to be given on bandaging Date TBA

30. Minor Open Wounds Abrasions Small amount of damage and bleeding Care: – Use a barrier between your hand and the wound (wear disposable gloves and put sterile dressing on wound) – Apply direct pressure for a few minutes to control bleeding

31. Minor Open Wounds Care (cont.): – Wash the wound thoroughly with soap and water (if possible, irrigate for 5 minutes with clean, running tap water) – Apply triple-antibiotic ointment or cream if no known allergies/sensitivities to medication – Cover wound with sterile dressing/bandage if still bleeding slightly or if area is likely to come into contact with dirt or germs

32. Major Open Wounds Has serious tissue damage and severe bleeding Must act at once (Do not waste time washing wound) Care: – Call 9-1-1 or local emergency number – Put on disposable gloves – If needed eye protection (if blood might spatter)

33. Major Open Wounds Care (cont.): – Control bleeding by Covering wound with dressing and applying pressure with gloved hand Applying pressure bandage over dressing to maintain pressure on wound and hold dressing in place – If blood soaks through bandage, do not remove it – add more dressings and bandages to help absorb blood

34. Major Open Wounds Care (cont.): – Continue to monitor person’s ABCs – Observe closely for signs of person’s condition is worsening, such as faster or slower breathing, changes in skin color and restlessness – Keep person from getting chilled or overheated – Have person rest comfortably and reassure him/her – Wash your hands immediately after giving care

35. Burns Classified by their sources: – Heat – Chemicals – Electricity – Radiation – includes sunburns

36. Burns Also classified by depth – First degree: superficial – Second degree: partial thickness – Third degree: full thickness

37. Characteristics of Burns First degree – Involves only top layer of skin – Skin is red and dry, usually painful and may swell – Usually heals within a week without permanent scarring

38. Characteristics of Burns Second degree – Involves top layers of skin – Skin is red; usually painful; has blisters that may open and weep clear fluid, skin appears wet, mottled – Often swollen – Usually heals in 3 to 4 weeks and may scar

39. Characteristics of Burns Third degree – May destroy all layers of skin and some or all of underlying structures ( fat, muscles, bones, nerves) – Skin may be brown or black (charred) with tissue underneath appearing white – Can be extremely painful or relatively painless – Healing may require medical assistance – Scarring is likely

40. Caring for Burns Thermal (heat) burn: – Check scene for safety – Stop burning by removing person from source of burn – Check for life-threatening conditions – Cool the burn with large amounts of cold running water – Cover burn loosely with sterile dressing – Prevent infection – Take steps to minimize shock – Keep person from getting chilled or overheated – Comfort and reassure

41. Caring for Burns DO NOT: – Apply ice or ice water except on a small, superficial burn and then for no more than 10 minutes (Ice can cause body to lose heat and further damage to delicate tissues) – Touch a burn with anything except a clean covering – Remove pieces of clothing that stick to the burned area – Try to clean a severe burn – Break blisters – Use any kind of ointment on a severe burn

42. Caring for Burns Chemical burns: – Important to remember that chemical will continue to burn as long as it is on the skin – Must remove chemical from body as quickly as possible – If burn was caused by dry chemicals, brush off chemicals using gloved hands before flushing with tap water (under pressure) – Be careful not to get chemicals on yourself or victim – Flush burn with large amounts of cool running water. Continue flushing burn for at least 20 minutes or until EMS personnel arrive

43. Caring for Burns Chemical burns (cont.): – If an eye is burned by a chemical flush affected eye with water until EMS personnel arrive. Tip head so that the affected eye is lower than the unaffected eye as you flush – If possible, have person remove contaminated clothes to prevent further contamination while you continue to flush area – Be aware that chemicals can be inhaled damaging airway or lungs

44. Caring for Burns Electrical Burns: – Never go near the person until sure he or she is not still in contact with power source – Call 9-1-1 in case of high voltage electrocution – Turn off power at its source and care for any life-threatening conditions – Be aware that electrocution can cause cardiac and respiratory emergencies – Be prepared to give CPR or defibrillation – Care for shock and thermal burns – Remember that anyone suffering from electric shock requires advanced medical care

45. Caring for Burns Radiation (Sun) Burns: – Care as you would other burns – Always cool the burn and protect area from further damage by keeping out of sun

46. Critical Burns Require medical attention Potentially life threatening, disfiguring, and disabling Difficult to tell if a burn is critical Even superficial burns can be critical if affect large area or certain body parts Cannot judge by amount of pain

47. Critical Burns Always call 9-1-1 or local emergency number if burned person – – Has trouble breathing – Has burns covering more than one body part or a large surface area – Has suspected burns to airway (burns to nose and mouth may signal this) – Has burns to head, neck, hands, feet or genitals – Has a full-thickness burn and is younger than 5 or older than 60 – Has a burn resulting from chemicals, explosions or electricity

48. Preventing Burns Heat burns can be prevented by preventing fire and by being careful around sources of heat. Chemical burns can be prevented by following manufacturer’s guidelines when handling chemicals. Electrical burns can be prevented by following safety practices around electrical lines and equipment and by leaving outdoor areas when lightning could strike. Sunburn can be prevented by wearing appropriate clothing and using sunscreen with sun protection of SPF of at least 15.

49. Special Situations Severed Body Parts – Call 9-1-1 – Try to find missing part – Wrap it in sterile gauze or any clean material – Put wrapped part in plastic bag – Keep part cold by placing bag on ice, but do not freeze. – Be sure the part is taken to hospital with person, doctors may be able to reattach it

50. Special Situations Embedded Objects – Do not remove it! – Place several dressings around it to keep it from moving – Bandage dressings in place around object – If splinter close to surface, remove with tweezers if not in eye (If in eye call 9-1-1) After removal, wash area with soap and water for about 5 minutes – dry area – apply triple-antibiotic ointment, and cover to keep it clean

51. Special Situations Nose Injuries – Usually caused by blow from a blunt object – Results in nosebleed – High blood pressure or changes in altitude can also cause nosebleeds – Can be controlled by having person sit with head slightly forward while pinching the nostrils together for about 10 minutes – Can also use ice pack (non-chemical) to the bridge of nose or putting pressure on upper lip just beneath nose.

52. Special Situations Remember ice should not be applied directly to skin, it can damage skin tissue. Place a cloth between the ice and the skin Seek medical attention if bleeding persists or recurs or if person says it results from high blood pressure.

53. Special Situations Mouth Injuries – Make sure person is able to breathe – May cause breathing problems or loose teeth that can obstruct airway – If bleeding from mouth, do not suspect head, neck or back injury, place person in seated position with head tilted slightly forward – If possible place person on side in recovery position to allow blood to drain from mouth.

54. Special Situations Lip injuries – Place a rolled dressing between the lip and gum – You can place another dressing on the outer surface of the lip – If tongue is bleeding, apply dressing and direct pressure – Applying cold to lips or tongue can help reduce swelling and ease pain

55. Special Situations Tooth injuries – If tooth is knocked out, control bleeding and save tooth for possible reinsertion – When fibers and tissues are torn from socket, it is important for the person to seek dental care within 30 minutes to an hour after the injury – If person is conscious and able to cooperate, rinse out mouth with cold tap water if available – Control bleeding by placing a rolled sterile dressing into the space left by missing tooth – Have victim gently bite down to maintain pressure – Place tooth in milk or cool water – Be careful to pick up tooth by crown rather than by the root

56. Special Situations Injuries to Chest – Leading cause of trauma deaths yearly – Can be caused by motor vehicle accidents, falls, sports mishaps or crushing or penetrating forces – May involve bones of chest cavity or organs and structures in the cavity – Either open or closed

57. Special Situations Open chest wound – Occur when an object penetrates the chest wall – Fractured ribs may break through the skin to cause and open chest injury *Closed chest wound - does not break skin - generally caused by blunt objects, like steering wheel

58. Special Situations Signals of serious chest injury – Trouble breathing – Severe pain at site of injury – Flushed, pale, ashen, or bluish skin – Obvious deformity, possible fracture – Coughing up blood (may be bright red or dark like coffee grounds) – Bruising at site of a blunt injury (seatbelt) – A “sucking” noise or distinct sound when person breathes

59. Special Situations Rib Fractures – Usually caused by direct force to chest – Painful – If simple fracture, usually not life threatening – Breathing is shallow – Victim usually tries to support injured area with hand or arm – Less common in children (more flexible)

60. Special Situations In children, forces that can cause fractures in adults can severely bruise the lung tissue which can be life- threatening Look for signals – Bruising on chest – Trouble breathing

61. Special Situations Care for Rib Fractures – Have person rest in a position that makes breathing easier – Do not move person if suspect head, neck, or back injury – Call 9-1-1 – Bind person’s upper arm to the chest on injured side to make breathing easier – Can use pillow or rolled blanket to support and immobilize area – Monitor breathing and skin condition – Take steps to minimize shock

62. Special Situations Puncture Wounds to Chest – Range from minor to life threatening – Stab and gunshot wounds are examples – Penetrating object can injure any structure or organ within the chest, including lungs – Puncture injury can allow air to enter chest through wound – Air in chest cavity does not allow lungs to function normally

63. Special Situations Puncture wounds cause varying degrees of internal and external bleeding Puncture wound to chest is a life threatening injury Hear a sucking sound coming from wound with each breath Call 9-1-1 Condition will cause lungs to fail to function and breathing will become more difficult

64. Special Situations Care for a Sucking Chest Wound – Cover wound with large occlusive dressing – A piece of plastic wrap or plastic bag folded several times should be placed over the wound if no occlusive dressing available – Tape dressing in place, keeping one side or corner loose. – Call 9-1-1 – Take steps to minimize shock

65. Special Situations Abdominal Injury – Can be open or closed – Can be very painful – Even with closed wound, rupture of organ can cause serious internal bleeding resulting in shock – Difficult to determine, especially if unconscious

66. Special Situations Abdominal Injury Signals – Severe pain- Pain, tenderness, in – Bruising abdomen (tight) – External bleeding- Organs protruding – Nausea- Rigid abdominal – Vomiting (can contain blood)muscles – Weakness- Other signals of – Thirst shock

67. Special Situations Care for Abdominal Injuries – Abdominal organs sometimes protrude through wound – Should : Call 9-1-1 – Put on disposable gloves or use another barrier – Carefully position the person on his or her back with knees bent, if position does not cause pain – Do not apply direct pressure – Do not push any protruding organs back in – Remove clothing from around wound – Apply moist, sterile dressings loosely over wound – Cover dressing loosely with plastic wrap, if available