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1 Soft Tissue Injuries. 2 Skin Anatomy and Physiology Body’s largest organ Body’s largest organ Three layers: Three layers: Epidermis Epidermis Dermis.

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Presentation on theme: "1 Soft Tissue Injuries. 2 Skin Anatomy and Physiology Body’s largest organ Body’s largest organ Three layers: Three layers: Epidermis Epidermis Dermis."— Presentation transcript:

1 1 Soft Tissue Injuries

2 2 Skin Anatomy and Physiology Body’s largest organ Body’s largest organ Three layers: Three layers: Epidermis Epidermis Dermis Dermis Subcutaneous tissue Subcutaneous tissue

3 3 Skin Anatomy and Physiology Complex system, variety of functions Complex system, variety of functions Sensation Sensation Control of water loss Control of water loss Protection against microbes Protection against microbes Temperature control Temperature control

4 4 Assessment

5 5 Wear BSI. Wear BSI. Do not touch equipment with bloody gloves; wear several pairs. Do not touch equipment with bloody gloves; wear several pairs. Beware of contaminating one patient with another patient’s blood. Beware of contaminating one patient with another patient’s blood. Wear eye protection. Wear eye protection. Consider MOI. Consider MOI. Scene Size-up

6 6 Decide SICK/NOT SICK. Decide SICK/NOT SICK. There may be internal underlying injuries. There may be internal underlying injuries. Injuries can affect airway and breathing. Injuries can affect airway and breathing. Provide spinal immobilization. Provide spinal immobilization. Open chest wound? Evaluate for bubbling or sucking sounds. Open chest wound? Evaluate for bubbling or sucking sounds. Initial Assessment

7 7 Quickly place an occlusive dressing over wound (SCW) Quickly place an occlusive dressing over wound (SCW) Provide high-flow oxygen. Provide high-flow oxygen. Assess pulse and skin for shock. Assess pulse and skin for shock. Control significant bleeding. Control significant bleeding. Initial Assessment

8 8 Focused physical exam Focused physical exam Focus on isolated injury, complaint, and affected body region. Focus on isolated injury, complaint, and affected body region. Rapid physical exam Rapid physical exam Perform if there is significant trauma affecting multiple systems. Perform if there is significant trauma affecting multiple systems. Look for DCAP-BTLS. Look for DCAP-BTLS. Be sure that spine is stabilized. Be sure that spine is stabilized. Focused Exam

9 9 Perform if patient is stable and time allows. Perform if patient is stable and time allows. Detailed Exam

10 10 Reassess all bandaging. Reassess all bandaging. Reassess ABCs. Reassess ABCs. Communication and documentation Communication and documentation Include description of MOI and patient’s position. Include description of MOI and patient’s position. Describe location, size, depth of injury. Describe location, size, depth of injury. Provide accurate account of how you treated injuries. Provide accurate account of how you treated injuries. Ongoing Assessment

11 11 Baseline Vitals/SAMPLE Baseline vital signs Baseline vital signs Will help determine if patient is going into shock Will help determine if patient is going into shock SAMPLE history SAMPLE history Anemia and hemophilia Anemia and hemophilia Medications that thin the blood (aspirin, prescribed blood thinners) Medications that thin the blood (aspirin, prescribed blood thinners)

12 12 Soft Tissue Injuries Closed Closed Open Open Burns Burns

13 13 Closed Injury Associated with blunt trauma Associated with blunt trauma Skin remains intact Skin remains intact Damage occurs below skin surface Damage occurs below skin surface Types: Types: Contusions Contusions Hematomas Hematomas

14 14 Contusion Blunt force damages dermal structures Blunt force damages dermal structures Blood, fluid leak into injury area (pain/swelling) Blood, fluid leak into injury area (pain/swelling) Ecchymosis Ecchymosis

15 15 Hematoma Larger vessel damage with mass of blood collecting at injury site Larger vessel damage with mass of blood collecting at injury site Fist-sized = 10% volume loss Fist-sized = 10% volume loss

16 16 Closed Soft Tissue Injury Considerations: Considerations: How much blood is tied up in that injury rather than circulating in the vessels? How much blood is tied up in that injury rather than circulating in the vessels? What could the force that caused the soft tissue trauma have done to underlying organs? What could the force that caused the soft tissue trauma have done to underlying organs?

17 17 BLS Care Request ALS if indicated Request ALS if indicated O2, assist ventilations O2, assist ventilations Maintain airway, breathing, c-spine Maintain airway, breathing, c-spine RICE RICE Maintain body temperature Maintain body temperature Monitor vital signs Monitor vital signs Calm and reasssure Calm and reasssure Transport Transport

18 18 Closed Injury Management Rest Rest Ice Ice Compression Compression Elevation Elevation Splint Splint

19 19 Open Injury Skin broken Skin broken Protective function lost Protective function lost External bleeding, infection become problems External bleeding, infection become problems

20 20 Open Injury Types Abrasions Abrasions Lacerations Lacerations Punctures Punctures Avulsions Avulsions Amputations Amputations

21 21 Abrasion Loss of portions of epidermis, upper dermis by rubbing or scraping force. Loss of portions of epidermis, upper dermis by rubbing or scraping force. Usually associated with capillary oozing, leaking of fluid Usually associated with capillary oozing, leaking of fluid “Road rash” “Road rash”

22 22 Abrasion

23 23 Laceration Cut by sharp object Cut by sharp object Typically longer than it is deep Typically longer than it is deep May be associated with severe blood loss, damage to underlying tissues May be associated with severe blood loss, damage to underlying tissues Types Types Linear Linear Stellate Stellate

24 24 Lacerations

25 25 Punctures Result from stabbing force Result from stabbing force Wound is deeper than it is long Wound is deeper than it is long Difficult to assess injury extent Difficult to assess injury extent Object producing puncture may remain impaled in wound Object producing puncture may remain impaled in wound

26 26 Puncture Wounds

27 27 Avulsions Piece of skin torn loose as a flap or completely torn from body Piece of skin torn loose as a flap or completely torn from body Result from accidents with machinery and motor vehicles Result from accidents with machinery and motor vehicles Replace flap into normal position before bandaging Replace flap into normal position before bandaging Treat completely avulsed tissue like amputated part Treat completely avulsed tissue like amputated part

28 28 Avulsions

29 29 Amputations Disruption of continuity of extremity or other body part Disruption of continuity of extremity or other body part Part should be wrapped in sterile gauze, placed in plastic bag, transported on top of cold pack Part should be wrapped in sterile gauze, placed in plastic bag, transported on top of cold pack Do NOT pack part directly in ice Do NOT pack part directly in ice Do NOT let part freeze Do NOT let part freeze

30 30 Amputations

31 31 Open Wound Management Manage ABCs first Manage ABCs first Position of comfort Position of comfort Control bleeding Control bleeding Prevent further contamination, but do not worry about trying to clean wound Prevent further contamination, but do not worry about trying to clean wound Immobilize injured part Immobilize injured part Mange hypoperfusion if present (O2) Mange hypoperfusion if present (O2)

32 32 Special Considerations Impaled objects Impaled objects Eviscerations Eviscerations Open chest wounds Open chest wounds Neck wounds Neck wounds Gunshot wounds Gunshot wounds Crush Injuries Crush Injuries Injection Injuries Injection Injuries

33 33 Impaled Objects Do NOT remove Do NOT remove Stabilize in place Stabilize in place Exception: Exception: Object in cheek Object in cheek Remove, dress inside and outside mouth Remove, dress inside and outside mouth

34 34 Imapled Objects

35 35 Eviscerations Internal organs exposed through wound Internal organs exposed through wound Cover organs with large unmoistened dressing, then with aluminum foil or dry multi-trauma dressing Cover organs with large unmoistened dressing, then with aluminum foil or dry multi-trauma dressing Do NOT use individual 4 x 4’s Do NOT use individual 4 x 4’s Do NOT attempt to replace organs Do NOT attempt to replace organs

36 36 Eviscerations

37 37 Open Chest Wound May prevent adequate ventilation May prevent adequate ventilation Cover with occlusive dressing Cover with occlusive dressing Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax) Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax) If tension pneumo develops lift dressing corner to relieve pressure If tension pneumo develops lift dressing corner to relieve pressure

38 38 Open Chest Wounds

39 39 Neck Wounds Risk of severe bleeding from large vessels Risk of severe bleeding from large vessels Risk of air entering vein and moving through heart to lungs Risk of air entering vein and moving through heart to lungs Cover with occlusive dressing Cover with occlusive dressing Do NOT occlude airway or blood flow to brain Do NOT occlude airway or blood flow to brain Suspect presence of spinal injury Suspect presence of spinal injury

40 40 Neck Wounds

41 41 Gunshot Wounds Special type of puncture wound Special type of puncture wound Transmitted energy can cause injury remote from bullet track Transmitted energy can cause injury remote from bullet track Bullets change direction, tumble Bullets change direction, tumble Impossible to assess severity in field or ER Impossible to assess severity in field or ER Patient must go to OR Patient must go to OR

42 42 Gunshot Wounds

43 43 Crush Injuries MOI will determine sverity of injury MOI will determine sverity of injury Do not be fooled by signd of minimal injury Do not be fooled by signd of minimal injury Beware of crush syndrome (rhabdomyolysis) Beware of crush syndrome (rhabdomyolysis)

44 44 Injection Injuries Serious tissue injury caused by high pressure injections Serious tissue injury caused by high pressure injections External injury may look minor but internal injury may be very severe External injury may look minor but internal injury may be very severe Treat like a puncture injury Treat like a puncture injury

45 45 Eye Injuries Lacerations Lacerations Lacerations to the eyes require very careful repair. Lacerations to the eyes require very careful repair. Never exert pressure on or manipulate the eye. Never exert pressure on or manipulate the eye. If part of the eyeball is exposed, apply a moist, sterile dressing. If part of the eyeball is exposed, apply a moist, sterile dressing. Cover the injured eye with a protective metal eye shield. Cover the injured eye with a protective metal eye shield.

46 46 Eye Injuries Blunt trauma Blunt trauma Blunt trauma can cause a number of serious injuries. Blunt trauma can cause a number of serious injuries. ̶ A fracture of the orbit (blowout fracture) ̶ Retinal detachment May range from a black eye to a severely damaged globe May range from a black eye to a severely damaged globe

47 47 Eye Injuries Hyphema Hyphema Bleeding in the anterior chamber of the eye Bleeding in the anterior chamber of the eye May seriously impair vision May seriously impair vision

48 48 Eye Injuries Eye Injuries Blowout fracture Blowout fracture May occur from blunt trauma caused by a fracture of the orbit May occur from blunt trauma caused by a fracture of the orbit Bone fragments may entrap muscles that control eye movement, causing double vision. Bone fragments may entrap muscles that control eye movement, causing double vision.

49 49 Eye Injuries Retina detachment Retina detachment Often seen in sports injuries Often seen in sports injuries Produces flashing lights, specks, or floaters in field of vision Produces flashing lights, specks, or floaters in field of vision Needs prompt medical attention Needs prompt medical attention

50 50 BLS Indicators Conscious and alert Conscious and alert Stable vital signs Stable vital signs Soft tissue injuries limited to the superficial layer of skin Soft tissue injuries limited to the superficial layer of skin Single digit amputations Single digit amputations Controlled bleeding by direct pressure and/or elevation Controlled bleeding by direct pressure and/or elevation

51 51 BLS Care Request ALS if indicated Request ALS if indicated O2, assist with ventilations O2, assist with ventilations Maintain airway, breathing, c-spine Maintain airway, breathing, c-spine Control bleeding Control bleeding Maintain body temperature Maintain body temperature Monitor vital signs Monitor vital signs Calm and reassure Calm and reassure Transport Transport

52 52 ALS Indicators Significant head injury Significant head injury Signs/symptoms of shock Signs/symptoms of shock Airway compromise Airway compromise Excessive, uncontrolled bleeding Excessive, uncontrolled bleeding Altered LOC Altered LOC High index of suspicion based on MOI High index of suspicion based on MOI


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