1. Soft Tissue Injuries
OEC Chapter 18

2. Objectives List four functions of the skin List the layers of the skin
List and describe three types of closed soft-tissue injuries
List and describe nine types of open soft-tissue injuries
Describe the emergency care for the following injuries:
Closed soft-tissue injury
Open soft-tissue injury
Amputation
Impaled object

3. Objectives cont…
Describe and demonstrate three methods for controlling external bleeding
Compare and contrast a dressing and a bandage
Demonstrate the proper procedure for applying each of the following:
Dressing
Bandage
Compression dressing
Tourniquet

4. Anatomy & Physiology

5. The Skin Important functions of the skin:
Protective barrier
Regulates body temperature
Maintains water balance
Synthesizes vitamin D
Epidermis: The outer layer of the skin that acts as a watertight protective covering
Dermis: Inner layer of skin that contains hair follicles, sweat glands, nerve endings, and blood vessels
Subcutaneous Tissue: composed almost entirely of fat; insulates the body and stores energy
Sweat glands in dermis help with body temp regulation
Amount of subcutaneous tissue varies from body part to body part

6. Bleeding & Clotting Arteries Pulsating spurts of blood Bright red
Veins
Steady, slow flow
Darker red
Capillaries Slow, oozing flow
Arteries
High arterial pressure causes the blood to come out in spurts
Bright red because of higher O2 content
Veins
Blood flows under less pressure
Darker red due to lower oxygen content
Capillaries
- Oozes because of small size of vessels and low pressure of blood

7. Bleeding & Clotting Blood vessels constrict to minimize blood loss
Platelets and plasma proteins bind together to form temporary “plug”
Additional platelets and plasma proteins form scab
White blood cells fight infection
Platelets temporarily seal the hole in the vessel along the inner wall
Inflammatory response leads to swelling in the area
Scab acts s a barrier that keeps out bacteria and other contaminants
BLOOD THINNING MEDICATIONS
Anticoagulants – slow the normal clotting process in patients with certain medical conditions
More difficult to control the bleeding in these patients
Can find out if they’re taking blood thinners through SAMPLE

8. Types of Soft Tissue Injuries

9. Closed Injuries
Damage to structures beneath the skin or a mucous membrane while the overlying skin remains intact
Contusions
Outer layer of skin is not disrupted
Cells within dermis are injured; small blood vessels torn
Ecchymosis
Hematomas
Extravascular collection of blood within the body’s tissues or in a body cavity
Subungual hematoma
Contusions
Usually from a blunt force
Extent and severity can vary
Ecchymosis: blue/black skin discoloration – bruise
Hematomas
In severe cases, can lead to hemorrhagic shock
Subungal hematoma: occurs beneath the nail bed
Compartment Syndrome
Leads to great amounts of pressure that can cause tissue damage and cut off blood flow
Requires rapid transport to prevent loss of limb
Crush Injuries
When an extensive force strikes the body suddenly or a force is continually applied over an extended period of time
Compartment Syndrome: swelling of injured muscles within their connective tissue coverings

10. Open Injuries
Abrasion: caused when a body part scuffs or grates across a rough, abrasive surface
Incision: a cut with clean, smooth edges
Laceration: a cut with jagged edges
Avulsion: incomplete separation of the soft-tissue layers in which the injured tissue is left dangling as a flap
Amputation: complete or nearly complete separation of a body part or limb
Puncture: injury involving the penetration of soft tissue
Impaled object: an object that causes a puncture wound and remains embedded in the patient’s body
Abrasions are usually only on the epidermis
Incisions and lacerations can be superficial or can extend deep into the tissue
Punctures can cause severe bleeding if they occur in the chest/abdomen or near an artery

11. More Open Injuries
Open Crush Injury: compression injury in which a great amount of force is applied to the body
High-Pressure Injection: the introduction of a liquid or gas into the body from a pressurized source
Mechanical tattooing: occurs when foreign debris such as dirt, rocks, or tar is ground into a wound or the adjacent skin

12. Burns
Lesions of the skin caused by thermal or frictional heat, chemicals, electricity, or nuclear radiation
See chapter 19

13. Assessment & Management

14. Assessment
Despite the often impressive superficial damage, it is important to use the same approach used with any other trauma or medical emergency
Scene size-up
Primary assessment: ABCDs
Secondary assessment
Be suspicious of hidden injuries and damage to underlying structures
Assess and manage for shock

15. Management
Emphasis on controlling external bleeding and preventing further contamination
Controlling external bleeding
Direct pressure: primary method; place a dressing on the wound and apply firm pressure over the wound
Dressings: Place the dressing over the wound and apply firm pressure
Once applied, do not remove original dressing
Pressure dressing: a dressing that closes blood vessels by compressing the wound
Tourniquet: applied only when hemorrhaging cannot be controlled by other methods
Make sure to ensure BSI and use standard precautions
Dressings
Once a dressing has been applied, don’t remove – can damage tissue and disrupt clotting
If new dressing is needed, apply directly on top
Tourniquet
Major artery may have been punctured
May need to be used to control bleeding while other ABCDs are being addressed
Risk of losing the patient’s limb
Use if patient is at risk of exsanguination – bleeding to death
Write the time the tourniquet was applied on a piece of tape and put it on the patient’s forehead

16. Treatment of Specific Soft-Tissue Injuries
Contusions Rest Ice Compression Elevation Splint
Open Injuries
Important to reduce risk of wound contamination/infection
Control bleeding
Irrigate the wound
Cover with a dressing
Secure the dressing with a bandage
Splint all wounds in extremities and elevate

17. Treatment of Specific Soft-Tissue Injuries
Avulsions
Control bleeding
Cleanse the injury
Replace the flap in its original position
Apply a sterile compression bandage
Amputations
Control bleeding
For incomplete amputations, immobilize and splint. Never detach partial amputation
For complete amputations, preserve all amputated parts
Wrap in saline-moistened gauze and place in a plastic bag
Put plastic bag in a container with ice
Transport amputated part with patient
Amputation
Objective is to keep amputated part cool without allowing it to freeze
Do not place it directly in the ice
Also do not submerge in water – could damage the tissue

18. Treatment of Specific Soft-Tissue Injuries
Impaled Objects
After controlling bleeding, the primary goal is to stabilize the object – try to leave impaled object in patient
Manually stabilize the object
Remove or cut all clothing around the impaled object
Control bleeding
Apply bulky dressing around the object. It may be necessary to shorten the object
Keep the object from moving during transportation

19. Dressing & Bandaging
Universal dressing: sterile, soft, highly absorbent, individually wrapped dressing that provides padding and protection
Bandage: a strip or roll of gauze or other material used for wrapping or binding a body part
Used to hold a dressing or splint in place
Always leave fingers and toes exposed to check for CSMs
Bandaging could potentially restrict circulation, which is why it’s important to leave toes/fingers exposed

20. Special Types of Dressings & Bandages
Pressure Dressings
Occlusive Dressings
Stabilizing Dressings
Hemostatic Dressings
Pressure dressing is used to maintain direct pressure on a bleeding wound
Occlusive dressings: cover sucking chest wounds and open neck wounds
Prevent air and liquids from entering/exiting the wound
Stabilizing dressing used to secure an impaled object in place
Layers of thick dressing wrapped around the object
Doughnut
Hemostatic dressings contain a topical hemostatic agent that promotes clotting