Soft Tissue Injury

The Skin

External Bleeding BSI-always!!!! Severity of blood loss: Amount Rate Other injuries or existing conditions Existing medical conditions Patients age

Estimated Blood Volume Normal adult-70 ml/kg Infants & children-80 ml/kg A 200 ml blood loss in adult only is a 4% loss, but in an infant would be 25%.

Remember –severity of blood loss is a percentage of how much blood is estimated to be lost, but don’t get focused on how much rather than what signs & symptoms your patient is showing.

Airway & Breathing take priority Need to control bleeding, but do not get tunnel vision. Remember the basics first Scene Size-up Primary Secondary Airway & Breathing take priority

Types of Bleeding

Controlling Bleeding Direct Pressure Tourniquets Bandages Fingertip pressure If foreign object seen, secure in place and place dressing around area. DO NOT remove unless affecting airway Tourniquets

Scene Size-up, Primary Assessment, and Rapid Secondary Assessment Standard Precautions Scene safety General impression Control significant bleeding ABCs Apply O2 Rapid secondary assessment Obtain vital signs

Factors that increase bleeding Movement Low body temperature Medications Intravenous fluids Removal of dressings & bandages

PASG pneumatic antishock garment Contraindications Indications Suspected pelvic fracture with hypotension <90 mmHg Suspected intraperitoneal hemorrhage <90 mmHg Penetrating thoracic trauma Splinting of lower extremity fractures Eviscerated abdominal organs Impaled object in abdomen Pregnancy Cardiopulmonary arrest CHF Pulmonary Edema Once placed, do not remove with medical control authorization

Wound-injury to the skin and underlying tissues Wounds categories Closed Open Single multiple

Closed Injuries Hematoma Contusion Ecchymosis

Open Injuries

Abrasions Caused by scraping, rubbing, or shearing Considered to be superficial Very painful Can be life threatening Not necessarily to injury but potential for infection, contamination, & potential for other life threatening injuries

Lacerations Break in skin May be linear or stellate (irregular) Linear Knife Razor Broken glass Edges smooth Stellate Blunt objects Edges are jagged

Avulsions Loose flap of skin & underlying tissue that is torn loose or pulled completely off Bleeding may be severe Healing prolonged Extensive scarring

Amputations Disruption of the continuity of an extremity or other body part Ripping or tearing Incomplete amputation will bleed more than a complete Always consider shock

Punctures & Penetrations Result of sharp, pointy object May be little, but underlying damage may be worst Stab wounds May be small & undetectable Remember underlying internal damage Gunshot wounds Entrance and exit sites Entrance will be smaller Exit larger and will be bleed profusely Assess for more than one wound and remember underlying internal damage

Crush Injuries Caused by blunt trauma or crushing forces May not appear serious May be swollen, painful, & deformity External bleeding minimal or even absent Always suspect internal bleeding Walking wounded

Combination of crush and penetration injury Bites Dog bites most common Complications Infection Cellulitis Septicemia Rabies Tetanus Combination of crush and penetration injury

Clamping injury Body part that is caught in machinery Time is key

Assessment Scene size up & primary assessment Secondary assessment Emergency medical care Reassessment

Special Considerations Chest injuries Abdominal injuries Impaled objects Amputations Large open injuries

Dressings & Bandages Dressings Bandages Pressure dressings Gauze pad Self adhering dressing Universal or multitrauma dressing Occlusive dressing Bandages Self adhering Gauze rolls Triangular bandage Air splint Pressure dressings

General principles of dressing & bandages No hard or fast rules Must adapt to what is available Conditions Clean Do not tape in place until bleeding controlled Must cover wound Attempt to remove all jewelry Do not leave too loose Do not wrap too tightly If covering small wound on extremity, wrap larger area Once positioned, leave where it is Tourniquet if unable to control bleeding