Soft Tissue Injuries Chapter 7

Wounds Any injury to the soft tissue is called a wound Two types of wounds: – Open – Close Closed wounds do not involve the tearing of the skin – Bruises – Usually non-life threatening – Violent force can cause deeper bruising and damage blood vessels / organs

Internal Bleeding Signs and Symptoms Tender, Swollen, Bruised or Hard (Rigid) areas of the body such as the abdomen Rapid / Weak Pulse Cool or Moist Skin Vomiting Blood / Coughing up Blood Excessive Thirst Extremity below the injury is blue or pale

When to call? Patient complains of severe pain Serious force caused the injury Blue / Pale Extremity Tender Abdomen / Rigid Area Vomiting Blood / Coughing up Blood Decreased LOC, Confused, Drowsy, etc.

Care for Closed Wounds Most cases are not serious and can be treated with ice and rest. When applying ice: – Be sure to have a barrier between the ice and skin – Apply for 20 minutes and then remove for at least 20 minutes before reapplying – Elevate the injured area if possible Take the time to be sure the injury is not more serious. Ask questions! Poke and Prod

Open Wounds Skin break can be minor or severe. Bleeding will vary, pain will vary. Four main types of Open Wounds: – Abrasions – Lacerations – Avulsions – Punctures

Abrasions Most Common Usually caused by something rubbing the skin away Minimal Bleeding High Opportunity for infection from dirt and debris

Lacerations Cut in the skin Deep lacerations can cut layers of fat, muscle, damage nerves and blood vessels Bleeding will vary, shallow lacerations = more bleeding, Deeper may not bleed as much unless there is vessel damage

Lacerations (con’t)

Avulsions Very serious Portion of the soft tissue is completely torn away If body part is completely torn away – amputation Bleeding may be hard to control due to the violent tearing, twisting, crushing of the extremity

Punctures Pointed object causes a hole in the soft tissue Nails, wood, glass, bullets, etc. Minimal bleeding unless blood vessel damage High risk of infection Items that remain in the wound is considered embedded

Punctures (con’t) A note about embedded objects – LEAVE THE OBJECT IN PLACE – DO NOT PULL IT OUT

When to call? Any major open wound – – Heavy bleeding – Deep wound – Violent Nature – Signs of Shock – Loss of Consciousness

What to do while waiting General Care includes 1.Care for bleeding 2.Prevent Infection 3.Dress the wound 4.Monitor ABC’s and Treat for Shock

Preventing Infection Clean the area – Warm Water and Soap Irrigate with large amounts of water If the wound is deep, requires medical attention, or heavy bleeding – don’t worry about cleaning as much as stopping the bleeding Signs of Infection: – Tenderness around the wound site – Red / Swollen tissue – Warm to touch / Throbbing – Fever and Chills (more serious infections) – Nausea

Stitches or Not? If ever in doubt – Yes If the wound involves and artery or the bleeding can’t be stopped Wounds that show muscle, bone, involve joints, wide gapes, hands and feet Human or Animal Bits (depth) Face wounds If the skin does not fall together or the wound is over ½ inch long

Dressings and Bandages Dressings are pads placed directly on the wound Porous Sterile May have non-stick surface Occlusive – complete seal to prevent air and water from the wound Bandages are any material used to wrap or cover any part of the body Hold the dressings in place May be used to apply pressure Support limbs or body parts

Dressings and Bandages (con’t) Any bandage applied snugly to create pressure is known as a pressure bandage 2x2 4x4 Trauma Dressing Roller Bandages Bandage Compress

Guidelines for Bandaging Check for feeling in extremities, warmth, color, etc. Elevate the injury if possible Secure one end of the bandage – continue to wrap until the wound is completely covered Tie or Tape in place Do not cover fingers or toes – Check after wrapping for feeling, warmth, color, etc. Apply additional dressing if blood soaks through

Minor Wound Care Don’t forget your protection Apply Direct Pressure and Elevate Wash the wound, irrigate for about 5 minutes Apply ointment to minor wounds when no allergies or sensitivities Cover the wound with a sterile dressing / bandage

Major Wound Care Protection Cover the wound with a dressing, press hard and elevate DO NOT REMOVE A DRESSING. If blood soaks through add more dressings Watch for Shock

Tourniquets VERY LAST RESORT Should only be used in delayed care situations If you have to apply one: – Apply just above the wound – If using a manufactured tourniquet follow those directions – Wrap, then insert stick or something straight and firm and twist until the bright red bleeding stops – Note the time it was applied for EMS – DO NOT EVER REMOVE OR LOOSEN IN THE FIELD.

Injuries to Muscles, Bones and Joints SED 205 – First Aid & CPR

Background Our skeleton is made up of muscles, bones, tendons and ligaments Muscles are soft tissues that can shorten and lengthen. Connected to bones by tendons Bones are hard / dense, rich blood supply and a lot of nerves. Connected to each other at joints by ligaments Children’s bones are harder to break – more flexible, but if they damage the growth plate, it can have lasting effects Elderly folks bones are more brittle and break easily the older they get Osteoporosis

Our Muscles Approx 640+ skeletal muscles in the human body

Muscles

Bones 206 Bones in the human body Key bones related to life-threatening injury: – Femur – Humerus – Pelvic Girdle – Ribs

Bones

Joints, Ligaments and Tendons Where two or more bones come together = joint Ligaments hold the bones in the proper place at the joint Specified range of motion – beyond this you get injury Tendons tie muscles to bones Specified range of motion and elasticity Susceptible to strains especially in the back, neck, and back of leg

Main bone and muscle injuries Fractures Dislocation Sprain Strain

Fractures Open Fracture: – Open wound – Bone tears through skin surface – Object entering skin that breaks bone (bullet) – Serious Injury Closed Fracture – Does NOT break the skin surface – Still serious – Internal bleeding, swelling, etc. Complete break, chip, or crack in a bone. A fall, blow, or even twisting can lead to a fracture

Dislocation More obvious than fracture – forms bump, ridge or hollow that does not normally exist When a bone moves away from another bone at the joint – tearing ligaments Joint no longer functions

Sprain Tearing of the ligaments at the joints. – Mild – just swelling, quick recovery – Severe – Tearing of ligament, can also involve or be a part of a fracture – Most often occurs at ankle, wrist and knee

Strain Stretching or tearing of tendon Most often caused by lifting a heavy object Usually occurs in neck, back, and back of legs

What to look for… PAIN Significant bruising / swelling Significant deformity Normal use is not present Protruding bone fragments Feel bones grinding, or heard snap / pop Injured area is cold to the touch, numb, or tingly Mechanism of injury – Falling in the floor versus being hit by a bus Suspect possibility of serious injury for any of these signs

When to call When in doubt Obvious deformity Moderate / Severe swelling Grinding Noise Snap or Pop was heard Open fracture Cold / Numb Head / Neck / Spine Trouble Breathing Unsafe to transport to hospital without EMS While you wait…RICE – Rest – No Moving – Immobilize – Stabilize the injured area without moving it – Cold – Apply ice to help with swelling, Control ANY bleeding – Elevate – Only if this doesn’t cause more pain. Get the injured area higher than the heart level to help with swelling and bleeding

Splinting an Injury Anatomic Splint – Using the person’s body as a splint Soft Splint – Folded blanket, towel, pillow, etc. Rigid Splint – Padded boards, Magazines, etc. The Ground – Injured leg or arm laying on the ground for support After you have splinted the injury, you should apply ice and elevate if possible

Applying Anatomic Splint - SKILL Get Consent Support the injured part Check Circulation Position Bandages Align body parts Tie Bandages Recheck Circulation

Applying a soft splint Get Consent Support the injured part Check Circulation Position Bandages Wrap with Soft Object Tie Bandages Securely Recheck Circulation

Applying a rigid splint Get consent Support the injured part Check circulation Place Splint Secure Bandages Recheck Circulation

Applying Sling & Binder Get Consent Support injured part Check circulation Position Sling Secure Sling Bind with Bandage Recheck Circulation

Head, Neck and Spinal Injuries Life threatening Permanent life-altering damage 12,000 annually Mostly men over 40 Car Crash, Falls, Violence, Sports Head / Neck injuries: – Paralysis – Speech Problems – Memory Problems – Can’t see these injuries, so always suspect them with violent accidents

Brain Injury Head injury can cause blood vessels to rupture in the brain, blood leaks out and causes pressure / swelling, pressure on brain = brain injury First sign is altered LOC

What to look for… Determine the mechanism of injury – Car crash – Fall – Diving – Fight If unconscious – always treat for head / neck injury If… – Motor Vehicle Crash – Fall from height greater than standing – Wearing safety helmet that is cracked or broken – Complains of head / neck / back pain – Not fully alert – Tingling or Numbness – Over 65 or Under 3

What to do… MINIMIZE Movement Control C-Spine with head immobilization trick If wearing a helmet – LEAVE IT ON If breathing stops or they are bleeding this takes precedent Concussion – Temporary loss of brain function – Signs can appear quickly or be delayed – Mood changes – Cognitive disturbance – Sensitivity to light and noise – Headache – Memory Loss – Nausea Vomiting

What to do… Support the head and neck Maintain an open airway Control bleeding Do NOT apply direct pressure If clear fluid is leaking from ears or a scalp wound, cover it with loose gauze Monitor

Chest Injuries Broken ribs are painful, but rarely life threatening Shallow breathing Try to support the area with their hand or arm Serious injuries may cause trouble breathing If trouble breathing they may – Have ashen or blue skin – Cough up blood – These are all serious and should result in a call to 911 ASAP

When to call and What to do Call when in doubt Trouble breathing Coughing up blood Numbness / Tingling Spinal injury as well If they are standing, DON’T TRY TO LAY THEM DOWN. Keep them still and support the head / neck Monitor breathing and LOC

Pelvic Injuries Risk of damage to major arteries Signals include – Severe pain – Nausea – Bruising – Weakness – Tender Abdomen – Loss of sensation in legs – Altered LOC Don’t move the person Try to keep them lying flat or in the position you find them Watch for signs of shock indicating internal bleeding