1 Soft Tissue Injuries

2 Skin Functions Protection –Barrier to keep out microorganisms, debris and chemicals. –Tissues & organs are protected from environment Water Balance –Prevents water loss & stops environmental water from entering body

3 Skin Functions Temperature Regulation –Blood vessels dilate to carry more blood to skin allowing heat to radiate from the body – constrict to prevent heat loss Excretion –Salts and excess water can be released through the skin Shock (impact/absorption) –Skin and its layers of fat help protect the underlying organs

4 Skin Anatomy and Physiology Body’s largest organ Three layers –Epidermis – Outer layer of skin (composed of 4 layers) consisting of dead cells constantly being rubbed off and replaced. –Dermis – layer of skin below the epidermis. Rich in blood vessels and special structures such as sweat glands, oil glands, hair follicles, blood vessels. Specialized nerve endings allow for sense of touch, feeling heat/cold and pain

5 –Subcutaneous tissue – layers of fat and soft tissue. Acts as shock absorption and as a body insulator

6 Soft Tissue Injuries CLOSED

7 Contusion (Bruise) Produced when blunt force damages dermal structures Blood leaks into damaged area causing swelling & pain Presence of blood causes skin discoloration called ecchymosis (bruise)

8 Hematoma Collection of blood beneath the skin Larger amount of tissue damage as compared to contusion Larger vessels are damaged Patient may lose one or more liters of blood Fist-sized hematoma = 10% volume loss

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10 Crush Injuries Crushing forces cause damage to soft tissue and internal organs May cause painful, swollen, deformed extremities External bleeding may be minimal or absent Can cause internal organ rupture Internal bleeding may be severe with shock (hypoperfusion)

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14 Emergency Medical Care PPE for BSI Maintain airway and provide oxygen as needed If shock or internal bleeding is suspected, treat for shock Splint a painful, swollen deformed extremity Transport

15 Closed Injury Management Rest Ice Compression Elevate Splint When in doubt assume underlying fractures are present

16 Soft Tissue Injuries OPEN

17 Open Injury Types Abrasions Lacerations Punctures Avulsions Amputations

18 Abrasion Outermost layer of the skin is damaged by rubbing or scraping force. “Road rash” Can be a painful injury, even though superficial There is very little or no oozing of blood. Usually associated with capillary oozing, leaking of fluid

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22 Laceration Break in skin of varying depth Typically longer than it is deep Caused by forceful impact with sharp object Bleeding may be severe Types –Linear (regular) –Stellate (jagged/irregular)

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

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29 De-gloving Injury

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33 Penetration/Punctures A.Penetrating puncture  Can be shallow or deep  Only entrance wound B.Perforating puncture  Has both an entrance and exit wound Caused by a sharp pointed object Wound is deeper than it is long Difficult to assess extent of injury – may not be external bleeding Examples –Gun Shot Wound –Stab Wound

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38 Gunshot Wounds Gunshot wounds have unique characteristics – entrance/exit wounds

39 Open Wound Management 1.PPE for BSI 2.Manage ABCs first – consider oxygen 3.Expose wound 4.Control bleeding 5.Prevent further contamination 6.Apply dry sterile dressing to the wound and bandage securely in place 7.Keep the patient calm & quiet 8.Manage hypoperfusion if present

40 Special Considerations

41 Chest Injuries Pneumothorax – occurs when the lung collapses as a result of air entering the chest cavity (SUCKING CHEST WOUND) Tension pneumothorax – found in closed chest injuries or when the chest is sealed with an occlusive dressing. –Pressure builds & puts pressure on the heart, lungs, and vessels

42 Chest Injuries Hemothorax – occurs when the chest fills with blood. May lead to shock Hemopneumothorax – when the chest fills with blood and air. May also lead to shock

43 Chest Tube – releases air and allows lung to re-inflate

44 Chest Injuries Traumatic Asphyxia – sudden compression of the chest, sternum and ribs – exerts severe pressure on the heart and lungs, forcing blood out of the right atrium and up into the jugular veins

45 Chest Injuries Cardiac Tamponade – Injury to the heart –Causes blood to flow into the surrounding pericardial sac –Unyielding sac fills with blood & compresses the chambers of the heart to the point they no longer fill adequately, backing up blood into the veins

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47 Care for Chest Wounds Administer oxygen Cover with occlusive dressing – secure only on 3 sides Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax) If tension pneumo develops lift corner of dressing to relieve pressure Treat for shock

48 Flutter Valve – Inspiration

49 Flutter Valve – Exhalation

50 Eviscerations Internal organs exposed through wound in the abdomen Do NOT touch or attempt to replace organs Cover exposed organs with large moistened sterile dressing Flex the patient’s hips and knees, if uninjured

51 Impaled Objects Do NOT remove; unless it is through the facial cheek, would interfere with chest compressions, or interferes with transport Manually secure & stabilize in place using bulky dressings Control bleeding

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55 Amputations Part should be wrapped in sterile gauze Wrap or bag the amputated part in plastic and keep COOL Transport amputated part with the patient Do NOT pack part directly in ice Do NOT let part freeze Do NOT complete partial amputations Immobilize to prevent further injury

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57 Neck Wounds Risk of air entering vein and moving through heart to lungs (air embolism) Cover with occlusive dressing Do NOT occlude airway or blood flow to brain Compress carotid artery ONLY if necessary to control bleeding

58 Burns Classification – according to depth

59 First Degree (Superficial) –Involves only epidermis –Red –Painful –Possible swelling, no blisters

60 Second Degree (Partial Thickness) –Extends through epidermis into dermis –Salmon pink –Moist, shiny – INTENSE PAIN –Blisters may be present

61 Third Degree (Full Thickness) –Through epidermis, dermis into muscle, bone or organs –Skin dry and leathery and may appear white, dark brown or charred –May bleed from vessel damage –Painless –Require grafting

62 Severity Based on depth or degree of the burn: a.Superficial b.Partial thickness c.Full thickness Percentage of body area burned – size of the patient’s hand is equal to 1%

63 Rule of Nines Adult a.Head & Neck – 9% b.Each upper ext. – 9% c.Anterior trunk – 18% d.Posterior trunk – 18% e.Each lower ext. – 18% f.Genitalia – 1%

64 Infant a.Head & Neck – 18% b.Each upper ext. – 9% c.Anterior trunk – 18% d.Posterior trunk – 18% e.Each lower ext. – 14% f.Genitalia – 1%

65 Location of Burn – Special Concern 1.Face & Upper airway – respiratory system 2.Hands & Feet 3.Genitalia Infants/Elderly or preexisting medical problems may be of concern

66 Determine Severity of Burns

67 Critical Burns Full thickness burns of the hands, feet, face or genitalia Burns associated with respiratory injury Full thickness burns covering more than 10% of the body surface Partial thickness burns covering more than 30% of body surface Burns complicated by painful, swollen deformed extremity Moderate burns in young children and elderly patients Burns encompassing any body part (ex. Arm, leg or chest)

68 Moderate Burns Full thickness burns of 2% to 10% of the body surface (excluding hands, feet, face, genitalia & upper airway) Partial thickness burns of 15% to 30% of body surface Superficial burns of greater than 50% of body surface

69 Mild Burns Full thickness burns of less than 2% of body surface Partial thickness burns of less than 15% of body surface

70 Emergency Care for Burns 1.Stop the burning process, initially with water or saline 2.Remove smoldering clothing & jewelry 3.PPE for BSI 4.Continually monitor the airway for evidence of closing 5.Prevent further contamination 6.Cover burned area with dry, sterile dressing 7.Do not use any type of ointment, lotion or antiseptic 8.Do not break blisters 9.Transport to appropriate facility

71 Infants and Children 1.Greater surface area in relationship to total body size 2.Results in greater fluid and heat loss 3.Any full or partial thickness burn greater than 20% or burns involving hands, feet, face, airway or genitalia 4.Any partial thickness burn of 10% to 20% is moderate burn 5.Any partial thickness burn less that 10% is a minor burn

72 Infants and Children Are at higher risk for shock, airway problems, or hypothermia. Consider the possibility of child abuse

73 Chemical Burns  Take necessary scene safety precautions to protect yourself  Wear gloves and eye protection Phosphorous Burns

74 Emergency Medical Care Remove chemical from skin Liquids –Flush with large amounts of water Dry chemicals –Brush away –Flush what remains with water

75 Electrical Burns Scene Safety 1. DO NOT ATTEMPT TO REMOVE PATIENT FROM THE ELECTRICAL SOURCE unless trained to do so 2. If the patient is still in contact with electrical source or you are unsure, DO NOT touch the patient

76 Electrical Burns Emergency Care ABC’s & oxygen Monitor patient for respiratory & cardiac arrest (consider need for AED) Massive internal tissue damage that may not be easily seen Treat soft tissue injuries associated with burn. Look for both entrance and exit wounds

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