1. Chapter 18
Soft-Tissue Injuries

2. Objectives 18.1 List four functions of the skin.
18.2 List the layers of the skin.
18.3 List and describe three types of closed soft-tissue injuries.
18.4 List and describe nine types of open soft-tissue injuries.
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3. Objectives
18.5 Describe the emergency care for the following injuries:
closed soft-tissue injury
amputation
open soft-tissue injury
impaled object
18.6 Describe and demonstrate three methods for controlling external bleeding.
continued

4. Objectives 18.7 Compare and contrast a dressing and a bandage.
18.8 Demonstrate the proper procedure for applying each of the following:
dressing
compression dressing
bandage
tourniquet

5. Topics Anatomy and Physiology of Skin
Physiology of Bleeding and Clotting
Types of Soft-Tissue Injuries
Assessment
Management
Chapter Summary

6. Case Presentation
During a bike race, a rider loses control and falls on a gravel road. His left arm and leg are covered in blood, with a significant laceration in his left bicep. He is wearing a helmet, is responsive and alert, and has no neck or back pain. He is in obvious pain from the laceration and from multiple abrasions on his arms and legs.
Discussion Points:
What should you do?
Discuss MOI to reinforce content from Chapter 17.
Is this person in danger from upcoming riders?
Possibly discuss the choices you have for dealing with that situation.

7. Anatomy and Physiology of the Skin
Largest organ of the body
Multi purpose
Two layers
Epidermis
Dermis
Discussion Points:
Chapter 6, Anatomy & Physiology, covered the skin, so this will be a review to prepare students for the specific information in this chapter.
Note for students that some wounds will affect the epidermis most often, and at times, the dermis.
Possibly discuss whether wounds should automatically be considered worse if they go down to the dermis layer.

8. Anatomy and Physiology of the Skin

9. Physiology of Bleeding and Clotting
Bleeding is a leak in a blood vessel
Artery
Vein
Capillary
Clotting /coagulation naturally close wounds so skin repair can begin
Multiple body systems are involved
Medications may alter the normal clotting process
Discussion Points:
Discuss the characteristics of bleeding from each type of vessel, and ask which type patrollers may see the most, and why.
Further discussion would be on the process of clotting and the effect that “blood thinning” medications have on bleeding control.

10. Physiology of Bleeding and Clotting
The characteristics of bleeding from arteries, veins, and capillaries.

11. Types of Soft-Tissue Injuries
Closed Injury: Skin remains intact
Contusion
Hematoma
Crush injuries
Compartment syndrome
Discussion Points:
Discuss the characteristics of each closed injury.
Note that some injuries may not have observable signs such as bruising or swelling until post injury. Other signs such as point tenderness and guarding may be seen earlier. The MOI and monitoring vital signs can give the patroller clues as to the severity of closed injuries.
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12. Types of Soft-Tissue Injuries
• An example of a contusion.
• An example of a crush injury.
• An abrasion.
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13. Types of Soft-Tissue Injuries
Open Injury: Skin is disrupted
Abrasion
Incision
Laceration
Avulsion
Amputation
Puncture
Open crush injury
High pressure injection
Mechanical tattooing
Discussion Point:
These are self-explanatory; pictures will demonstrate each.
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14. Types of Soft-Tissue Injuries
Copyright E. M. Singletary, MD
• An incision, which has smooth, straight edges.
• An avulsion involving the ear.
• An amputation of the thumb.
• Wrap an amputated part in saline-moistened gauze.
continued
Copyright E. M. Singletary, MD
Copyright E. M. Singletary, MD

15. Types of Soft-Tissue Injuries
Burns Injury: Exposure to excessive energy
Thermal
Friction
Chemicals
Electricity
Nuclear radiation
Discussion Point:
Burns are covered more extensively in the next chapter; just a quick mention here.
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16. Case Update What actions does the patroller take?
What injuries are found?
Are there any complications?
Discussion Point:
What should you do now?
Discuss the point at which the patient can be moved so that the race can resume.

17. Assessment Use PPE / Standard Precautions
Standard assessment procedures – ABCDs, SAMPLE, and vitals
Be aware of other potential injuries
Check for shock
Check CMS
Document findings
Discussion Points:
Remind students what PPE and BSI stand for. The text has details about scene safety and primary/secondary surveys, so the slide is just a summary of standard assessment procedures. The text also mentions some legal issues which may arise if the injuries are the result of violence, and this should be mentioned in the documentation section of your discussion.

18. Management Direct Pressure Pressure Bandage Hemostatic Bandage
Tourniquet
Discussion Points:
These steps are described in the book and may be demonstrated/practiced in your practice session, along with the various bandaging techniques students need to know.
Tourniquet cautions should be emphasized.

19. Management
Most bleeding can be controlled by applying direct pressure to the wound.

20. Management
A tourniquet is used only when bleeding cannot be controlled using any other method.

21. Management
Tourniquets are often commercially produced but can be made from a cravat.

22. Management
A blood pressure cuff can be used as a tourniquet.

23. Treating for Specific Injuries
Contusions (closed injuries)
Cold therapy
R. I. C. E. S
Open Injuries
Control bleeding
Provide wound care
Cover wound with a dressing
Bandage
Splint extremity wounds
Discussion Point:
Chapter 18 minimally covers closed injuries by smaller applications of force. Later chapters describe other injuries that may be caused by significant forces if students ask about more severe injuries. The open injury treatment echoes the bleeding control steps.
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24. Treating for Specific Injuries
R stands for rest.
continued
Copyright Edward McNamara

25. Treating for Specific Injuries
I stands for ice.
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Copyright Edward McNamara

26. Treating for Specific Injuries
C stands for compression.
continued
Copyright Edward McNamara

27. Treating for Specific Injuries
E stands for elevation.
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Copyright Edward McNamara

28. Treating for Specific Injuries
S stands for Splinting.
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Copyright Edward McNamara

29. Treating for Specific Injuries
Always apply a sling and swathe after splinting an upper extremity.
continued
Copyright Edward McNamara

30. Treating for Specific Injuries
After placing several sterile dressings over the wound, begin distal to the injury and wrap the roller bandage over the dressing in a proximal direction.
continued
Copyright Edward McNamara

31. Treating for Specific Injuries
If necessary to stop bleeding secure the roller bandage in place with a cravat knotted over the wound to add pressure.
continued
Copyright Edward McNamara

32. Treating for Specific Injuries
Complex Injuries:
Avulsion
Clean, replace flap, bandage
Amputation
Preserve part, keep moist and cool, send with patient
Splint injured area
Discussion Point:
Additional details for amputated parts and impaled objects is given in the text.
continued

33. Treating for Specific Injuries
Wrap all amputated parts in sterile dressings moistened with sterile saline, place them in plastic bags, and seal the bags. Place the sealed plastic bags in an ice-filled container, but do not place the bags directly on the ice.
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34. Treating for Specific Injuries
Complex Injuries:
Impaled object
Stabilize in place; rarely needs to be removed
Airway obstructions may need to be removed
Discussion Point:
There tends be controversy around whether/how impaled objects might be cut down without moving the object enough to cause further injury. You will have to determine how much time to allow for such discussions should they come up.
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35. Treating for Specific Injuries
• Stabilizing an impaled object with a bulky dressing or several layers of cravats.
• Anchoring an impaled object with cravats to keep it from moving.
• It is safe to remove an impaled object from the cheek, only if the object is obstructing airflow.
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36. Dressing and Bandaging
Multiple materials may be used as dressings:
Sterile
Non-sterile
Pressure
Occlusive
Stabilizing
Hemostatic
Discussion Point:
Show students the materials that are available in your first aid area, as well as those which might be carried by OEC techs in pockets or packs.

37. Dressings and Bandages
Different locations/injuries need different types of bandages:
Joints
Conical regions
Head
Hands and fingers
Check CMS before and after bandaging
Discussion Points:
This slide will require more demos and practice than discussion to be useful to the student.
Discuss how to check for CMS, especially if you are covering distal areas of limbs.

38. Case Disposition
How were the patient’s wounds treated? Were any other forms of treatment given? What transportation decision was made?
Discussion Point:
Local protocols based on dialogue with receiving medical personnel may determine how much OEC techs will do relative to removing contaminants from open wounds.

39. Chapter Summary
The skin is the largest organ in the body, and it serves three purposes: it provides a protective barrier, it functions in the control of body temperature, and it acts as a sensory organ.
The three types of soft-tissue injuries are closed injuries, open injuries, and burns.
Discussion Point:
Involve students in wrapping up this topic with a review of the major points.
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40. Chapter Summary
External bleeding is controlled using direct pressure, a pressure dressing, or rarely a tourniquet.
When applying a dressing to control bleeding, do not remove it because doing so can disrupt clots and cause more bleeding. Instead, add additional dressings.
Hemostatic bandages contain a substance that helps stop external bleeding.
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41. Chapter Summary Do not use elastic bandages to secure dressings.
Splinting a soft-tissue injury helps decrease bleeding and reduces pain.
Applying an effective field dressing and bandage is an important skill for OEC Technicians.