1. Chapter Seven
Soft Tissue Injuries

2. Wounds
Soft tissues are the layers of skin and the fat and muscle beneath the skin’s outer layer.
Wounds are defined as:
injury to the soft tissue of the body.

3. Closed Wounds Closed wounds occur when:
the body is hit and the force of the blow damages the soft tissue layers beneath the skin causing internal bleeding.
This type of wound could be as simple as a
contusion (bruise) or as severe as internal bleeding

4. Signals of Internal Bleeding
Tender, swollen, bruised or hard areas of the body such as the abdomen
Rapid, weak pulse
Skin that feels cool or moist or look pale or bluish
Vomiting blood or coughing up blood
Excessive thirst
An injured extremity that is blue or extremely pale
Becoming confused, drowsy, or unconscious

5. Call if…
A person complains of severe pain or cannot move a body part without pain.
You think the force that caused the injury was great enough to cause serious damage.
An injured extremity is blue or extremely pale.
The person’s abdomen is tender and distended.
The person is vomiting blood or coughing up blood.
The person shows signs of shock.

6. Care for Closed Wounds Help the person rest in a comfortable position
Apply direct pressure on the area
Apply ice early on
Elevate the injured area only if it will not cause more pain

7. Open Wounds Open wounds occur when there is a break in the skin.
The four main types of open wounds are –
Abrasions
Lacerations
Avulsions
Punctures

8. Abrasions Most common type of open wound
Caused by something rubbing roughly against the skin
Does not bleed very much
It is usually painful because scrapes expose sensitive nerve endings

9. Lacerations A cut in the skin commonly caused by a sharp object
Deep lacerations can cut through fat and muscle, damaging both nerves and blood vessels
Laceration can become easily infected

10. Avulsions
An injury in which a portion of the skin and sometimes soft tissue is partially or completely torn away
Bleeding is often significant

11. Punctures Usually caused by a pointed object piercing the skin
Do not bleed very much unless a blood vessel has been injured
Can carry germs deep into the body
If the object remains in the wound, it is called an embedded object

12. Infection Care Signs & Symptoms Swollen and red Warm to the touch
Injury will throb with pain
Wound may discharge pus
Person may become feverish and ill
Care
Wash the area with soap and water
Irrigate with large amounts of fresh running water
Do not wash major open wounds

13. Determining if the Person Needs Stitches
The wound edges of the skin do not fall together
The laceration involves the face
The wound is over ½ inch long
Bleeding from an artery or uncontrolled bleeding
Can see muscle, bone, involve joints, hands or feet
Wounds from large or deeply embedded objects
Wounds from human or animal bites
If left unstitched, could leave conspicuous scars

14. Materials used when caring for an open wound include -
Disposable gloves – create a barrier between you and the victim
Dressings – pads placed directly on the wound to absorb blood and other fluids to prevent infection
Occlusive dressings – prevents the wound from being exposed to the air or water
Bandages – material used to wrap or cover any part of the body, used to hold dressings in place

15. General Guidelines Applying a Roller Bandage
Check for feeling, warmth and color below the injury site before and after applying the bandage.
Elevate the injury only if it doesn’t cause further injury.
Do not cover fingers or toes with a bandage.
Apply additional dressing if blood soaks through the first bandange.

16. Applying an Elastic Bandage
Check for circulation of the limb beyond where you will be placing the bandage.
Place the end of the bandage against the skin and use overlapping turns.
Gently stretch the bandage as you wrap.
Check the snugness, a finger should easily pass under the bandage.

17. Care for Minor Open Wounds
Put on gloves
Apply direct pressure for a few minutes to control any bleeding
Wash the wound thoroughly with soap and water
Apply an antibiotic ointment
Cover the wound with a sterile dressing and a bandage

18. Care for a Major Open Wound
Call 9-1-1
Put on gloves
Control bleeding by –
Covering the wound and pressing firmly
Apply a pressure bandage
Adding more bandages if necessary
Monitor life signs
Care for shock
Wash hands immediately after giving care

19. Using Tourniquets When Help is Delayed
A tourniquet is a tight band placed around an arm or leg to constrict blood vessels in order to stop blood flow around the wound.
Use only as a last resort.
If used, a tourniquet should not be removed in until the victim gets to the hospital.

20. Hemostatic Agents
Substances that speed up clot formation by absorbing excess moisture caused by bleeding.
Can be a treated sponge or gauze pad, powder or granular form.

21. Burns Burns are a special kind of soft tissue injury
Burns can be classified in two ways –
The source of the burn
Heat
Chemical
Electricity
Radiation
The depth of the burn
Superficial (first degree)
Partial Thickness (second degree)
Full Thickness (third degree)

22. Depth Classifications
Top layer of skin
Red, dry skin
Pain, swelling
Usually heals within a week
Top layers of skin
Red, painful, blisters that may open and weep clear fluid
Usually heals in 3 to 4 weeks
May scar
May destroy layers of skin and underlying structures
Charred skin, tissue underneath white, painful or painless
Healing may require medical care
Scarring likely

23. Critical Burns
Critical burns require immediate medical attention because they are potentially life threatening, disfiguring, and/or disabling.
You should always call if the burned person –
Has trouble breathing or suspected burned airway
Has burns covering more than one body part
Has burns to the head, neck, hands, feet or genitals
Has a burn and is younger than 5 or older than 60
Has burns resulting from chemicals, explosions, or electricity

24. Caring for a Thermal Burn
Check the scene
Remove the person from the source of the burn
Check for life threatening conditions
Cool the burn with large amounts of cool running water
Cover the burn loosely
Prevent infection
Minimize shock

25. Care for a Thermal Burn DO NOT – Apply ice or ice water
Touch a burn with anything except a clean bandage
Remove pieces of clothing that stick to the burn
Try to clean a severe burn
Break blisters
Use ointment on a severe burn

26. Care for a Chemical Burn
Important – chemical burns will continue to burn as long as the chemical is on the body.
If the burn was caused by dry chemicals, brush off the chemical using gloved hands before flushing with water.
Flush the burn with large amount of running water. Flush for at least 20 minutes.
Eyes burns should be flushed with water until EMS arrive
If possible have the person remove contaminated clothes.

27. Care for Electrical Burns
Important – Never go near the victim until you are sure he or she is no longer in contact with the power source.
Call 9-1-1
Turn off the power source
Be prepared to give CPR or use an AED
Care for shock and thermal burns

28. Radiation (Sun) Burns
Care for sunburn the same way you would for any other burn.
Always cool the burn and protect the area from further damage by keeping it out of the sun.

29. Preventing Burns Follow safety practices that prevent fire
Follow manufacturer’s guidelines when handling chemicals
Follow safety practices around electrical lines and go indoors when lightning could strike
Wear appropriate clothing and use sunscreen

30. Crush Injuries Call 9-1-1 Care for specific injuries found
Assume that internal injuries are present
Care for shock

31. Care for an Embedded Object
Do not remove the object.
Place several dressings around it to keep it from moving.
Bandage around the object to keep it from moving.

32. Sucking Chest Wound
This injury occurs when a puncture wound penetrates the chest cavity and air passes in and out of the wound.

33. Care for a Sucking Chest Wound
Cover the wound with a large occlusive dressing (closes the wound) and tape the dressing except for one side.
The dressing will keep air from entering the wound when the person inhales and allow the air to escape when the person exhales.

34. Care for Abdominal Injury