Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Soft-Tissue Injuries

Soft tissues• Skin• Fatty tissues• Muscles• Blood vessels• Fibrous tissues• Membranes• Glands• Nerves

Major functions of the skin• Protection• Water balance• Temperature regulation• Excretion• Shock absorptionLayers• Epidermis• Dermis• Subcutaneous

Closed woundsInternal injury, impact from blunt objectTypes• Contusion• Hematoma

Larger blood vessels• Crush injury

severe bleeding and shock

Patient Assessment• MOI and presence of shockCare• Standard precautions• ABCs and O2• Splint painful, swollen, deformed extremities• Be observant for vomiting• Monitor for shock• Rapid Transport

Open Wounds

• Abrasions

• Lacerations

• Punctures

penetrating

perforating; entrance and exit wound

• Avulsions

• Amputation

• Crush injuries

Care

• Standard precautions

• Initial assessment

ABCs

Severe bleeding

• Expose the wound• Clean• Control bleeding• If serious, care for shock• Prevent further contamination• Bandage after bleeding controlled• Keep pt. still and reassure

In addition

• Abrasions and lacerations*Check PMS *Distal injury• Puncture Wounds*May go to bone*May cause serious internal bleeding*GSW can fx. Bone, causing extensive sof-

tissue and injury to organs

*Immobilize the spine when patient’s head is injured

*Transport• Impaled Objects*Do not remove or put pressure on the object*Stabilize*If needed contact medical direction*Care for shock*Keep Pt. at rest

*Transport carefully and ASAP• Objects impaled in the cheek*If possible remove

same direction it entered*If not possible turn for drainage*Suction as needed*Dress outside, taking care material doesn’t

enter airway

*Monitor mental status*O2*Care for shock• Eye Injury; puncture/impaled object*Stabilize; cup or cone*Dress and bandage uninjured eye*O2 *Care for shockReassure and provide emotional support

• Avulsions

*Clean

*Gently fold the skin back in position

*Control bleeding

*Dress using bulky pressure dressing

*Saving an avulsed part

• Amputations

*Control bleeding

bulky pressure dressing

*Amputated parts

• Wounds to the neck

*Bleeding control

*Remember the characteristics of bleeding

arterial

venous

*Danger of air embolism

Care• Airway• Place gloved hand over wound• Occlusive dressing• Place dressing over occlusive dressing• If needed apply direct pressure

do not apply pressure to both carotids at the same time

• Once bleeding is controlled

bandage; do not restrict airway, or arteries and veins when doing so

• If MOI indicates, immobilize

• Chest InjuriesPericardial TamponadeFlail chestSucking chest woundSpontaneous pneumothoraxPneumothoraxSubcutaneous Emphysema

• Chest Injuries

Blunt trauma

Penetrating trauma

Compression

• Flail Chest

Paradoxical motion

Pt. Assessment• MOI• Signs of shock and hypoxia• Pt. may become fatiguedCare• Initial assessment• Airway management and O2• Stabilize with bulky dressing• Carefully monitor

• Open Chest Injuries;

*Skin of chest wall is broken

*Considered to be life-threatening

*Assess for perforating puncture wound and treat accordingly

• Sucking chest woundCare• May be gasping for air• BLS as indicated• Seal• O2• Care for shock• Rapid transport on injured side if possible

Pneumothorax

• Diminished lung sounds

• JVD

• Tracheal deviation

• Shock

Spontaneous pneumothorax

• Hemothorax and hemopneumothorax

Vessels rupture

Extensive bruising of face and neck

May have bulging eyes, JVD, broken blood vessels in face

Signs of shock

Traumatic Asphyxia

Sudden compression of the chest

• Severe pressure on the heart and lungs forcing blood out of the right atrium and up into the jugulars

• Bulging eyes, distended neck veins, and broken blood vessels in the face

Cardiac Tamponade

• Blood in the pericardial sac

• JVD

• Signs of shock

• Narrowing pulse pressure

Aortic injury and dissection• Injury

penetrating trauma• Dissection

blunt trauma; deceleration injury• May complain of pain in chest, abd or back• Signs of shock• Different pulse/b/p in Right/left arm/leg• Do not palpate any pulsating mass

• Subcutaneous emphysema

Abdominal injuries• EviscerationSigns and symptoms of abdominal injuries• Pain; mild – intolerable• Cramps• Nausea• Weakness• Thirst• Obvious lacerations and puncture wounds

• Laceration and puncture wounds to the middle and lower back or chest wounds near the diaphragm

• Large bruised area• Intense bruise on the ABD• Signs of shock• coughing or vomiting of blood• Rigid or tender ABD• ABD distension• Lies still with legs drawn

Care• Monitor for and manage vomiting• Airway• Position on back with legs flexed• O2• Care for shock• NPO• Monitor vs

• Control external bleeding and dress all wounds

• Do not touch or replace eviscerated parts

• Do not remove any impaled objects

• Leave patients legs in place

Burns

Patient Assessment

Classified in three ways

• Agent and source

• Depth

• Severity

Agent and source

• Never assume

• Gather information

scene size-up

bystanders

patient interview

Depth

Superficial {1st degree}

• Epidermis

• Reddening

• Possibly swelling

Partial thickness burn

• Dermis

• Intense pain

• Noticeable reddening

• Blisters

• Mottled appearance

Full thickness

• All layers

• Charred black or brown or areas that are brown or white

Layers:• Epidermis: Outermost most layer• Dermis: Deeper layer of the skin; contains sweat and

sebaceous glands, hair follicles, blood vessels, and nerve endings

• Subcutaneous: The third layer of human skin is called the subcutaneous (meaning “under the skin”) fatty layer. It is made up of fat cells, connective tissue, and blood vessels. It also contains hair roots, from which hair growth takes place. The fat in this layer supplies nutrients to the other two layers. It also cushions the body and protects it from the cold.

•

Severity• Agent or source• Body region

groin, genitalia, buttocks can be serious• Circumferential burns can be very serious• Depth• Extent of burn

rule of nines• Age

infants, children <5 and adults >55 are at greatest risk for death

• Other illnesses and injuries

heart disease, respiratory dis., diabetes

Classifying burns by severity

• Order and type of care, order of transport and destination

• Infants at higher risk of shock, airway compromise and hypothermia

• Treating specific types of burnsThermal burns• Dry, sterile dressing• Never apply ointment, spray or butter• Never break blisters• Do not apply ice• Keep clean• Keep pt. warm

Chemical burns• Scene safety• Requires immediate care• Flush; copious amts. Of water at least 20 min.• Remove all jewelry and clothing

without contaminating other areas of body

without contaminating yourself

• If dry chemical, brush off

• Apply sterile dressing or burn sheet

• Treat for shock

• Transport

Chemical burns to eyes

• Immediately flush

avoid flushing contaminate to other eye

• Flush medial to lateral

• Flush for at least 20 minutes

• After washing, cover eyes with moistened pads

• If reoccurring burning or irritation, flush another 5 minutes

Specific chemical burnsMixed or strong acidsUnidentified substances• Continue flushing even if pt. c/o no

pain/discomfortDry lime• Brush• Take care not to contaminate eyes

• Flush only after lime has been brushed away from body; should be done quickly and continuously

Carbolic acid

embalming fluid; herbicides

• Do not mix with water

• If available use alcohol for initial flush

then flush with water

Sulfuric acid

• Heat is produced but preferable to flush other than leaving on skin

Hydrofluoric acid

• Even if burns aren’t evident, flush

• Rapid transport to find neutralizing agent

Inhaled vapors

• High concentration O2

• Rapid transport

Electrical Injuries

Electrical current

Lightning

• Skin is burned where current entered and where it flows to the ground

• Tissue damage along the path

• Chemical Δs takes place in nerves, heart and muscle

• Scene safety

Make sure source of electricity is still active until a qualified person tells you otherwise

Do not attempt rescue unless trained and have necessary equipment and personnel

Pt. Assessment• Burns {entrance and exit wounds}• Paralysis

disrupted nerve pathways• Muscle tenderness, with or without muscle

twitching• Respiratory distress, or failure, or arrest• Irregular heartbeat or cardiac arrest

• Elevated B/P or hypotension with s/s of shock

• Restless or irritability if conscious

• Loss of consciousness

• Visual difficulties

• Fractures and dislocations from severe muscle contractions or from falling

• Seizures; in severe cases

Care• Airway care

may be swelling• Cardiac arrest management• Care for shock• O2• Care for spinal; head injuries and fractures• Serious pts should be fully immobilized

• Elevate electrical burns

• Cool the burn areas and any smoldering clothing the same as for a flame burn

• Apply dry, sterile dressing to burn sites

• Rapid transport

Dressing and bandaging

• Dressing

• Bandage

Dressing open wounds

• Standard precautions

• Do not remove unless to control bleeding

Bandaging

• Not too tight, not too loose

• Do not cover tips of fingers or toes

• When bandaging a joint, do not bend once wrapped