Chapter 12 SOFT TISSUE INJURIES. Soft Tissue Injuries - Closed Wounds Bruises (Ecchymosis) Contusions Hematomas Internal Lacerations Internal Punctures.

Chapter 12

SOFT TISSUE INJURIES

Soft Tissue Injuries - Closed Wounds

• Bruises (Ecchymosis)• Contusions

• Hematomas

• Internal Lacerations

• Internal Punctures

• Rupture of Internal Organs

Soft Tissue Injuries - Care

• Most do not require medical care

• Direct pressure, elevation, cold compress

• Be aware of other possible internal injuries

• If complaint of severe pain or inability to move affected area - EMS

• BSI

• High flow O2 if serious injury

Soft Tissue Injuries - Open Wounds

• Abrasions (road rash, mat burns, rug burns)– Ooze, painful– Risk of infection due to debris in wound

• Lacerations (incision vs. laceration)– Difficult to determine degree of underlying

injury– May bleed profusely

Soft Tissue Injuries - Open Wounds

• Punctures– Typically caused by nails, knives,etc.– Often no serious external bleeding but internal

may be profuse– Contamination can be a serious problem– Two types

• Penetrating

• Perforating

Soft Tissue Injuries - Open Wounds

• Avulsions– Flaps of skin &/or tissue torn loose or off

• degloving (ring avulsion)

• extruded avulsion (avulsed eye)

– May bleed profusely– Can have extensive tissue damage

Soft Tissue Injuries - Open Wounds

• Amputation– Feet, toes, hands, fingers or entire limbs– Bleeding - minimal to profuse– Tissue damage may be extensive– Includes

• Crush injuries– can cause “tourniquet shock”

• Degloving amputations

Care

• Minor Open Wounds– Superficial, minimal bleeding– Wash area thoroughly with soap & water– Cover with sterile dressing & apply direct

pressure to control bleeding– Once bleeding controlled, apply antibiotic

ointment– Dress and bandage (band-aid)

Care

• Major Open Wounds– Cover with a sterile (clean) dressing – Follow steps for controlling bleeding– Assess pulse or capillary refill, motor function,

sensation distal to injury• This should be done both before and after a bandage

has been applied

– Oxygen if available– Activate EMS when necessary

You May Need Stitches IF

• Bleeding from an artery or uncontrolled• Wounds

– Involve muscles, tendons, ligaments– Involve joints– Gape widely, involve thumb or palm of hand– Are large, involve deep punctures or deeply

embedded objects– Human or animal bites– If unattended, scar would be conspicuous

Care for Specific Types of Injuries

• Puncture Wounds– Always check for entrance and exit wounds

– Treat all gunshot and knife wounds as if serious

– Impaled Objects• Do Not remove (unless it is a perforating wound to the

cheek and is causing airway obstruction)• Stabilize object with bulky dressings• Immobilize the spine when the head, neck or chest is

impaled• If eye is involved- also cover the uninjured eye

Care for Specific Types of Injuries

• Avulsions– Fold flap back into place– Preserve avulsed flaps (parts) when possible

• Wrap in dry sterile dressing

• Place in plastic bag, place in a second bag

• Keep cool without freezing– Do Not immerse in ice, cold water, or saline

– Avulsed eye• cover with moist dressing and a cup, bandage both eyes

Care for Specific Types of Injuries

• Amputations– Wrap amputated part in sterile dressing– Place in a plastic bag– Place in a second plastic bag– Keep as cool as possible without freezing– Control bleeding as previously described

Specific Injuries - Scalp & Face

• First Concern - airway and breathing

• Do Not attempt to clear the surface of a scalp wounds

• Do not apply finger pressure if any change of a fracture

• Do not remove impaled objects unless it is through the cheek and causing an airway obstruction

Specific Injuries - Mouth

• Teeth– Place in milk– Do Not put back in socket– Do Not rub tooth in order to clean it– Control bleeding by having patient bite

GENTLY on rolled gauze pad

Specific Injuries - Eye(s)

• Do Not apply direct pressure if globe is cut

• Foreign Objects– Minor

• Flush with water gently for up to 20 minutes

– Major• Do Not remove object

• Do Not probe into the eye socket

• Reduce eye movement (bandage both eyes)

Specific Injuries - Ears

• External Ear Injuries– Treat based on type of injury and extent of

bleeding

• Internal Ear Injuries– Blood, bloody fluid or CSF draining from ears

• Do Not pack external ear canal

– Foreign objects - Do Not attempt to remove– “Clogged” or “stopped up” ears

• Do not probe into the ears

Specific Injuries - Nose

• Nosebleeds– Previously covered– Do Not pack nostrils– If victim is unconscious

• Slightly elevated head or place in recovery position

– CSF - Do Not pack nostrils– Foreign objects - Do Not remove object– Avulsions - safe part as previously described

Specific Injuries - Neck

• Signs of Neck Wounds• Difficulty speaking, loss of voice

• Obvious swelling or bruising of neck

• Tracheal deviation

• Depressions to neck

• Obvious cuts or punctures

• Care– Direct pressure, also use an occlusive dressing if

large veins are involved

Specific Injuries - Abdominal

• Lay victim on their back with knees flexed– Do Not flex if signs of pelvic, lower extremity

or spinal fractures

• Do Not touch any exposed internal organs

• Do Not push organs back in

• Cover with an occlusive dressing– Cover occlusive dressing with a towel– Do Not remove any impaled objects

Specific Injuries - Genitalia

• Two types of injuries– Blunt trauma– Cuts

• Do Not remove impaled objects

• Save avulsed parts

• Use cold compress with blunt trauma (for pain)