SOFT-TISSUE INJURIES

1. LESSON 17 SOFT-TISSUE INJURIES

2. Introduction • Wounds common with trauma and burns • In open wounds, skin is torn or cut and often bleeding • Muscle and soft tissue may be injured • Open wounds have risk of infection

3. Types of Soft-Tissue Injuries Type and amount of bleeding depend on wound type, location, depth

4. Closed Wounds • No break in skin • Discoloration and swelling from internal bleeding • Musculoskeletal injuries may be present

5. Abrasions • Superficial skin layers scraped off • Often painful • Underlying tissues not usually injured • Capillary bleeding stops itself • Foreign material can cause infection

6. Lacerations • May damage underlying tissue • May cause severe bleeding • Laceration through artery may be life-threatening

7. Punctures, Penetrating Wounds • Caused by object penetrating skin and deeper tissues • Little or no external bleeding • Severe internal bleeding • May be both entrance and exit wounds • Likely to trap foreign material • Increased infection risk

8. Avulsions Skin and soft tissue torn partially from body

9. Traumatic Amputations • Complete cutting or tearing off of all or part of extremity • Part may be surgically reattached

10. Burns Damage caused to skin and other tissue by heat, chemicals or electricity

11. General Principles of Wound Care • Control serious bleeding after primary assessment • With less serious bleeding, complete assessment and standard patient care first

12. Always Perform Standard Assessment • Size up scene • Complete primary assessment • Take history • Perform secondary assessment and physical examination as appropriate • Complete reassessments

13. Always Perform Standard Patient Care • Ensure EMS has been activated • Use body substance isolation • Maintain patient’s airway • Provide artificial ventilation if needed • Comfort, calm and reassure patient

14. Use needed BSI precautions Control bleeding Cover wound with sterile gauze Apply direct pressure Additional Care for Soft-Tissue Injuries

15. Additional Care for Soft-Tissue Injuries (continued) • With minor wounds: • Irrigate with large amounts of running water • Irrigate wound to remove foreign matter from wound • Pat area dry, apply sterile dressing, bandage • Prevent contamination with dressing and bandage • If stitches needed or patient’s tetanus vaccination not current, ensure patient receives medical attention

16. Wound Cleaning Alert! • Do not use alcohol, hydrogen peroxide or iodine on wound • Avoid breathing or blowing on wound • Do not attempt to remove clothing stuck to wound; cut around clothing and leave in place • Do not scrub wound

17. Purpose of Dressings • Helps control bleeding • Prevents infection • Absorbs drainage • Protects wound while healing

18. Types of Dressings • Sterile gauze pads • Roller gauze • Non-stick gauze pads • Adhesive strips • Bulky • Occlusive • Improvised

19. Improvising Dressings • If sterile dressing not available, use clean cloth • Non-fluffy cloth less likely to stick • Use clean towel, handkerchief, other material • Avoid cotton balls or cotton cloth • For bulky dressings, use sanitary pads, towels, baby diapers or many layers of gauze

20. Ring Dressing • Don’t put direct pressure over: • Skull fracture • Fractured bone protruding from a wound • Object impaled in wound • Control bleeding with pressure around object or fracture

21. Guidelines for Using Dressings • Wash hands and wear medical examination gloves • Choose dressing larger than wound • Do not touch part of dressing that will touch wound • Lay dressing on wound, cover whole wound

22. Guidelines for Using Dressings(continued) • If blood seeps through, do not remove dressing but add more on top • Use direct pressure to control bleeding if needed • Apply bandage to hold dressing in place

23. Purpose of Bandages • Cover a dressing • Keep dressing in place on wound • Maintain pressure to control bleeding • Support or immobilize musculoskeletal injury

24. Types of Bandages • Adhesive compresses • Adhesive tape rolls • Tubular • Elastic roller • Self-adhering • Gauze roller • Triangular • Improvised

25. Guidelines for Bandaging • Should be clean, not necessarily sterile • Apply bandage firmly but don’t cut off circulation • Never encircle neck • Don’t cover fingers or toes • Check fingers or toes for color, warmth, sensation

26. Guidelines for Bandaging (continued) • If reduced circulation, unwrap bandage and reapply • Keep checking tightness of bandage • Be sure bandage is secure • Anchor first end and tie, tape, pin or clip ending section • Use elastic roller bandage to make pressure bandage around a limb to control bleeding

27. Guidelines for Bandaging(continued) • Elastic roller bandages support joints and prevent swelling • Wrap from bottom of limb upward • Bandage joint in position it will be kept • Use wide bandage with evenly distributed pressure for extremities

28. Puncture Wounds

29. Puncture Wounds • May involve unseen deeper injuries • Check for exit wound • Carry great risk of infection • Internal bleeding may be significant

30. Care for Puncture Wounds • Follow general principles of wound care • Remove small objects and dirt but not large impaled objects • Irrigate the wound with large amounts of water • With small punctures, gently press wound edges • Don’t put medication inside or over puncture wound • Dry the area and apply dressing and bandage • Seek medical attention if appropriate

31. Impaled Objects • Objectoften seals wound or damaged blood vessels

32. Impaled Object (continued) • Removing object could cause more injury and bleeding • Leave it in place and dress wound around it • Control bleeding by applying direct pressure at sides of object

33. Impaled Object (continued) • Dress wound around object • Use bulky dressings to stabilize object • Support object while bandaging dressings in place • Seek medical attention

34. Avulsion • With skin flap, try to move skin or tissue into normal position (unless contaminated) • Control bleeding • Provide wound care • If avulsed body part completely separated – care for it like an amputation

35. Amputation Control bleeding and care for wound first, then recover and care for amputated part

36. Care for Amputated Part • Wrap severed part in dry sterile dressing or clean cloth; do not wash • Place part in plastic bag and seal • Place sealed bag in another bag or container with ice and water  part should not touch water or ice directly or be surrounded by ice • Do not let part become saturated with water • Give part to responding EMS

37. Animal Bites

38. Seriousness of Animal Bites • Bleeding and tissue damage can be severe • Increased risk of infection • All bites carry rabies risk

39. Care of Animal Bites • Follow general principles of wound care • Clean with large amounts of water with or without soap (except when bleeding severely) • Control bleeding • Dress and bandage

40. Care of Animal Bites (continued) • Ensure patient sees health care provider as soon as possible • Do not try to catch animal  but note its appearance • Report bite to animal control or law enforcement

41. Chest Injuries

42. Follow general principles of wound care Keep patient still, seated or lying down Do not remove object unless it interferes with chest compressions when CPR is needed Care for Impaled Object in Chest

43. Manually secure object while exposing wound area and controlling bleeding Stabilize impaled object with bulky dressings Bandage area around object Monitor breathing and vital signs Treat for shock Care for Impaled Object in Chest (continued)

44. Sucking Chest Wound • Open wound in chest caused by penetrating injury • Wound lets air move in and out of chest during breathing • Can be life-threatening • Use special dressing to allow air to escape through the wound but prevent air from being sucked in

45. Care for SuckingChest Wound

46. Closed Chest Injury • Organ damage or internal bleeding can be serious • Consider possibility of pneumothorax or hemothorax with any trauma to chest

47. Pneumothorax • Air escapes from injured lung into thoracic cavity causing collapse of some or all of lung • Results in respiratory distress

48. Hemothorax • Blood from injury accumulates in thoracic cavity, compressing the lung • Causes respiratory distress and possibly shock

49. Signs and Symptoms of Pneumothorax or Hemothorax • Little or no external evidence of injury • Signs and symptoms of shock • Respiratory distress

50. Care for Chest Injuries • Perform standard patient care • Help responsive patient to position of easiest breathing • Treat for respiratory distress • Follow local protocol for oxygen