24: Soft-Tissue Injuries

1. 24: Soft-Tissue Injuries

2. Cognitive Objectives(1 of 6) 5-2.1 State the major functions of the skin. 5-2.2 List the layers of the skin. 5-2.3 Establish the relationship between body substance isolation (BSI) and soft-tissue injuries. 5-2.4 List the types of closed soft-tissue injuries. 5-2.5 Describe the emergency medical care of the patient with a closed soft-tissue injury. 5-2.6 State the types of open soft-tissue injuries.

3. Cognitive Objectives(2 of 6) 5-2.7 Describe the emergency medical care of the patient with an open soft-tissue injury. 5-2.8 Discuss the emergency medical care considerations for a patient with a penetrating chest injury. 5-2.9 State the emergency medical care considerations for a patient with an open wound to the abdomen. 5-2.10 Differentiate the care of an open wound to the chest from an open wound to the abdomen.

4. Cognitive Objectives(3 of 6) 5-2.11 List the classification of burns. 5-2.12 Define superficial burn. 5-2.13 List the characteristics of a superficial burn. 5-2.14 Define partial-thickness burn. 5-2.15 List the characteristics of a partial-thickness burn. 5-2.16 Define full-thickness burn.

5. Cognitive Objectives(4 of 6) 5-2.17 List the characteristics of a full-thickness burn. 5-2.18 Describe the emergency medical care of the patient with a superficial burn. 5-2.19 Describe the emergency medical care of the patient with a partial-thickness burn. 5-2.20 Describe the emergency medical care of the patient with a full-thickness burn. 5-2.21 List the functions of dressing and bandaging. 5-2.22 Describe the purpose of a bandage.

6. Cognitive Objectives(5 of 6) 5-2.23 Describe the steps in applying a pressure bandage. 5-2.24 Establish the relationship between airway management and the patient with chest injury, burns, and blunt and penetrating injuries. 5-2.25 Describe the effects of improperly applied dressings, splints, and tourniquets. 5-2.26 Describe the emergency medical care of a patient with an impaled object.

7. Cognitive Objectives(6 of 6) 5-2.27 Describe the emergency medical care of a patient with an amputation. 5-2.28 Describe the emergency care for a chemical burn. 5-2.29 Describe the emergency care for an electrical burn. • There are no affective objectives for this chapter.

8. Psychomotor Objectives (1 of 3) 5-2.29 Demonstrate the steps in the emergency medical care of closed soft-tissue injuries. 5-2.30 Demonstrate the steps in the emergency medical care of open soft-tissue injuries. 5-2.31 Demonstrate the steps in the emergency medical care of a patient with an open chest wound. 5-2.32 Demonstrate the steps in the emergency medical care of a patient with open abdominal wounds.

9. Psychomotor Objectives (2 of 3) 5-2.33 Demonstrate the steps in the emergency medical care of a patient with an impaled object. 5-2.34 Demonstrate the steps in the emergency medical care of a patient with an amputation. 5-2.35 Demonstrate the steps in the emergency medical care of an amputated part. 5-2.36 Demonstrate the steps in the emergency medical care of a patient with superficial burns. 5-2.37 Demonstrate the steps in the emergency medical care of a patient with partial-thickness burns.

10. Psychomotor Objectives (3 of 3) 5-2.38 Demonstrate the steps in the emergency medical care of a patient with full-thickness burns. 5-2.39 Demonstrate the steps in the emergency medical care of a patient with a chemical burn. 5-2.40 Demonstrate completing a prehospital care report for patients with soft-tissue injuries.

11. Anatomy of the Skin

12. Function of the Skin • Protection • Sensation • Temperature control

13. Soft-Tissue Injuries • Closed injuries • Soft-tissue damage beneath the skin • Open injuries • Break in the surface of the skin • Burns • Soft tissue receives more energy than it can absorb

14. Contusion • Results from blunt force striking the body

15. Hematoma • Pool of blood that has collected in the body

16. Crushing Injury • Occurs when a great amount of force is applied to the body

17. Scene Size-up • Observe for hazards. • Take BSI precautions. • Place several pairs of gloves in pocket. • You may be able to identify bleeding before even reaching patient. • Look for indicators of MOI.

18. Initial Assessment (1 of 2) • Observe patient for seriousness of condition. • Does patient have any apparent life threats? • Look for hidden injuries. • Ensure patent airway. • Protect patient from further spinal injury. • Quickly assess breathing. • Palpate chest wall for DCAP-BTLS.

19. Initial Assessment (2 of 2) • If soft-tissue injury is discovered on chest or abdomen: • Check for clear and symmetrical breath sounds. • Provide high-flow oxygen or assisted ventilations. • Quickly assess pulse rate and quality. • Closed soft-tissue injuries do not have visible signs of bleeding. • Pulse will indicate how aggressively you need to treat for shock.

20. Transport Decision • If patient has signs of shock or airway or breathing problem, consider quickly transporting or requesting ALS. • Do not delay transport of closed-injury patient who may have more serious deeper injury.

21. Focused History and Physical Exam • Patients with significant MOI may need a rapid physical exam to identify injuries. • Focused physical exam • Focus assessment on the isolated closed injury, complaint, and affected body region. • Rapid physical exam • Perform if significant trauma has likely affected multiple systems. • Make sure cervical collar is applied.

22. Baseline Vital Signs • Closed-injury patients may rapidly become unstable. • Look for tachycardia; tachypnea; low blood pressure; weak pulse; and cool, moist skin. • Soft-tissue injuries, even without a significant MOI, can cause shock.

23. SAMPLE History • Obtain from responsive patient or bystanders/family. • Look for medical ID jewelry or cards.

24. Interventions • Provide complete spinal immobilization early if spinal injuries are suspected. • Provide high-flow oxygen. • Treat aggressively for shock. • Request ALS if necessary. • Do not delay transport.

25. Detailed Physical Exam • Any time there is a significant MOI, perform detailed physical exam if time permits.

26. Ongoing Assessment • Repeat the initial assessment. • Reassess vital signs frequently. • Communication and documentation • Provide accurate account of how you treated injuries.

27. RICES • Rest—keep patient quiet and comfortable as possible. • Ice slows bleeding. • Compression over an injury slows bleeding. • Elevation above the level of the heart reduces swelling. • Splinting decreases bleeding and reduces pain.

28. Abrasions • Caused by friction

29. Laceration • Jagged cut

30. Avulsion • Separation of various layers of the skin

31. Penetrating Wound • Results from a sharp pointed object

32. Gunshot Wounds • Gunshot wounds have unique characteristics

33. Crushing Open Wound • May involve damaged internal organs or broken bones

34. Scene Size-up • Wear BSI. • Do not touch equipment with bloody gloves; wear several pairs. • Beware of contaminating one patient with another patient’s blood. • Wear eye protection. • Consider MOI.

35. Initial Assessment • There may be internal underlying injuries. • Injuries can affect airway and breathing. • Provide spinal immobilization. • If the patient has an open chest wound, evaluate for bubbling or sucking sounds. • Quickly place an occlusive dressing over wound. • Provide high-flow oxygen. • Assess pulse and skin for shock. • Control significant bleeding.

36. Transport Decision • Consider quick transport if patient has airway or breathing problem or significant bleeding. • Stay focused on problems at hand. • Patients with significant bleeding or internal bleeding may quickly become unstable. • Watch for signs of shock.

37. Focused History and Physical Exam • Focused physical exam • Perform in responsive patient with simple open injury. • Focus on isolated injury, complaint, and affected body region. • Rapid physical exam • Perform if there is significant trauma likely affecting multiple systems. • Look for DCAP-BTLS. • Do not delay transport. • Be sure that spine is stabilized.

38. Baseline Vital Signs/SAMPLE History • Baseline vital signs • Will help determine if patient is going into shock • SAMPLE history • Anemia and hemophilia • Medications that thin the blood (aspirin, prescribed blood thinners)

39. Interventions • Control bleeding. • If bleeding is not significant, control later in assessment. • Stabilize spine and assist breathing. • Splint painful, swollen, deformed extremities.

40. Detailed Physical Exam • Perform if patient is stable and time allows.

41. Ongoing Assessment • Assess all bandaging frequently. • Reassess ABCs often. • Communication and documentation • Include description of MOI and patient’s position. • Estimate and report amount of blood loss. • Describe location, size, depth of injury.

42. Emergency Medical Care (1 of 3) • Use proper BSI precautions. • Administer oxygen if needed. • Treatment priority is ABCs—including controlling bleeding.

43. Emergency Medical Care (2 of 3) • Apply dry, sterile dressing over entire wound. • Maintain pressure and secure dressing with a roller bandage.

44. Emergency Medical Care (3 of 3) • Leave original dressing in place if bleeding continues. • Apply a second dressing on top of first and secure. • Splint the extremity.

45. Abdominal Wounds • Open wound in abdomen may expose organs. • Organ protruding through abdomen is called an evisceration.

46. Abdominal Wound Management • Do not touch exposed organs. • Cover organs with a moist sterile dressing. • Transport immediately.

47. Impaled Objects (1 of 2) • Do not attempt to move or remove object.

48. Impaled Objects (2 of 2) • Control bleeding and stabilize object. • Tape a rigid item over object to prevent movement. • Transport to hospital carefully.

49. Amputations • Immobilize partial amputation with bulky dressings and splint. • Wrap complete amputation in dry sterile dressing and place in plastic bag. • Put bag in cool container filled with ice. Do not let object freeze! • Transport severed part with patient.

50. Neck Injuries (1 of 2) • An open neck injury can be life threatening. • Air can get into the veins and cause an air embolism.