Soft Tissue Injuries

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Chapter 28

• Soft Tissue Injuries

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Topics

• The skin
• Closed soft tissue injuries
• Open soft tissue injuries
• Dressings and bandages
• Enrichment

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Introduction

• As a general rule, soft tissue injuries can be
  extremely graphic, but rarely life-threatening
• The major concern with soft tissue injuries is
  the associated hemorrhage or infection risk
  created by these injuries

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The Skin

• The skin is the largest and most durable system
  of the body. It is also the system that is
  commonly injured as a result of trauma.

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The Skin

• The term wound refers to an injury to the skin
  and its underlying tissues
• Wounds may be categorized as closed, open,
  single, or multiple

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Closed Soft Tissue Injuries

• Closed soft tissue injuries
• No external breaking of the skin
• They may be categorized into one of three types
• Contusion
• Hematoma
• Crush injury

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Closed Soft Tissue Injuries

• Closed soft tissue injuries
• Contusion
• Commonly known as a bruise
• Injury to the cells and small blood vessels
  within the dermis
• You may note some discoloration, called ecchymosis

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Closed Soft Tissue Injuries

• Closed soft tissue injuries
• Contusion

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Closed Soft Tissue Injuries

• Closed soft tissue injuries
• Hematoma
• Similar to a contusion, but it involves a larger
  amount of skin damage
• Characterized by a large lump, and overlying
  ecchymosis is common

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Closed Soft Tissue Injuries

• Closed soft tissue injuries
• Hematoma

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Closed Soft Tissue Injuries

• Closed soft tissue injuries
• Crush injuries
• These types of injury mechanisms can result in
  either open or closed soft tissue injury
• A large external force is applied to the body
  resulting in internal damage (ranging from
  fractured bones to organ rupture)

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Closed Soft Tissue Injuries

• Assessment closed soft tissue injuries
• Scene size-up and initial assessment
• Take BSI precautions.
• Assure scene safety and approach the patient
• Take manual cervical control if necessary
• Initially focus on mental status, airway,
  breathing, and circulatory assessments

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Closed Soft Tissue Injuries

• Assessment closed soft tissue injuries
• Focused history and physical exam
• Perform either a rapid trauma assessment with a
  high priority patient, or a focused physical exam
  with a low one
• Follow this with vitals and a SAMPLE history
• Use the DCAP-BTLS to help assess the injuries

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Closed Soft Tissue Injuries

• Assessment closed soft tissue injuries
• Signs and symptoms
• Swelling, pain, discoloration
• Indications of hypoperfusion
• Is area large enough to cause hypoperfusion?
• Femur (thigh area)
• Body cavities

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Closed Soft Tissue Injuries

• Emergency medical care closed injuries
• Take BSI precautions
• Assure an open airway and adequate breathing
  give oxygen
• Treat for shock (hypoperfusion) if present
• Splint any painful, swollen, deformed extremities

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Closed Soft Tissue Injuries

• Assessment closed soft tissue injuries
• Detailed physical exam and ongoing assessment
• Time allowing, conduct a detailed physical exam
• During your ongoing assessment, reassess the
  components of your initial assessment and provide
  modifications in treatment as needed
• Notify hospital of the patients status

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Occur when the trauma sustained causes a break in
  the surface of the skin
• These types of injuries carry with them the risk
  of hemorrhage as well as infection
• There are six general types of open injuries

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Abrasion
• Caused by scraping, rubbing, or shearing away of
  the epidermis.
• Blood may leak from site, but is extremely well
  controlled with pressure.

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Abrasion

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Laceration
• Essentially a break in the skin of varying length
• May be described as linear or stellate
• Tend to bleed more than other types of open soft
  tissue injuries
• May result in venous or arterial bleeding

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Laceration

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Laceration to the face

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Laceration with deep abrasion

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Avulsion
• Occurs when the trauma results in the skin being
  torn away from the body
• May bleed severely, and are most commonly from
  industrial accidents and involve the extremities,
  nose, and ears
• If an avulsion is only hanging on by a flap,
  NEVER remove it completely from the body

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Avulsion

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Avulsion

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Amputation
• An amputation involves a disruption in the
  continuity of an extremity or other body part
• Bleeding may be severe, or minimally present,
  depending on the dynamics of the injury itself
• All amputated body parts MUST be kept on ice and
  transported to the hospital

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Finger amputation

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Multiple finger amputations

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Penetration and puncture
• This results when a sharp or pointed object is
  pushed or driven into the soft tissues of the
  body

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Penetration and puncture

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Gunshot wound to the anterior left foot, slightly
  medial

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Gunshot wound to the first finger of the left
  hand, proximal to the middle knuckle

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Gunshot wound to the leg, with both entry and
  exit wounds

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Gunshot wound to the right lateral mandibular
  region

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Gunshot wound to the inferior aspect of the left
  temporal region, anterior to the left ear

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Crush Injury
• Usually the result of blunt trauma or crushing
  forces
• Although it may not appear serious, it may in
  fact be fatal
• If the patient is still trapped or pinned, once
  the pressure is released, the patient may rapidly
  degrade into arrest

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Open Soft Tissue Injuries

• Open soft tissue injuries
• Open crush injury

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Open Soft Tissue Injuries

• Assessment open soft tissue injuries
• Scene size-up and initial assessment
• Take BSI precautions, assure scene safety
• Form general impression and take manual cervical
  control if the situation warrants
• Initially focus on mental status, airway,
  breathing, and circulatory assessments
• Control any external hemorrhage that is life
  threatening in nature

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Open Soft Tissue Injuries

• Assessment open soft tissue injuries
• Focused history and physical exam
• Perform either a rapid trauma assessment with a
  high priority patient, or a focused physical exam
  with a low one
• Follow this with vitals and a SAMPLE history
• Use the DCAP-BTLS to help assess the injuries

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Open Soft Tissue Injuries

• Assessment open soft tissue injuries
• Signs and symptoms
• A break in the skin with external bleeding
• Localized pain, swelling, and discoloration at
  the site
• Possible indications of hypoperfusion

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Open Soft Tissue Injuries

• Emergency medical care open injuries
• Take BSI precautions
• Assure an open airway and adequate breathing
• Expose the wound, and control the bleeding with
  direct pressure
• Prevent any further contamination

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Open Soft Tissue Injuries

• Emergency medical care open injuries
• Dress and bandage the wound
• Keep the patient calm and quiet
• Treat for shock (hypoperfusion) if necessary
• Treat any other soft tissue trauma that may be
  present as appropriate
• Transport

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Open Soft Tissue Injuries

• Assessment open soft tissue injuries
• Detailed physical exam and ongoing assessment
• Conduct a detailed physical exam
• During your ongoing assessment, reassess the
  components of your initial assessment and
  provide modifications as needed
• Notify hospital of the patients status

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Chest injuries
• A penetrating injury to the chest may allow the
  lung to collapse as the space outside the lung
  fills with air

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Application of an occlusive dressing

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Abdominal injuries (evisceration)
• An evisceration is when an open injury to the
  abdominal cavity allows the organ(s) to protrude
  out of the wound

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Abdominal injuries (evisceration)

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Impaled objects
• Impaled objects are those that are still
  penetrating into the body upon your arrival

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Open Soft Tissue Injuries

• Impaled object

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Open Soft Tissue Injuries

• Impaled object

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Impaled objects should be immobilized in place

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Expose the injury prior to stabilization

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Secure the object in place

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Fashion a cravatinto a doughnut shape if
  neededto help stabilizethe object

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Only remove an impaled object if itimpinges on
  the airway

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Amputation
• The amputated portion of the body should be
  wrapped in sterile dressings, placed in plastic,
  and kept cool
• Transport the amputation with the patient, unless
  disentangling the amputated part will delay
  transport of the patient

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Caring for the amputated part

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Caring for the amputated part

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Caring for the
• amputated part

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Open neck injury
• Treatment centers around covering the neck with
  an occlusive dressing and controlling bleeding
• Be cautious to not accidentally compress BOTH
  carotid arteries during your direct pressure

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Open Soft Tissue Injuries

• Special considerations for specific types of soft
  tissue trauma
• Open injury(linear laceration)to the
  postero-lateral neck, inferior to the left ear

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Dressings and Bandages

• Dressings
• A dressing covers an open wound
• Various sizes are available to accommodate the
  different sizes and shapes that the injuries may
  present in

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Dressings and Bandages

• Dressings

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Dressings and Bandages

• Dressings
• Multi-trauma dressings

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Dressings and Bandages

• Dressings
• Materials that can be used for occlusive
  dressings

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Dressings and Bandages

• New types of dressings and bleeding inhibitors
• Hemostatic and Chitosan dressings
• Use of QuickClot

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Dressings and Bandages

• Bandages
• Types
• Self-adhering bandage
• Gauze rolls
• Triangular bandage
• Air splint

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Dressings and Bandages

• Bandages
• Pressure dressing and bandaging
• Cover wound with sterile material
• Apply hand pressure
• Bandage firmly to inhibit bleeding
• If this fails, remove material and attempt
  fingertip pressure to site of hemorrhage

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Dressings and Bandages

• Bandages
• Head and/or eye bandage

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Dressings and Bandages

• Bandages
• Head and/or earbandage

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Dressings and Bandages

• Bandages
• Cheek bandage

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Dressings and Bandages

• Bandages
• Hand bandage

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Dressings and Bandages

• Bandages
• Shoulder bandage

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Dressings and Bandages

• Bandages
• Foot and/orankle bandage

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Dressings and Bandages

• Bandages
• Knee bandage

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Dressings and Bandages

• Bandages
• Self-adhering bandage
• Step 1 Step 2 Completed

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Dressings and Bandages

• Bandages
• Triangular bandage as an arm sling

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Dressings and Bandages

• Bandages
• Air splint used to hold a dressing in place

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Enrichment

• Other soft tissue injuries
• Bites
• Usually a combination of a penetration injury and
  crush injury (from the clamping of the jaw), and
  then possibly avulsion or stellate lacerations as
  the person tries to pull their arm (or leg) free
• Person also at risk for cellulitis, septicemia,
  rabies, and tetanus

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Enrichment

• Other soft tissue injuries
• Dog bite to a childs face

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Enrichment

• Other soft tissue injuries
• Human bite to the lower leg

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Enrichment

• Other soft tissue injuries
• Clamping injury
• A clamping injury occurs when a body part is
  caught or strangled by some piece of machinery

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Enrichment

• Other soft tissue injuries
• Clamping injury to the left hand