Soft Tissue Injuries

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Soft Tissue Injuries
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Skin Anatomy and Physiology

• Bodys largest organ
• Three layers
• Epidermis
• Dermis
• Subcutaneous tissue

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Skin Anatomy and Physiology

• Complex system, variety of functions
• Sensation
• Control of water loss
• Protection against microbes
• Temperature control

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Soft Tissue Injuries

• Closed
• Open

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Closed Injury

• Associated with blunt trauma
• Skin remains intact
• Damage occurs below surface
• Types
• Contusions
• Hematomas

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Contusion

• Produced when blunt force damages dermal
  structures
  
• Blood, fluid leak into damage area causing
  swelling, pain
  
• Presence of blood causes skin discoloration
  called ecchymosis (bruise)

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Hematoma

• Blood lump
• Larger blood vessel damaged
• Causes mass of blood to collect in the injured
  area
  
• Fist-sized hematoma 10 volume loss

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With Closed Soft Tissue Injury

• How much blood is tied up in that injury rather
  than circulating in the vessels?
  
• What could the force the caused the soft tissue
  trauma have done to underlying organs?

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Closed Injury Management

• Rest
• Ice
• Compression
• Elevate
• Splint

When in doubt assume underlying fractures are
present
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Open Injury

• Skin broken
• Protective function lost
• External bleeding, infection become problems

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Open Injury Types

• Abrasions
• Lacerations
• Punctures
• Avulsions
• Amputations

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Abrasion

• Loss of portions of epidermis, upper dermis by
  rubbing or scraping force.
  
• Usually associated with capillary oozing, leaking
  of fluid
  
• Road rash

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Laceration

• Cut by sharp object
• Typically longer than it is deep
• May be associated with severe blood loss, damage
  to underlying tissues
  
• Types
• Linear
• Stellate

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Punctures

• Result from stabbing force
• Wound is deeper than it is long
• Difficult to assess injury extent
• Object producing puncture may remain impaled in
  wound

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Avulsions

• Piece of skin torn loose as a flap or completely
  torn from body
  
• Result from accidents with machinery and motor
  vehicles
  
• Replace flap into normal position before
  bandaging
  
• Treat completely avulsed tissue like amputated
  part

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Amputations

• Disruption of continuity of extremity or other
  body part
  
• Part should be wrapped in sterile gauze, placed
  in plastic bag, transported on top of cold pack
  
• Do NOT pack part directly in ice
• Do NOT let part freeze

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Open Wound Management

• Manage ABCs first
• Control bleeding
• Prevent further contamination, but do not worry
  about trying to clean wound
  
• Immobilize injured part
• Mange hypoperfusion if present

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Special Considerations

• Impaled objects
• Eviscerations
• Open chest wounds
• Neck wounds
• Gunshot wounds

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Impaled Objects

• Do NOT remove
• Stabilize in place
• Exception
• Object in cheek
• Remove, dress inside and outside mouth

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Eviscerations

• Internal organs exposed through wound
• Cover organs with large moistened dressing, then
  with aluminum foil or dry multi-trauma dressing
  
• Do NOT use individual 4 x 4s
• Do NOT attempt to replace organs

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Open Chest Wound

• May prevent adequate ventilation
• Cover with occlusive dressing
• Monitor patient for signs of air becoming trapped
  under pressure in chest (tension pneumothorax)
  
• If tension pneumo develops lift dressing corner
  to relieve pressure

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Neck Wounds

• Risk of severe bleeding from large vessels
• Risk of air entering vein and moving through
  heart to lungs
  
• Cover with occlusive dressing
• Do NOT occlude airway or blood flow to brain
• Suspect presence of spinal injury

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Gunshot Wound

• Special type of puncture wound
• Transmitted energy can cause injury remote from
  bullet track
  
• Bullets change direction, tumble
• Impossible to assess severity in field or ER
• Patient must go to OR