SoftTissue Injuries

1
Soft-Tissue Injuries

• Lesson 13

2
Introduction

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

3
Types of Soft-Tissue Injuries

• Type/amount of bleeding depend on wound type,
  location, depth

4
Closed Wounds

• No break in skin
• Discoloration/swelling from internal bleeding
• Musculoskeletal injuries may be present

5
Abrasions

• Top 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 heavy bleeding
• Laceration through artery may be life-threatening

7
Punctures, Penetrating Wounds

• Caused by object penetrating skin/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/soft tissue torn partially from body

9
Traumatic Amputations

• The complete cutting/tearing off of all/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
• Perform initial assessment
• With less serious bleeding complete assessment
  and standard patient care first

12
Always Perform Standard Assessment

• Size up scene
• Complete initial assessment
• Perform physical examination as appropriate
• Complete ongoing assessments

13
Always Perform Standard Patient Care

• Ensure EMS has been activated
• Use body substance isolation
• Maintain patients airway
• Provide artificial ventilation if needed
• Comfort, calm, and reassure patient

14
Additional Care for Soft-Tissue Injuries

• Select needed BSI precautions
• Control bleeding
• cover the wound with sterile gauze
• apply direct pressure

15
Additional Care for Soft-Tissue Injuries continued

• With minor wounds only
• Irrigate under running water
• Irrigate wound for 5 minutes or until no foreign
  matter in wound
• Pat area dry, apply sterile dressing, bandage
• Prevent contamination with dressing/bandage
• If stitches needed or patients 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
Dressing a Wound
18
Purpose of Dressings

• Helps stop bleeding
• Prevents infection
• Protects wound while healing

19
Types of Dressings

• Gauze squares
• Roller gauze
• Nonstick pads
• Adhesive strips
• Bulky
• Occlusive
• Improvised

20
Improvising Dressings

• If a 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

21
Ring Dressing

• Dont put direct pressure over
• skull fracture
• fractured bone protruding from a wound
• object impaled in wound
• Control bleeding with pressure around
  object/fracture
• Use ring dressing to control bleeding

22
Guidelines for Using Dressings

• Wash hands and wear medical exam gloves
• Choose dressing larger than wound
• Do not touch part of dressing that will touch
  wound
• Lay dressing on wound
• Cover whole wound

23
Guidelines for Using Dressings

• If blood seeps through, do not remove dressing
  but add more on top
• Apply bandage to hold dressing in place

24
Purpose of Bandages

• Cover a dressing
• Keep dressing on wound
• Maintain pressure to control bleeding

25
Types of Bandages

• Adhesive compresses
• Adhesive tape rolls
• Tubular
• Elastic
• Self-adhering
• Gauze roller
• Triangular
• Improvised

26
Guidelines for Bandaging

• Should be clean, not necessarily sterile
• Apply bandage firmly ? Dont cut off circulation
• Never encircle neck
• Dont cover fingers/toes
• Check fingers/toes for color, warmth, sensation

27
Guidelines for Bandaging Continued

• If reduced circulation, unwrap bandage and
  reapply
• Dont use elastic bandages for dressings
• Keep checking tightness of bandage
• Be sure bandage is secure
• Anchor first end and tie, tape, pin, or clip
  ending section

28
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

29
Skill

• Roller Bandage

30
Anchor starting end of bandage
31
Turn bandage diagonally across top of foot and
around ankle
32
Continue with overlapping figure-eight turns
33
Fasten end of bandage
34
Puncture Wounds
35
Puncture Wounds

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

36
Care for Puncture Wounds

• Follow general principles of wound care
• Remove small objects/dirt, not large impaled
  objects
• With small punctures, gently press wound edges
• Dont put medication inside/over puncture wound
• Irrigate with running water
• Dress wound an seek medical attention

37
Impaled Objects

• Often seal wound or damaged blood vessels

38
Impaled Object

• Removing an 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

39
Impaled Object

• Pad object in place with large dressings or
  folded cloth
• Support object while bandaging it in place
• Keep victim still
• Seek medical attention

40
Avulsion

• 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

41
Amputation

• Control bleeding and care for wound first, then
  recover and care for amputated part

42
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/container with
  ice and water. Part should not touch water or ice
  directly
• Give part to responding EMS

43
Animal Bites
44
Seriousness of Animal Bites

• Bleeding/tissue damage can be severe
• Increased risk of infection
• All bites carry rabies risk

45
Care of Animal Bites

• Follow general principles of wound care
• Clean with soap and water. Run water over wound
  for gt 5 minutes (except when bleeding severely)
• Control bleeding
• Dress and bandage

46
Care of Animal Bites Continued

• See healthcare provider a.s.a.p.
• Do not try to catch animal
• Report bite to animal control or law enforcement

47
Impaled Objects
48
Care for Impaled Object in Chest

• Follow general principles of wound care
• Keep patient still, seated, or lying down

49
Care for Impaled Object in Chest

• Use bulky dressings or cloth to stabilize object
• Bandage area around object
• Monitor breathing and vital signs. Treat for
  shock

50
Chest Injuries
51
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

52
Care for Sucking Chest Wound
53
Closed Chest Injury

• Organ damage or internal bleeding can be serious
• Consider the possibility of a pneumothorax or
  hemothorax with any trauma to the chest

54
Pneumothorax

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

55
Hemothorax

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

56
Signs and Symptoms of Pneumothorax or Hemothorax

• Little/no external evidence of injury
• Signs and symptoms of shock
• Respiratory distress

57
Care for Chest Injuries

• Perform standard patient care
• Help responsive victim to position of easiest
  breathing
• Treat for respiratory distress
• Follow local protocol re oxygen

58
Abdominal Injuries
59
Open Abdominal Wound

• Usually injures internal organs (intestines,
  liver, kidneys, or stomach)
• Large wound may cause evisceration
• Abdominal organs protrude through wound
• Serious emergency

60
Care for Open Abdominal Wounds

• Follow general principles of wound care
• Position patient on back
• Loosen tight clothing
• Cover wound and organs with a dry, non-adherent
  dressing or sterile, moist dressing

61
Care for Open Abdominal Wounds continued

• Cover dressing with large, occlusive dressing
• Cover area with blanket or towel
• Monitor vital signs, and treat for shock

62
Genital Injuries
63
Genital Injuries

• Rare because of the protected location
• Occur from blunt trauma, an impact, or sexual
  abuse
• Provide privacy

64
Genital Injuries

• Injured testicles
• Support with towel between legs
• Vaginal bleeding
• Have woman press sanitary pad or clean folded
  towel to area

65
Head and Face Injuries
66
Head and Face Wounds

• Consider possible neck or spinal injury
• Do not move victims head while giving first aid

67
Scalp Wound

• Before controlling bleeding, confirm no signs of
  skull fracture
• Deformed area of skull
• A depressed/spongy area in skull
• Blood or fluid from ears/nose
• Eyelids swollen shut or bruising
• Raccoon eyes
• Battles sign
• Unequal pupils
• Object impaled in skull

68
Care for Scalp Wound

• With no signs of a skull fracture
• Apply a dressing
• Use direct pressure to control bleeding
• Follow general principles of wound care
• Never wrap bandage around neck

69
Scalp Wound Without Suspected Skull Fracture

• Replace skin flaps and cover wound with sterile
  dressing
• Control bleeding with direct pressure
• Secure dressing with roller bandage
• Use triangular bandage as needed

70
Neck Injuries

• Bruising, swelling, difficulty speaking, airway
  obstruction may result
• Treat minor wounds like other wounds
• Significant open wounds are medical emergencies

71
Care for Neck Injuries

• Follow general principles of wound care
• Control bleeding with direct pressure
• Place occlusive dressing over wound and tape on
  all sides
• Apply pressure on dressing to control bleeding
• When bleeding is controlled, apply pressure
  dressing over occlusive dressing

72
Eye Injuries

• Serious because vision may be affected
• Avoid putting pressure on eyeball
• Movement of eye will worsen injury
• Keep unaffected eye covered

73
For a Large Object Embedded in the Eye

• Follow general principles of wound care
• Do not remove object
• Stabilize with dressings or bulky cloth (paper
  cup for large object)
• Cover both eyes

74
Dirt or Small Particle In Eye

• Do not let victim rub eyes
• Wait to see if victims tears will flush out
  object
• Gently pull upper eyelid out and down over lower
  eyelid to catch particle on lashes
• If particle remains and is visible try to brush
  it out

75
For Chemical or Substance Splashed in Eye

• Follow general principles of wound care
• Rinse the eye with running water for gt 20 minutes
• Position affected eye lower than unaffected eye
• Follow local protocol to consult PCC

76
Ear Injuries

• Bleeding or cerebrospinal fluid from ear a sign
  of serious head injury
• Do not use direct pressure to stop fluid coming
  out of ear
• Do not remove any foreign object
• If insect in ear, gently pour lukewarm water into
  ear to float it out

77
Care for External Ear Injuries

• Control bleeding with direct pressure
• Dress the wound

78
Care for Internal Ear Injuries

• Follow general principles of wound care
• Help patient sit up
• Tilt affected ear lower than unaffected ear
• Cover ear with loose sterile dressing
• Dont apply pressure or/plug ear closed

79
Nose Injuries

• Nose injuries can cause heavy bleeding
• Bleeding from back of nose down throat needs
  immediate medical attention
• Allow blood to drain from mouth

80
Care for Nose Injuries

• Follow general principles of wound care
• Patient sits with head slightly forward with
  mouth open
• Dont remove objects from nose
• Dont tilt patients head backward
• Pinch nostrils just below bridge of nose for 10
  minutes

81
Care for Nose Injuries Continued

• Release pressure slowly. Pinch nostrils for
  another 10 minutes
• Put unresponsive patient on side and pinch
  nostrils. Dont pack with dressing

82
Cheek Injuries

• Object impaled in cheek (possible airway
  obstruction)
• Remove it
• Place dressing inside mouth between wound and
  teeth
• Place another dressing on outside of wound
• Apply pressure as needed

83
Teeth and Mouth Injuries

• Control bleeding with direct pressure on dressing
• Priority is
• Ensure airway is open
• Ensure blood drains from mouth

84
Other Bleeding in Mouth

• Have victim sit with head tilted forward
• Wound penetrating lip
• Put rolled dressing between lip and gum
• Second dressing against outside lip
• Bleeding tongue
• Put dressing on wound and apply pressure

85
Knocked Out Tooth

• Save tooth
• May be re-implanted if victim sees dentist
• Touch only tooths crown
• Rinse if dirty
• Place in container of milk or commercial tooth
  saver kit
• Do not place tooth back in socket
• Get victim and tooth to dentist

86
Burns
87
Burns

• Major cause of death and injury
• Caused by sun, heat, chemicals, electricity

88
Assessing a Burn

• Perform the standard assessment
• Consider
• burn depth
• burn size
• specific body areas burned
• patients age and health status

89
Classification of Burns

• Superficial
• Partial-thickness
• Full-thickness

90
Superficial Burns

• Also called first-degree burns
• Damage only outer layer (epidermis)
• The skin is red, dry, painful
• Usually minor except for extensive area

91
Partial-Thickness Burns

• Also called second-degree burns
• Damage skins deeper layer (dermis)

92
Partial-Thickness Burns

• The skin is red, mottled, very painful
• Blisters and weeping clear fluid
• Often need medical attention

93
Full-Thickness Burns

• Also called third-degree burns
• Damage through subcutaneous layer and may include
  muscle/other tissues

94
Full-Thickness Burns

• The skin is charred/blackened or white/leathery
• Pain is not present but likely in adjacent areas
• Medical emergencies

95
Assessing Burn Size and Severity

• Rule of Nines

96
Emergency Burns by Size

• Any full-thickness burn gt 50-cent piece
• Partial-thickness burn gt 10 of adult body (5 of
  child/older adult)
• Superficial burn over gt 50 of body

97
Assess Burn Location

• Partial- or full-thickness burns on face,
  genitals, hands or feet need/immediate medical
  care
• Circumferential burns should receive immediate
  medical attention
• Burns around the nose and mouth may affect
  breathing and are medical emergencies

98
Assess Burned Patients Age and Health

• Burns in those lt age 5 or gt age 55 more serious
• Chronic health disorders make burns more serious

99
Principles of Care for Heat Burns

• Cool with cold water except for burn gt 20 of
  body or 10 in child
• Cool as long patient feels pain
• Continually add fresh water
• Protect burned area from additional
  trauma/pathogens
• Provide supportive care

100
Emergency Care for Heat Burns

• Perform standard patient care
• Follow general principles of wound care
• Remove the heat source and smoldering clothing
• Cool burn with cold water (except large,
  full-thickness burns)
• Remove constricting clothing and jewelry
• If clothing sticks cut around it

101
Emergency Care for Heat Burns Continued

• Treat for shock
• Cover burn with nonstick dressing. Use sheet
  over large area
• Follow local protocol re oxygen
• Dont apply cream/ointment. Dont break blisters
• Dont give patient anything to drink
• Monitor breathing. Give BLS if needed

102
Emergency Care for Heat Burns Continued

• For large burns in children
• Keep environment warm
• Consider possibility of child abuse

103
Smoke Inhalation
104
Smoke Inhalation

• Airway may swell and make breathing difficult
• Damage to alveoli may affect ability to receive
  oxygen
• Symptoms may not be obvious for up to 48 hours
  after exposure

105
Signs and Symptoms of Smoke Inhalation

• Coughing, wheezing, hoarse voice
• Possible burned area
• Blackening on face or chest
• Difficulty breathing

106
Care for Smoke Inhalation

• Perform standard patient care
• Get patient to fresh air, or fresh air to patient
  
• Follow local protocol re oxygen
• Help position into easy breathing
• Put unresponsive patient in recovery position.
• Monitor breathing. Give BLS if needed

107
Chemical Injuries
108
Chemical Burns

• Strong chemicals can burn skin on contact
• Sometimes burns develop slowly
• Acids, alkalis, liquids and solids can cause
  burns
• Flush substance off skin with water as soon as
  possible

109
Signs and Symptoms of Chemical Burns

• Pain or burning sensation
• Chemical on patients skin or clothing
• Spilled substance on/around unresponsive patient
• Smell of fumes

110
Emergency Care for Chemical Burns

• Perform standard patient care
• Wear gloves and eye protection if appropriate
• With a dry chemical, brush off skin with cloth,
  paper, cardboard, etc.

111
Emergency Care for Chemical Burns

• Move patient or ventilate area
• Flush area ASAP with running water gt 30 minutes

112
Emergency Care for Chemical Burns Continued

• Dont neutralize an acid with an alkaline or vice
  versa
• Remove clothing/jewelry while flushing
• Put dry nonstick dressing over burn

113
Electrical Injuries
114
Electrical Burns and Shocks

• Occurs when body contacts electricity
• Typical injuries occur with faulty appliances or
  power cords or appliance in contact with water

115
Signs and Symptoms of Electrical Injury

• A source of electricity nearby
• External entrance and exit wounds
• Unresponsiveness, seizures, changing levels of
  responsiveness
• Breathing abnormalities
• Weak or irregular pulse
• Can cause unseen internal injuries

116
Emergency Care for Electrical Burns

• Perform standard patient care
• Dont touch patient until area is safe
• Stop burning, cool area, remove clothing/jewelry,
  cover burn
• Treat for shock

117
Emergency Care for Electrical Burns Continued

• Keep unresponsive patient in recovery position
  and monitor
• Assume patient with lightning strike/high-voltage
  shock has spinal injury. Stabilize head and neck