11

Soft Tissue Soft Tissue InjuriesInjuries

22

Skin Anatomy and Skin Anatomy and PhysiologyPhysiology

Body’s largest Body’s largest organorgan

Three layers:Three layers:EpidermisEpidermis

DermisDermisSubcutaneous Subcutaneous

tissuetissue

33

Skin Anatomy and Skin Anatomy and PhysiologyPhysiology

Complex system, variety of functionsComplex system, variety of functionsSensationSensation

Control of water lossControl of water lossProtection against microbesProtection against microbes

Temperature controlTemperature control

44

AssessmentAssessment

55

Wear BSI.Wear BSI.Do not touch equipment with Do not touch equipment with

bloody gloves; wear several pairs.bloody gloves; wear several pairs.Beware of contaminating one Beware of contaminating one

patient with another patient’s patient with another patient’s blood.blood.

Wear eye protection.Wear eye protection.Consider MOI.Consider MOI.

Scene Size-upScene Size-up

66

Decide SICK/NOT SICK.Decide SICK/NOT SICK.There may be internal underlying There may be internal underlying

injuries.injuries. Injuries can affect airway and Injuries can affect airway and

breathing.breathing.Provide spinal immobilization.Provide spinal immobilization.Open chest wound? Evaluate for Open chest wound? Evaluate for

bubbling or sucking soundsbubbling or sucking sounds..

Initial AssessmentInitial Assessment

77

Quickly place an occlusive Quickly place an occlusive dressing over wound (SCW)dressing over wound (SCW)

Provide high-flow oxygen.Provide high-flow oxygen.Assess pulse and skin for shock.Assess pulse and skin for shock.Control significant bleeding.Control significant bleeding.

Initial AssessmentInitial Assessment

88

Focused physical examFocused physical examFocus on isolated injury, complaint, Focus on isolated injury, complaint,

and affected body region.and affected body region.Rapid physical examRapid physical examPerform if there is significant trauma Perform if there is significant trauma

affecting multiple systems.affecting multiple systems.Look for DCAP-BTLS.Look for DCAP-BTLS.Be sure that spine is stabilized.Be sure that spine is stabilized.

Focused ExamFocused Exam

99

Perform if patient is stable and time Perform if patient is stable and time allows.allows.

Detailed ExamDetailed Exam

1010

Reassess all bandaging.Reassess all bandaging. Reassess ABCs.Reassess ABCs. Communication and documentationCommunication and documentation Include description of MOI and Include description of MOI and

patient’s position.patient’s position. Describe location, size, depth of Describe location, size, depth of

injury.injury. Provide accurate account of how you Provide accurate account of how you

treated injuries.treated injuries.

Ongoing AssessmentOngoing Assessment

1111

Baseline Vitals/SAMPLE Baseline Vitals/SAMPLE Baseline vital signsBaseline vital signs

Will help determine if patient is going Will help determine if patient is going into shock into shock

SAMPLE historySAMPLE historyAnemia and hemophiliaAnemia and hemophiliaMedications that thin the blood Medications that thin the blood

(aspirin, prescribed blood thinners)(aspirin, prescribed blood thinners)

1212

Soft Tissue InjuriesSoft Tissue Injuries

ClosedClosed

OpenOpen

BurnsBurns

1313

Closed InjuryClosed InjuryAssociated with blunt traumaAssociated with blunt trauma

Skin remains intactSkin remains intactDamage occurs below skin surfaceDamage occurs below skin surface

Types:Types:ContusionsContusionsHematomasHematomas

1414

ContusionContusionBlunt force Blunt force

damages dermal damages dermal structuresstructures

Blood, fluid leak Blood, fluid leak into injury area into injury area (pain/swelling)(pain/swelling)

EcchymosisEcchymosis

1515

HematomaHematomaLarger vessel Larger vessel

damage with damage with mass of blood mass of blood collecting at collecting at injury siteinjury site

Fist-sized = 10% Fist-sized = 10% volume lossvolume loss

1616

Closed Soft Tissue InjuryClosed Soft Tissue Injury

Considerations:Considerations:How much blood is tied up in How much blood is tied up in

that injury rather than that injury rather than circulating in the vessels?circulating in the vessels?

What could the force that What could the force that caused the soft tissue trauma caused the soft tissue trauma have done to underlying have done to underlying organs?organs?

1717

BLS Care BLS Care Request ALS if indicatedRequest ALS if indicatedO2, assist ventilationsO2, assist ventilationsMaintain airway, breathing, c-spineMaintain airway, breathing, c-spineRICERICEMaintain body temperatureMaintain body temperatureMonitor vital signsMonitor vital signsCalm and reasssureCalm and reasssureTransportTransport

1818

Closed Injury Closed Injury ManagementManagement

RestRestIceIce

CompressionCompressionElevationElevation

SplintSplint

1919

Open InjuryOpen Injury

Skin brokenSkin broken

Protective function lostProtective function lost

External bleeding, infection External bleeding, infection become problemsbecome problems

2020

Open Injury TypesOpen Injury Types

AbrasionsAbrasionsLacerationsLacerationsPuncturesPuncturesAvulsionsAvulsions

AmputationsAmputations

2121

AbrasionAbrasion

Loss of portions of epidermis, upper Loss of portions of epidermis, upper dermis by rubbing or scraping force. dermis by rubbing or scraping force.

Usually associated with capillary Usually associated with capillary oozing, leaking of fluidoozing, leaking of fluid

““Road rash”Road rash”

2222

AbrasionAbrasion

2323

LacerationLacerationCut by sharp objectCut by sharp objectTypically longer than it is deepTypically longer than it is deepMay be associated with severe blood May be associated with severe blood

loss, damage to underlying tissuesloss, damage to underlying tissuesTypesTypes

LinearLinearStellateStellate

2424

LacerationsLacerations

2525

PuncturesPuncturesResult from stabbing forceResult from stabbing forceWound is deeper than it is longWound is deeper than it is longDifficult to assess injury extentDifficult to assess injury extentObject producing puncture may Object producing puncture may

remain impaled in woundremain impaled in wound

2626

Puncture WoundsPuncture Wounds

2727

AvulsionsAvulsionsPiece of skin torn loose as a flap or Piece of skin torn loose as a flap or

completely torn from bodycompletely torn from bodyResult from accidents with Result from accidents with

machinery and motor vehiclesmachinery and motor vehiclesReplace flap into normal position Replace flap into normal position

before bandagingbefore bandagingTreat completely avulsed tissue like Treat completely avulsed tissue like

amputated partamputated part

2828

AvulsionsAvulsions

2929

AmputationsAmputationsDisruption of continuity of Disruption of continuity of

extremity or other body partextremity or other body partPart should be wrapped in sterile Part should be wrapped in sterile

gauze, placed in plastic bag, gauze, placed in plastic bag, transported on top of cold packtransported on top of cold pack

Do Do NOTNOT pack part directly in ice pack part directly in iceDo Do NOTNOT let part freeze let part freeze

3030

AmputationsAmputations

3131

Open Wound Open Wound ManagementManagement

Manage ABCs firstManage ABCs firstPosition of comfortPosition of comfortControl bleedingControl bleedingPrevent further contamination, but do Prevent further contamination, but do

not worry about trying to clean woundnot worry about trying to clean wound Immobilize injured partImmobilize injured partMange hypoperfusion if present (O2)Mange hypoperfusion if present (O2)

3232

Special ConsiderationsSpecial Considerations Impaled objectsImpaled objects

EviscerationsEviscerationsOpen chest woundsOpen chest wounds

Neck woundsNeck woundsGunshot woundsGunshot wounds

Crush InjuriesCrush Injuries Injection InjuriesInjection Injuries

3333

Impaled ObjectsImpaled Objects

Do Do NOTNOT remove removeStabilize in placeStabilize in placeException:Exception:

Object in cheekObject in cheekRemove, dress inside and Remove, dress inside and

outside mouthoutside mouth

3434

Imapled ObjectsImapled Objects

3535

EviscerationsEviscerations Internal organs exposed through Internal organs exposed through

woundwoundCover organs with large Cover organs with large

unmoistened dressing, then with unmoistened dressing, then with aluminum foil or dry multi-trauma aluminum foil or dry multi-trauma dressing dressing

Do Do NOTNOT use individual 4 x 4’s use individual 4 x 4’sDo Do NOTNOT attempt to replace organs attempt to replace organs

3636

EviscerationsEviscerations

3737

Open Chest WoundOpen Chest WoundMay prevent adequate ventilationMay prevent adequate ventilationCover with occlusive dressingCover with occlusive dressingMonitor patient for signs of air Monitor patient for signs of air

becoming trapped under pressure becoming trapped under pressure in chest (tension pneumothorax)in chest (tension pneumothorax)

If tension pneumo develops lift If tension pneumo develops lift dressing corner to relieve pressuredressing corner to relieve pressure

3838

Open Chest WoundsOpen Chest Wounds

3939

Neck WoundsNeck WoundsRisk of severe bleeding from large Risk of severe bleeding from large

vesselsvesselsRisk of air entering vein and moving Risk of air entering vein and moving

through heart to lungsthrough heart to lungsCover with occlusive dressingCover with occlusive dressingDo NOT occlude airway or blood Do NOT occlude airway or blood

flow to brainflow to brainSuspect presence of spinal injurySuspect presence of spinal injury

4040

Neck WoundsNeck Wounds

4141

Gunshot WoundsGunshot WoundsSpecial type of puncture woundSpecial type of puncture woundTransmitted energy can cause Transmitted energy can cause

injury remote from bullet trackinjury remote from bullet trackBullets change direction, tumbleBullets change direction, tumble Impossible to assess severity in Impossible to assess severity in

field or ERfield or ERPatient must go to ORPatient must go to OR

4242

Gunshot WoundsGunshot Wounds

4343

Crush InjuriesCrush Injuries MOI will determine MOI will determine

sverity of injurysverity of injury Do not be fooled by Do not be fooled by

signd of minimal signd of minimal injuryinjury

Beware of crush Beware of crush syndrome syndrome (rhabdomyolysis)(rhabdomyolysis)

4444

Injection InjuriesInjection Injuries Serious tissue Serious tissue

injury caused by injury caused by high pressure high pressure injectionsinjections

External injury may External injury may look minor but look minor but internal injury may internal injury may be very severebe very severe

Treat like a Treat like a puncture injurypuncture injury

4545

Eye InjuriesEye Injuries LacerationsLacerations Lacerations to the eyes Lacerations to the eyes

require very careful require very careful repair.repair.

Never exert pressure on Never exert pressure on or manipulate the eye.or manipulate the eye.

If part of the eyeball is If part of the eyeball is exposed, apply a moist, exposed, apply a moist, sterile dressing.sterile dressing.

Cover the injured eye Cover the injured eye with a protective metal with a protective metal eye shield.eye shield.

4646

Eye InjuriesEye Injuries Blunt traumaBlunt trauma Blunt trauma can Blunt trauma can

cause a number of cause a number of serious injuries.serious injuries.̶O A fracture of the orbit A fracture of the orbit

(blowout fracture)(blowout fracture)̶O Retinal detachmentRetinal detachment

May range from a May range from a black eye to a black eye to a severely damaged severely damaged globeglobe

4747

Eye InjuriesEye Injuries HyphemaHyphema Bleeding in the Bleeding in the

anterior chamber of anterior chamber of the eyethe eye

May seriously impair May seriously impair visionvision

4848

Eye InjuriesEye Injuries Blowout fractureBlowout fracture May occur from blunt May occur from blunt

trauma caused by a trauma caused by a fracture of the orbitfracture of the orbit

Bone fragments may Bone fragments may entrap muscles that entrap muscles that control eye control eye movement, causing movement, causing double vision.double vision.

4949

Eye InjuriesEye Injuries Retina detachmentRetina detachment Often seen in sports Often seen in sports

injuriesinjuries Produces flashing Produces flashing

lights, specks, or lights, specks, or floaters in field of floaters in field of visionvision

Needs prompt medical Needs prompt medical attentionattention

5050

BLS IndicatorsBLS IndicatorsConscious and alertConscious and alertStable vital signsStable vital signsSoft tissue injuries limited to the Soft tissue injuries limited to the

superficial layer of skinsuperficial layer of skinSingle digit amputationsSingle digit amputationsControlled bleeding by direct Controlled bleeding by direct

pressure and/or elevationpressure and/or elevation

5151

BLS Care BLS Care Request ALS if indicatedRequest ALS if indicatedO2, assist with ventilationsO2, assist with ventilationsMaintain airway, breathing, c-spineMaintain airway, breathing, c-spineControl bleedingControl bleedingMaintain body temperatureMaintain body temperatureMonitor vital signsMonitor vital signsCalm and reassureCalm and reassureTransportTransport

5252

ALS IndicatorsALS IndicatorsSignificant head injurySignificant head injurySigns/symptoms of shockSigns/symptoms of shockAirway compromiseAirway compromiseExcessive, uncontrolled bleedingExcessive, uncontrolled bleedingAltered LOCAltered LOCHigh index of suspicion based on MOIHigh index of suspicion based on MOI