Ch. 7 Soft-Tissue Injuries

1. Ch. 7Soft-Tissue Injuries 1

2. 7.1 Closed Injuries • Contusion • Hematoma • Crush Injuries 2

3. First Aid Care 1. If you suspect internal bleeding or the victim shows the signs and symptoms of shock, treat for shock. 2. Apply ice or cold compresses to help relieve pain and reduce swelling. 3. Splint painful, swollen, or deformed extremities to help control pain and swelling and prevent further injury. 3

4. Vocabulary Wound- An injury to the skin and underlying musculature that disrupts the normal continuity of the affected tissue, organ, or bone Contusion- A bruise Epidermis- The outermost layer of the skin Dermis- The second layer of skin, which contains the hair follicles, sweat glands, oil glands, and nerves Hematoma- A collection of blood beneath the skin 4

5. PROGRESS CHECK 1. A contusion is a ____________. (closed fracture/ bruise/laceration) 2. A hematoma is ____________ under the skin. (blood/swelling/ecchymosis) 3. Crushing injuries don’t break the skin but can cause internal injury severe enough to cause ____________. (hemorrhage/fracture/shock) 4. Apply ____________ to reduce the pain and swelling associated with closed injuries. (cold compresses/manual pressure/splints) 5

6. 7.2 Open Injuries • Abrasion • Laceration • Avulsion • Penetrating and Puncture Wounds • Amputations • Bites 6

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8. First Aid Care 1. Expose the wound so you can see it clearly; if necessary, cut the victim’s clothing from around the wound. 2. Control bleeding with direct pressure, using your gloved hand and a dry, sterile compression bandage, if possible. 3. Prevent further contamination by keeping the wound as clean as possible. Avoid touching the wound with anything that is not clean. Leave the cleaning of the wound to medical personnel. 4. Apply a dry, sterile dressing to the wound and bandage it securely in place. 8

9. Activate the EMS system if: • The wound has spurted blood, even if you have controlled the bleeding. • The wound is deeper than the outer layer of skin. • There is uncontrolled bleeding. • There is embedded debris, an embedded object, or extensive contamination. • The wound involves nerves, muscles, or tendons. • The wound involves the mouth, tongue, face, genitals, or any area where a scar would be disfiguring. • The wound is a human or animal bite. 9

10. Cleaning Wounds and Preventing Infection • Wash the area around the wound with soap and water. • Irrigate the wound with clean tap water; the water must flow at moderate pressure and be clean enough to drink. Never scrub the wound— you can damage the wounded tissues. • Gently pat the wound dry with sterile gauze and apply antibiotic ointment (such as Neosporin). • Cover the wound with a sterile, nonstick dressing, and bandage in place. 10

11. PROGRESS CHECK 1. The greatest threat from an abrasion is ____________. (infection/pain/blood loss) 2. Linear lacerations heal better than stellate lacerations because ____________. (there is less blood loss/the edges are smooth/infection is less likely) 3. The most dangerous dog bites are those in areas with few___________. (nerve endings/blood vessels/underlying tissues) 4. The greatest danger with an avulsion is compromised ____________ in the flap. (sensation/circulation/pain reception) 5. The most serious bites are ____________ bites. (snake/dog/human) 6. Blood loss from an amputation may actually be slight, because the elastic blood vessels may ____________. (be crushed/retract into surrounding tissue/shut down) 11

12. 7.3 Special Treatment Considerations • Chest Injuries • Abdominal Injuries • 1. Do not touch abdominal organs or try to replace them in the abdomen. • 2. Cover protruding abdominal organs with a clean, moist, sterile dressing. • 3. Cover the moist dressing with an occlusive material, such as plastic wrap, to retain moisture and warmth. • 4. Gently wrap the dressing in place with a bandage or clean sheet 12

13. Impaled Objects 1.Remove the victim’s clothing if necessary to expose the wound; cut it away without disturbing the impaled object. 2. Manually secure the impaled object to prevent any motion. 3. Control bleeding with direct pressure, but do not exert any pressure on the impaled object or on the edges of the skin around the cutting edge of the object. 4. Stabilize the impaled object with bulky dressings and bandage in place. 5. Calm and reassure the victim as you monitor for shock. 6. Keep the victim at rest. 7. Do not attempt to cut off, break off, or shorten an impaled object unless transportation is not possible with it in place. 8. Activate the EMS system immediately. 13

14. Amputations 1. If possible, rinse the amputated part with clean water, but do not scrub. Wrap the part in a dry sterile gauze dressing secured in place with a self-adherent roller bandage. 2. Place the wrapped part in a plastic bag, in accordance with local protocol. 3. Place the wrapped and bagged part in a cooler or any other available container so that it is on top of a cold pack or a sealed bag of ice (do not use dry ice). The part should be kept as cool as possible, without freezing. Do not cover the part with ice or immerse it in any kind of liquid. 4. When EMTs arrive, give them the amputated part so it can be transported with the victim. 14

15. Clamping Injuries 1. Remove the clamping object as quickly as possible. If you cannot remove the clamping object, apply a lubricant, such as green soap, and slowly but firmly wiggle the body part until it is loose. 2. If possible, elevate the affected extremity while you remove the clamping object. 3. If you are unable to loosen the body part or remove the clamping object, activate the EMS system. 15

16. PROGRESS CHECK 1. To treat a chest injury, cover the wound with an occlusive dressing and tape it on ____________ sides. (two/three/all) 2. Cover protruding abdominal contents with a dressing, then ____________ material. (occlusive/porous/adherent) 3. The goal in treating a wound with an impaled object is to prevent ____________ as much as possible. (bleeding/pain/motion) 4. If you find an amputated part, wrap it in gauze, then keep it ____________. (moist and cool/dry and cool/dry and room temperature) 5. In cases of a clamping injury, activate the EMS system if_______. (the wound bleeds/you cannot remove the clamping object/ there is severe pain) 16