Chapter Seven Soft Tissue Injuries
Wounds • Soft tissues are the layers of skin and the fat and muscle beneath the skin’s outer layer. • Wounds are defined as: • injury to the soft tissue of the body.
Closed Wounds • Closed wounds occur when: • the body is hit and the force of the blow damages the soft tissue layers beneath the skin causing internal bleeding. • This type of wound could be as simple as a contusion (bruise) or as severe as internal bleeding
Signals of Internal Bleeding • Tender, swollen, bruised or hard areas of the body such as the abdomen • Rapid, weak pulse • Skin that feels cool or moist or look pale or bluish • Vomiting blood or coughing up blood • Excessive thirst • An injured extremity that is blue or extremely pale • Becoming confused, drowsy, or unconscious
Call 9-1-1 if… • A person complains of severe pain or cannot move a body part without pain. • You think the force that caused the injury was great enough to cause serious damage. • An injured extremity is blue or extremely pale. • The person’s abdomen is tender and distended. • The person is vomiting blood or coughing up blood. • The person shows signs of shock.
Care for Closed Wounds • Help the person rest in a comfortable position • Apply direct pressure on the area • Apply ice early on • Elevate the injured area only if it will not cause more pain
Open Wounds • Open wounds occur when there is a break in the skin. • The four main types of open wounds are – • Abrasions • Lacerations • Avulsions • Punctures
Abrasions • Most common type of open wound • Caused by something rubbing roughly against the skin • Does not bleed very much • It is usually painful because scrapes expose sensitive nerve endings
Lacerations • A cut in the skin commonly caused by a sharp object • Deep lacerations can cut through fat and muscle, damaging both nerves and blood vessels • Laceration can become easily infected
Avulsions • An injury in which a portion of the skin and sometimes soft tissue is partially or completely torn away • Bleeding is often significant
Punctures • Usually caused by a pointed object piercing the skin • Do not bleed very much unless a blood vessel has been injured • Can carry germs deep into the body • If the object remains in the wound, it is called an embedded object
Infection • Signs & Symptoms • Swollen and red • Warm to the touch • Injury will throb with pain • Wound may discharge pus • Person may become feverish and ill • Care • Wash the area with soap and water • Irrigate with large amounts of fresh running water • Do not wash major open wounds
Determining if the Person Needs Stitches • The wound edges of the skin do not fall together • The laceration involves the face • The wound is over ½ inch long • Bleeding from an artery or uncontrolled bleeding • Can see muscle, bone, involve joints, hands or feet • Wounds from large or deeply embedded objects • Wounds from human or animal bites • If left unstitched, could leave conspicuous scars
Materials used when caring for an open wound include - • Disposable gloves – create a barrier between you and the victim • Dressings – pads placed directly on the wound to absorb blood and other fluids to prevent infection • Occlusive dressings – prevents the wound from being exposed to the air or water • Bandages – material used to wrap or cover any part of the body, used to hold dressings in place
General Guidelines Applying a Roller Bandage • Check for feeling, warmth and color below the injury site before and after applying the bandage. • Elevate the injury only if it doesn’t cause further injury. • Do not cover fingers or toes with a bandage. • Apply additional dressing if blood soaks through the first bandange.
Applying an Elastic Bandage • Check for circulation of the limb beyond where you will be placing the bandage. • Place the end of the bandage against the skin and use overlapping turns. • Gently stretch the bandage as you wrap. • Check the snugness, a finger should easily pass under the bandage.
Care for Minor Open Wounds • Put on gloves • Apply direct pressure for a few minutes to control any bleeding • Wash the wound thoroughly with soap and water • Apply an antibiotic ointment • Cover the wound with a sterile dressing and a bandage
Care for a Major Open Wound • Call 9-1-1 • Put on gloves • Control bleeding by – • Covering the wound and pressing firmly • Apply a pressure bandage • Adding more bandages if necessary • Monitor life signs • Care for shock • Wash hands immediately after giving care
Using Tourniquets When Help is Delayed • A tourniquet is a tight band placed around an arm or leg to constrict blood vessels in order to stop blood flow around the wound. • Use only as a last resort. • If used, a tourniquet should not be removed in until the victim gets to the hospital.
Hemostatic Agents • Substances that speed up clot formation by absorbing excess moisture caused by bleeding. • Can be a treated sponge or gauze pad, powder or granular form.
Burns • Burns are a special kind of soft tissue injury • Burns can be classified in two ways – • The source of the burn • Heat • Chemical • Electricity • Radiation • The depth of the burn • Superficial (first degree) • Partial Thickness (second degree) • Full Thickness (third degree)
Depth Classifications • Top layer of skin • Red, dry skin • Pain, swelling • Usually heals within a week • Top layers of skin • Red, painful, blisters that may open and weep clear fluid • Usually heals in 3 to 4 weeks • May scar • May destroy layers of skin and underlying structures • Charred skin, tissue underneath white, painful or painless • Healing may require medical care • Scarring likely
Critical Burns • Critical burns require immediate medical attention because they are potentially life threatening, disfiguring, and/or disabling. • You should always call 9-1-1 if the burned person – • Has trouble breathing or suspected burned airway • Has burns covering more than one body part • Has burns to the head, neck, hands, feet or genitals • Has a burn and is younger than 5 or older than 60 • Has burns resulting from chemicals, explosions, or electricity
Caring for a Thermal Burn • Check the scene • Remove the person from the source of the burn • Check for life threatening conditions • Cool the burn with large amounts of cool running water • Cover the burn loosely • Prevent infection • Minimize shock
Care for a Thermal Burn • DO NOT – • Apply ice or ice water • Touch a burn with anything except a clean bandage • Remove pieces of clothing that stick to the burn • Try to clean a severe burn • Break blisters • Use ointment on a severe burn
Care for a Chemical Burn • Important – chemical burns will continue to burn as long as the chemical is on the body. • If the burn was caused by dry chemicals, brush off the chemical using gloved hands before flushing with water. • Flush the burn with large amount of running water. Flush for at least 20 minutes. • Eyes burns should be flushed with water until EMS arrive • If possible have the person remove contaminated clothes.
Care for Electrical Burns • Important – Never go near the victim until you are sure he or she is no longer in contact with the power source. • Call 9-1-1 • Turn off the power source • Be prepared to give CPR or use an AED • Care for shock and thermal burns
Radiation (Sun) Burns • Care for sunburn the same way you would for any other burn. • Always cool the burn and protect the area from further damage by keeping it out of the sun.
Preventing Burns • Follow safety practices that prevent fire • Follow manufacturer’s guidelines when handling chemicals • Follow safety practices around electrical lines and go indoors when lightning could strike • Wear appropriate clothing and use sunscreen
Crush Injuries • Call 9-1-1 • Care for specific injuries found • Assume that internal injuries are present • Care for shock
Care for an Embedded Object • Do not remove the object. • Place several dressings around it to keep it from moving. • Bandage around the object to keep it from moving.
Sucking Chest Wound • This injury occurs when a puncture wound penetrates the chest cavity and air passes in and out of the wound.
Care for a Sucking Chest Wound • Cover the wound with a large occlusive dressing (closes the wound) and tape the dressing except for one side. • The dressing will keep air from entering the wound when the person inhales and allow the air to escape when the person exhales.