SOFT TISSUE INJURIES

Soft tissue injuries are common and dramatic, but rarely life threatening. Soft tissue injuries range from abrasions to serious full thickness burns. It is necessary for the EMT to become familiar with the treatment of soft tissue injuries with emphasis on controlling bleeding, preventing further injury, and reducing contamination.

OVERVIEW

Emergency Care of Burns, Amputations, Chest & Abdominal Wounds, Impaled Objects, Both Opened & Closed Soft Tissue Injuries

How to Recognize & Treat the Different Types of Burns & Electrical Injuries

How to Dress & Bandage Wounds

FIRST THING FIRST

Protect Yourself

Do the ABC’s

Treat Life-Threatening Problems

Assess the Whole Patient

SKIN

Largest Organ

Protection Inside & Out

Temperature Regulation

Excretion of Salt & H2O

Epidermis – Protection

Dermis – Vessels & Nerves

Subcutaneous – Insulation & Shock Absorber

CLOSED INJURIES

Definition

Internal Injury with No Open Pathway From the Outside to the Injured Site.

CLOSED INJURIES

Contusion

Epidermis Intact

Cells & Blood Vessels Damaged In Dermis

Painful

Discoloration

CLOSED INJURIES

Hematoma

Larger Than Contusion

Collection of Blood

Larger Vessels

CLOSED INJURIES

Crush

Crushing Force

Internal Organ Damage

Severe Bleeding

Shock

CLOSED INJURIES

Emergency Care

Remember the First Things

Protect Yourself, Scene Safe?, BSI?

Airway?, O2?, Ventilate

Examine

Treat for Shock

Splint

Painful

Swollen

Deformed

Transport

OPEN INJURIES

Definition

An Injury In Which the Skin is Interrupted, or Broken, Exposing the Tissue Underneath.

OPEN INJURIES

Abrasion

Superficial

Painful

Minor Bleeding

Oozing

OPEN INJURIES

Laceration

Clean or Jagged

Sharp or Blunt

Profuse Bleeding?

Depth

OPEN INJURIES

Avulsion

Flap of Tissue

OPEN INJURIES

Penetration / Puncture

Pointed Object

External Bleeding

Maybe Minimal

Internal Bleeding

Maybe Profuse

Exit Wound?

OPEN INJURIES

Crush Injuries

Damage Could Be Extensive

Internal Organs?

Painful, Deformed

External Bleeding

Maybe Minimal

Internal Bleeding

Maybe Profuse

OPEN INJURIES

Emergency Care

Do All of the First Things

Expose the Wound

Cut, Don’t Pull

Clean the Surface of Large Debris

Control Bleeding

Direct Pressure

Elevate

Pressure Points

OPEN INJURIES

Treat for Shock, Apply O2

Prevent Contamination

Dressing Then Bandage

Check Distal Pulse, Before & After

Reassess for Bleeding to Restart

Immobilize

Keep Patient Still

Reassure Patient

SPECIAL SITUATIONS

Amputations

Extremities

Fingers & Toes

Bleeding

Minimal

Severe

SPECIAL SITUATIONS

Care of an Amputation

Do Not Complete Amputation

Pressure Dressing on Stump

Pressure Points

Tourniquet – LAST RESORT

Not Distal to Elbow or Knee

Immobilize

SPECIAL SITUATIONS

Care of an Amputation

Amputated Part

Wrap In Sterile Dressing

Place In a Plastic Bag, Keep Dry

Keep Cool – Cold Packs, Icy Water

Not Directly On Ice

Transport With Patient

Do Not Directly Immerse Part In Water

SPECIAL SITUATIONS

Chest Injuries

Blunt

Penetrating

Compression

Traumatic Asphyxia

SPECIAL SITUATIONS

Chest Injury

Sucking Chest Wound

True Emergency

Occlude Wound With Gloved Hand

Occlusive Dressing With Flutter Valve

Load & Go

CHEST INJURY COMPLICATIONS

Pneumothorax

Hemothorax

Hemopneumothorax

Traumatic Asphyxia

Cardiac Tamponade

CHEST INJURY COMPLICATIONS

Assessment

Pneumothorax

Respiratory Difficulty

Shock – Poor Cardiac Output

Tracheal Deviation

Paradoxical Chest Movement

Absent or Reduced Lung Sounds

CHEST INJURY COMPLICATIONS

Assessment

Hemothorax / Hemopneumothorax

Same Signs & Symptoms as Pneumothorax

Frothy Red Blood

CHEST INJURY COMPLICATIONS

Assessment

Traumatic Asphyxia

Head & Shoulders – Purple or Blue

Eyes Bloodshot & Bulging

Tongue & Lips Swollen

Chest Deformity

Usually Has Poor Outcome

CHEST INJURY COMPLICATIONS

Assessment

Cardiac Tamponade

Very Weak Pulse

Low Blood Pressure

Narrowing Pulse Pressure

Systolic Minus Diastolic = Pulse Pressure

CHEST INJURY COMPLICATIONS

Care & Treatment of Chest Injuries

Patients Deteriorate Rapidly

ABC’s – Prepare to Suction

High Flow O2

Flutter Valve – Sucking Chest Wounds

Transport – S & G Method

ALS Back-Up

ABDOMINAL INJURIES

Abdominal Cavity

Organs

Hollow

Solid

Great Vessels

Evisceration

Protruding Organs

ABDOMINAL INJURIES

Assessment

Pain – Progressively Increases

Cramps

Nausea

Weakness

Thirst from Shock

Obvious Open Wound

ABDOMINAL INJURIES

Assessment (cont.)

Any Open Wounds – Pelvis, Lower or Middle Back, Chest Near Diaphragm

Blunt Trauma – Bruising

Shock

Coughing or Vomiting Blood

Rigid / Tender / Distended Abdomen

Guarding – Fetal Position

ABDOMINAL INJURIES

Care & Treatment

First Things First

ABC’s – Be Prepared for Vomiting

On Their Back – Legs Flexed

O2 & Treat for Shock

Nothing By Mouth

Evisceration – Sterile Moist Dressing

No Aluminum Foil – Lacerations

Stabilize Impaled Objects

IMPALED OBJECTS

DO NOT REMOVE

May be a Cork

STABILIZE

Manual

Bulky Dressings

DON’T GET HURT

Object May be Sharp

IMPALED OBJECTS

Care & Treatment

Expose – Cut Clothing

Manually Stabilize

Control Bleeding – No Pressure On Object

Bulky Dressings to Stabilize

Secure With Tape or Cravats

Immobilize Area

Splint or Long Board

IMPALED OBJECTS

Special Considerations for Impaled Objects

Can’t Fit Into the Ambulance

Cut Carefully

Needs CPR

Remove Object

Cheek

Remove if Airway Compromise – Suction?

Not Sure???

Contact Command

OPEN NECK WOUNDS

Large Blood Vessels

Carotid Arteries

Jugular Veins

Air Embolus

Profuse Bleeding

OPEN NECK WOUNDS

Care & Treatment

First Things First

Occlude Wound With Gloved Hand

Occlusive Dressing

Bulky Dressing

Apply Pressure – 1 Side Only

"Figure 8" Bandage (under opposite arm)

Immobilize

BURNS

Classification of Burns

Superficial

Partial Thickness

Full Thickness

BURNS

Superficial

Epidermis Only

Redness

Pain

Sunburn

BURNS

Partial Thickness

Epidermis & Dermis

Intense Pain

Blisters

Red & White Skin

Wet Waxy Oily

BURNS

Full Thickness

All Layers

May Include Muscles, Bones, Organs

White, Brown, Charred

Dry, Leathery

Little or No Pain

Painful Periphery

BURN SEVERITY

Considerations (What Is:)

Agent or Source

Depth or Degree

Percentage

Location

PMHx

SOURCES of BURNS

Thermal

Fire / Steam

Chemical

Wet / Dry

Electrical

AC / DC

Light

Welding

Radiation

Dirty Bombs / Nuclear Warfare / Sunshine

BURN PERCENTAGE

Rule of Nines – Adult

Head & Neck 9%

Each Arm 9%

Anterior Trunk 18%

Posterior Trunk 18%

Each Leg 18%

Genitalia 1%

BURN PERCENTAGE

Rule of Nines – Infant

Head & Neck 18%

Each Arm 9%

Anterior Trunk 18%

Posterior Trunk 18%

Each Leg 14%

BURNS

Regions of Concern

Face & Upper Airway

Signifies Further Airway Burns

Eyes

Scarring

Hands & Feet

Scarring Impedes Movement

Genitals, Buttocks, Medial Thighs

Infection From Bacterial Growth

BURNS

Other Considerations

Past Medical History

Diabetes

Respiratory

Cardiac

Harder for the Body to Heal

BURNS

Other Considerations

Less Than 5 Years Old

Greater Than 55 Years Old

DETERMINE SEVERITY

Critical Burns

Full Thickness – Face, Hands, Feet, Genitals

Respiratory Tract

10% Full Thickness

30% Partial Thickness

Extremities – If Deformed or Swollen

Moderate Burn in Young or Old

Encompassing Any Body Part

DETERMINE SEVERITY

Moderate Burn

2% to 10% Full Thickness

Excludes Airway, Face, Hands, Feet, Genitals

15% to 30% Partial Thickness

50% Superficial

Over 55 Years Old These May Be Critical

DETERMINE SEVERITY

Minor Burns

Less Than 2% Full Thickness

Less Than 15% Partial Thickness

EMERGENCY CARE of BURNS

Your First – Don’t Do Something Stupid

Stop the Burning – Water / Saline

Remove Clothing / Jewelry

Airway – Swelling

Oxygen Supports Fire

Prevent Further Contamination

EMERGENCY CARE of BURNS

Dry, Sterile Dressing

No Ointments, Lotions, or Antiseptic

Do Not Break Blisters

Check for Other Injuries

Transport to Appropriate Facility

BURNS – INFANTS & KIDS

Greater Surface Area in Relation to Total Body Size

Greater Fluid & Heat Loss

Higher Risk For:

Shock

Airway Compromise

Hypothermia

Possibility of Child Abuse???

BURNS – INFANTS & KIDS

Critical Burns

20% Full or Partial Thickness

Airway

Face

Hands

Feet

Genitals

BURNS – INFANTS & KIDS

Moderate Burns

10% to 20% Partial Thickness

Except Critical Areas

Minor Burns

Less Than 10% Partial Thickness

Except Critical Areas

CHEMICAL BURNS

Skin

Wear Appropriate Protective Clothing

Brush Off Dry Powders

Flush With Copious Amounts of Water

Make Sure Product Does Not React With Water

Flush for 20 Minutes

Flush During Transport

Do Not Contaminate Uninjured Parts

CHEMICAL BURNS

Eyes

Wear Appropriate Protective Clothing

Flush With Copious Amounts of Water

Make Sure Product Does Not React With Water

Flush for 20 Minutes

Hold Eye Open

Flush During Transport

IV NSS & Tubing

Do Not Contaminate Uninjured Parts

Flush Laterally From Nose

ELECTRICAL BURNS

TURN OFF POWER

IF YOU ARE NOT SURE DO NOT TOUCH THE PATIENT

ELECTRICAL BURNS

Scene Safe?, BSI?, # of Patients

ABC’s, Oxygen

Prepare for Cardiac or Respiratory Arrest

AED?

Look for Entrance & Exit Wounds

Internal Damage Worse Than External

Electricity Travels Path of Least Resistance

Wet Organs Easier Than Dry Skin

DRESSINGS & BANDAGES

Purpose

Stop Bleeding

Protect Wound From Further Damage

Prevent Contamination and Lessen Chance of Infection

DRESSINGS & BANDAGES

Dressings

Covers Wound – Usually Sterile

Bulky Dressings

4 x 4 Gauze Pads

Adhesive Type

Occlusive Dressings

DRESSINGS & BANDAGES

Bandages

Hold Dressings In Place

Roller Gauze

Triangular Bandage

Tape

Air Splints