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

1. Put on gloves2. Apply direct pressure for

a few minutes to control any bleeding

3. Wash the wound thoroughly with soap and water

4. Apply an antibiotic ointment

5. 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

1. Check the scene

2. Remove the person from the source of the burn

3. Check for life threatening conditions

4. Cool the burn with large amounts of cool running water

5. Cover the burn loosely

6. Prevent infection

7. 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

1. Important – chemical burns will continue to burn as long as the chemical is on the body.

2. If the burn was caused by dry chemicals, brush off the chemical using gloved hands before flushing with water.

3. Flush the burn with large amount of running water. Flush for at least 20 minutes.

4. Eyes burns should be flushed with water until EMS arrive

5. If possible have the person remove contaminated clothes.

Care for Electrical Burns

1. Important – Never go near the victim until you are sure he or she is no longer in contact with the power source.

2. Call 9-1-1

3. Turn off the power source

4. Be prepared to give CPR or use an AED

5. 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.

Care for Abdominal Injury