Copyright © 2004, Mosby Inc. All rights reserved

Copyright © 2004, Mosby Inc. All rights reserved.

Soft Tissue InjuriesSoft Tissue Injuries

Chapter 26Chapter 26


Slide 2

Case HistoryCase History

You are on the scene of a jetliner crash. You You are on the scene of a jetliner crash. You are directed to care for a male whose injuries are directed to care for a male whose injuries include an avulsion of the scalp and include an avulsion of the scalp and lacerations to the chest. Both are actively lacerations to the chest. Both are actively bleeding. There are also partial- and full-bleeding. There are also partial- and full-thickness burns to his entire back and burns thickness burns to his entire back and burns to the anterior surface of both arms and both to the anterior surface of both arms and both legs.legs.


Slide 3

Skin — FunctionsSkin — Functions

• Protects body from environmentProtects body from environment

• Barrier to infection and loss of fluidsBarrier to infection and loss of fluids

• Regulates temperatureRegulates temperature

• Sensory organ for touch, pain, temperature, Sensory organ for touch, pain, temperature, and pressure perceptionand pressure perception


Slide 4

Structure of SkinStructure of Skin


Slide 5

WoundsWoundsDCAP-BTLSDCAP-BTLS

• DDeformitieseformities• CContusionsontusions• AAbrasionsbrasions• PPuncturesunctures• BBurnsurns• TTendernessenderness• LLacerations acerations • SSwellingwelling


Slide 6

WoundsWounds• Closed woundsClosed wounds

Blunt or compression forces Blunt or compression forces applied to skinapplied to skin

Vessels may leak or rupture, Vessels may leak or rupture, causing swelling.causing swelling.

» ContusionsContusions

• Open woundsOpen wounds Any wound that results in a Any wound that results in a

break in the skinbreak in the skin Abrasions, lacerations, Abrasions, lacerations,

avulsions, amputations, avulsions, amputations, punctures, crush injuriespunctures, crush injuries


Slide 7

Severity and Complications – Severity and Complications – Soft Tissue InjuriesSoft Tissue Injuries

• Factors affecting severityFactors affecting severity Mechanism of injuryMechanism of injury Site of injurySite of injury Extent of injuryExtent of injury Introduction of foreign Introduction of foreign

bodies and contaminationsbodies and contaminations

• Common complicationsCommon complications BleedingBleeding InfectionInfection Damage to underlying Damage to underlying

structuresstructures


Slide 8

Wound ManagementWound Management

• Control bleeding.Control bleeding.

• Prevent further contamination.Prevent further contamination.

• Immobilize affected part.Immobilize affected part.

• Preserve avulsed or amputated parts.Preserve avulsed or amputated parts.

• Stabilize impaled objects.Stabilize impaled objects.


Slide 9

Emergency Medical CareEmergency Medical Care

• Take personal protection measures.Take personal protection measures. GlovesGloves Hand washingHand washing

• Ensure patent airway/artificial ventilation/oxygenationEnsure patent airway/artificial ventilation/oxygenation

• Treat for shock (hypoperfusion).Treat for shock (hypoperfusion).

• Splint fractures.Splint fractures.

• Transport.Transport.


Slide 10

Emergency Medical Care — Emergency Medical Care — Body Substance IsolationBody Substance Isolation

• GlovesGloves

• GownGown

• Eye protectionEye protection

• Hand washingHand washing


Slide 11

AmputationsAmputations

• Amputated part may remain viable for Amputated part may remain viable for up to 18 hours.up to 18 hours.

• Rinse off gross contamination.Rinse off gross contamination.

• Cover part with sterile dressing.Cover part with sterile dressing.

• Place in watertight plastic bag.Place in watertight plastic bag.

• Place bag in another container with Place bag in another container with ice.ice.


Slide 12

AvulsionsAvulsions

• Irrigate gross debris.Irrigate gross debris.

• Avulsed part may be Avulsed part may be returned to normal returned to normal anatomic position.anatomic position.

• Bandage.Bandage.


Slide 13

Impalement InjuryImpalement Injury

• Object may stop blood flow Object may stop blood flow from a severed vessel.from a severed vessel.

• Removal of object may Removal of object may cause active bleeding.cause active bleeding.

• Stabilize object in place with Stabilize object in place with bulky dressing unless in bulky dressing unless in cheek.cheek.

• Large objects may be cut to Large objects may be cut to facilitate transport.facilitate transport.


Slide 14

Neck WoundsNeck Wounds

• May lead to air embolismMay lead to air embolism Air may be sucked into Air may be sucked into

large veins during large veins during inspiration.inspiration.

Trapped air can obstruct Trapped air can obstruct blood flow.blood flow.

• TreatmentTreatment Cover with occlusive Cover with occlusive

airtight dressing.airtight dressing. Transport in supine or Transport in supine or

head-down position.head-down position.


Slide 15

DressingsDressings

• Any sterile material Any sterile material used to cover a woundused to cover a wound

• Types of dressingsTypes of dressings Multi-traumaMulti-trauma 4 4 xx 4 gauze 4 gauze OcclusiveOcclusive VaselineVaseline Prepackaged adhesivePrepackaged adhesive


Slide 16

BandagesBandages

• Attaches dressing to Attaches dressing to woundwound

• Provides continued Provides continued pressurepressure

• TypesTypes Self-adherentSelf-adherent TriangularTriangular ElasticElastic GauzeGauze Adhesive tapeAdhesive tape


Slide 17

Facial InjuriesFacial Injuries

• Airway management is first concern.Airway management is first concern.

• Bleeding, foreign bodies, and Bleeding, foreign bodies, and vomitus can obstruct airway.vomitus can obstruct airway.

• Swelling and hematomas can cause Swelling and hematomas can cause airway compromise.airway compromise.

• Airway controlAirway control Manually extract foreign bodies.Manually extract foreign bodies. Suction.Suction. Position patient to permit drainage.Position patient to permit drainage.


Slide 18

Facial Injuries – Facial Injuries – Impaled ObjectsImpaled Objects

• Object may cause bleeding Object may cause bleeding and obstruction of airway.and obstruction of airway.

• Object should be removed if Object should be removed if possible.possible.

• Control bleeding using direct Control bleeding using direct pressure.pressure.

• Position patient to allow for Position patient to allow for drainage.drainage.

• Suction as needed.Suction as needed.


Slide 19

Anatomy of the EyeAnatomy of the Eye


Slide 20

Foreign Bodies in EyeForeign Bodies in Eye

• Very irritatingVery irritating

• Cause considerable painCause considerable pain

• LocationLocation Eyeball, lower or upper eyelidEyeball, lower or upper eyelid Foreign body on lid may be felt during Foreign body on lid may be felt during

blinking.blinking.

• Superficial or deeply embeddedSuperficial or deeply embedded

• May require eye surgeryMay require eye surgery


Slide 21

Corneal AbrasionsCorneal Abrasions

• Cornea is particularly Cornea is particularly sensitive.sensitive.

• Scratches are very Scratches are very painful.painful.

• Feeling may persist Feeling may persist after a foreign body is after a foreign body is removed.removed.

• Patching the eye may Patching the eye may give some pain relief.give some pain relief.


Slide 22

Traumatic IritisTraumatic Iritis

• Trauma to eye can causeTrauma to eye can cause Spasm of irisSpasm of iris Inflammation of the conjunctivaInflammation of the conjunctiva

• Pupil Pupil May appear fixed in midposition or slightly dilatedMay appear fixed in midposition or slightly dilated May be unresponsive to lightMay be unresponsive to light May be confused with CNS injuryMay be confused with CNS injury


Slide 23

Extruded EyeballExtruded Eyeball

• Extruding from the Extruding from the socketsocket

• Moistened sterile Moistened sterile dressingdressing

• Cover with a cupCover with a cup


Slide 24

Anatomy of the EarAnatomy of the Ear


Slide 25

Injuries to EarInjuries to Ear

• Blunt trauma Blunt trauma Contusions and hematoma Contusions and hematoma

of the auricleof the auricle May damage eardrum with May damage eardrum with

resulting pain and/or resulting pain and/or bleedingbleeding

• If blood or fluid is present, If blood or fluid is present, consider possible skull consider possible skull fracture.fracture. Apply loose sterile dressing.Apply loose sterile dressing.


Slide 26

Foreign Bodies in EarForeign Bodies in Ear

• If Object is lodged in auditory canal, it should If Object is lodged in auditory canal, it should be removed in emergency department.be removed in emergency department.

• Eardrum is sensitive.Eardrum is sensitive. May be painful, if puncturedMay be painful, if punctured Penetration may cause bleeding.Penetration may cause bleeding.

• Be careful not to obstruct flow from auditory Be careful not to obstruct flow from auditory canal.canal.


Slide 27

Barotrauma Barotrauma

• Caused by changing environmental Caused by changing environmental pressures (flying or diving)pressures (flying or diving)

• Middle ear maintains equal pressure through Middle ear maintains equal pressure through eustachian tubes.eustachian tubes.

• Changes in pressure before equalization Changes in pressure before equalization cause distortion and rupture of eardrum.cause distortion and rupture of eardrum.


Slide 28

Mechanisms of BarotraumaMechanisms of Barotrauma


Slide 29

Mechanisms of BarotraumaMechanisms of Barotrauma


Slide 30

Barotrauma Barotrauma

• Pain and/or hearing lossPain and/or hearing loss

• Upper respiratory tract infections may Upper respiratory tract infections may predispose patients to barotraumapredispose patients to barotrauma

• No prehospital treatment for barotrauma No prehospital treatment for barotrauma of the earof the ear


Slide 31

Depth or Degree of the BurnDepth or Degree of the Burn

• SuperficialSuperficial

• Partial-thicknessPartial-thickness

• Full-thicknessFull-thickness


Slide 32

Burns — ClassificationBurns — Classification

• SuperficialSuperficial Involves only the epidermisInvolves only the epidermis Reddened skin and pain at the Reddened skin and pain at the

sitesite

• Partial-thickness Partial-thickness The epidermis and dermisThe epidermis and dermis White to red skin that is moist White to red skin that is moist

and mottledand mottled Blisters and intense painBlisters and intense pain


Slide 33

Burns – ClassificationBurns – Classification

• Full-thicknessFull-thickness Extend through all dermal Extend through all dermal

layerslayers Skin dry and leathery or Skin dry and leathery or

white, dark brown, or white, dark brown, or charredcharred

Little or no painLittle or no pain Hard to the touchHard to the touch


Slide 34

Rule of NinesRule of Nines

• Calculate extent of burns using rule of ninesCalculate extent of burns using rule of nines• Describe depth, extent, and location of burned areasDescribe depth, extent, and location of burned areas


Slide 35

Complicating FactorsComplicating Factors

• Age of the patientAge of the patient <5 years of age<5 years of age >55 years of age>55 years of age


Slide 36

Complicating FactorsComplicating Factors

• Inhalation injuriesInhalation injuries Most common cause of Most common cause of

death in firesdeath in fires Physical signs that should Physical signs that should

raise suspicionraise suspicion» Singed nasal hairsSinged nasal hairs» Carbonaceous sputumCarbonaceous sputum» Burns around nose and Burns around nose and

mouthmouth» HoarsenessHoarseness» Respiratory distressRespiratory distress


Slide 37

Burn SeverityBurn Severity

• Critical burns requiring transport to a burn centerCritical burns requiring transport to a burn center


Slide 38

Moderate BurnsModerate Burns

• Full-thickness burns of Full-thickness burns of 2% to 10% of the body2% to 10% of the body Excluding hands, feet, Excluding hands, feet,

face, genitalia, and upper face, genitalia, and upper airwayairway

• Partial-thickness burns Partial-thickness burns of 15% to 30% of BSAof 15% to 30% of BSA

• Superficial burns to Superficial burns to >50% BSA>50% BSA


Slide 39

Minor BurnsMinor Burns

• Full-thickness burns of Full-thickness burns of <2% of BSA<2% of BSA

• Partial-thickness burns of Partial-thickness burns of <15% of BSA<15% of BSA


Slide 40

Emergency Medical Care Emergency Medical Care

• Take personal protection measures.Take personal protection measures.

• Stop the burning process, initially with water or saline.Stop the burning process, initially with water or saline.

• Remove smoldering clothing and jewelry.Remove smoldering clothing and jewelry.

• Continually monitor the airway for evidence of closure.Continually monitor the airway for evidence of closure.

• Maintain body temperature.Maintain body temperature.


Slide 41

Emergency Medical Care - Emergency Medical Care - Prevent Further ContaminationPrevent Further Contamination

• Cover the burned area with Cover the burned area with a dry, sterile dressing.a dry, sterile dressing.

• Do not use any type of Do not use any type of ointment, lotion, or ointment, lotion, or antiseptic.antiseptic.

• Do not break blisters.Do not break blisters.

• Know local protocols for Know local protocols for transport to appropriate local transport to appropriate local facility.facility.


Slide 42

Infants and ChildrenInfants and Children

• Greater surface area in relationship to body Greater surface area in relationship to body sizesize Results in greater fluid and heat lossResults in greater fluid and heat loss

• Full-thickness burn or partial-thickness burnFull-thickness burn or partial-thickness burn Critical burnCritical burn

» >20% of BSA>20% of BSA» Burn involving the hands, feet, face, airway, or genitaliaBurn involving the hands, feet, face, airway, or genitalia


Slide 43

Infants and ChildrenInfants and Children

• Partial-thickness burn of 10% to 20% Partial-thickness burn of 10% to 20% Moderate burn in a childModerate burn in a child

• Partial-thickness burn <10%Partial-thickness burn <10% Minor burnMinor burn

• Higher risk for Higher risk for Shock (hypoperfusion)Shock (hypoperfusion) Airway problemAirway problem HypothermiaHypothermia

• Consider possibility of child abuseConsider possibility of child abuse


Slide 44

Chemical Burns – Chemical Burns – Emergency Medical CareEmergency Medical Care

• Dry powders should be brushed off before Dry powders should be brushed off before flushing.flushing.

• Immediately begin to flush with large amounts Immediately begin to flush with large amounts of water.of water. Do not contaminate uninjured areas when Do not contaminate uninjured areas when

flushing.flushing.

• Continue flushing the contaminated area Continue flushing the contaminated area while en route to receiving facility.while en route to receiving facility.


Slide 45

Electrical BurnsElectrical Burns

• Scene safety is paramount.Scene safety is paramount.

• Do not attempt to remove Do not attempt to remove patient from the electrical patient from the electrical source, unless trained to do source, unless trained to do so.so.

• If the patient is still in contact If the patient is still in contact with the electrical source, with the electrical source, do do notnot touch the patient. touch the patient.


Slide 46

Electrical Burns – Electrical Burns – Emergency Medical CareEmergency Medical Care

• Manage life threats with appropriate spinal precautions.Manage life threats with appropriate spinal precautions.• Splint fractures.Splint fractures.• Administer oxygen.Administer oxygen.• Monitor the patient for respiratory and cardiac arrest.Monitor the patient for respiratory and cardiac arrest.

Consider need for AED.Consider need for AED.

• Look for entrance and exit wounds.Look for entrance and exit wounds.• Injuries are often more severe than external indications.Injuries are often more severe than external indications.• Treat soft tissue injuries.Treat soft tissue injuries.


Slide 47

Lightning InjuriesLightning Injuries


Slide 48

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Copyright © 2004, Mosby Inc. All rights reserved