SOFT-TISSUE INJURIES

Bell Work 4-5-18 1. Medical term for bleeding is called? 2. Dark Red blood would indicate what type of bleeding? Arterial or venous? 3. When the patients limb won’t stop bleeding and the pressure dressing and elevation is not working. What do you do?

State Standards 13 and 14: Identify signs and symptoms as well as pathophysiology for the following injuries/diseases/disorders as they are connected to Rehabilitation Careers. Relate who the appropriate professional would be to provide the care: Acute inflammation related to an injury Open and closed wounds Soft Tissue Injuries

Objectives Students will be able to… Determine types of soft tissue injuries Determine treatment for different types of tissue injuries

Soft-Tissue Injuries Soft tissues Skin, muscles, nerves, blood vessels, fatty tissues, and cells

Soft-Tissue Injuries Closed wound Injury in which skin not broken Presence of swelling and/or bruises (contusions) Large bruises can mean serious blood loss. Fractures or extensive tissue damage under site of bruise

Figure 18. 9 Bruises are the most common form of closed wounds Figure 18.9 Bruises are the most common form of closed wounds. (© Edward T. Dickinson, MD)

Soft-Tissue Injuries Open wound Abrasions Skin has been damaged Obvious bleeding Abrasions Minor open wounds/ minor capillary bleeding Skinned elbows and knees, "road rash," and "rug burns"

Soft-Tissue Injuries Lacerations Skin is fully penetrated, with injury also occurring to tissues lying under skin. Smooth cuts, or incisions The edges of a smooth cut appear straight. Razor blades, knives, and broken glass Deep incisions can cause severe tissue damage and life. continued on next slide

Soft-Tissue Injuries Lacerations Jagged cuts These are tears with rough edges. Usually, they occur when the skin is cut by an object that does not have a very sharp edge. May be produced from the impact of a blunt object

Figure 18. 12 A laceration has edges that are irregular and jagged Figure 18.12 A laceration has edges that are irregular and jagged. (© Edward T. Dickinson, MD)

Soft-Tissue Injuries Crush injuries Body part is pressed between two surfaces. Greater the force, greater the damage Soft-tissues and internal organs may be crushed, often rupturing.

Figure 18.17 Crush injuries often result in significant damage to the underlying soft tissue and organs.

Soft-Tissue Injuries Punctures Objects such as knives, nails, and ice picks produce puncture wounds. Object puncturing body will tear through skin and usually proceed in straight line, damaging tissues. Discussion Question: Why is it important to set aside the object that caused the puncture injury (if not impaled) for EMS to bring to the hospital with the patient? (Note: this may not be possible if the police have secured the item as evidence in cases of assault.) Class Activity: After providing a variety of dressings and objects that can be used to simulate an impaled object; direct students to work in groups of three to demonstrate the proper care of a patient with an impaled object.

Soft-Tissue Injuries Puncture Wounds When dealing with puncture wound, assume extensive internal injury and internal bleeding. Always check for an exit wound. Stabilize impaled object by using bulky dressings. Do not remove the object.

18.3.1 Control any obvious bleeding. continued on next slide

Soft-Tissue Injuries Amputations Cutting or tearing off of fingers, toes, hands, feet, arms, or legs ****WARNING YUCKY PICTURES *****

Figure 18.16a Amputation of the thumb. (© Edward T. Dickinson, MD) continued on next slide

Soft-Tissue Injuries Avulsions Tearing loose or tearing off of large flaps of skin If avulsion occurs, gently fold skin back to normal position prior to applying direct pressure. Follow local protocols. Class Activity: Using moulage and simulated amputated parts; direct students to work in groups of three to demonstrate the proper care of a patient with an avulsion and one with an amputation injury. continued on next slide

Soft-Tissue Injuries Avulsions Save and preserve avulsed or amputated part. Wrap body part in sterile dressing. Place into plastic bag or wrap in plastic wrap. Class Activity: Using moulage and simulated amputated parts; direct students to work in groups of three to demonstrate the proper care of a patient with an avulsion and one with an amputation injury.

Soft-Tissue Injuries Protruding Organs Evisceration Deep open wound to abdomen Can cause organs to protrude Do not try to push protruding organ(s) back into body cavity. Class Activity: Provide the appropriate treatment materials (dressings, plastic wrap) and using moulage and simulated abdominal evisceration items; direct students to work in groups of three to demonstrate the proper care of a patient with an evisceration. continued on next slide

Soft-Tissue Injuries Protruding Organs Place plastic covering over exposed organs. Apply a thick dressing over top of covering to help conserve heat. Class Activity: Provide the appropriate treatment materials (dressings, plastic wrap) and using moulage and simulated abdominal evisceration items; direct students to work in groups of three to demonstrate the proper care of a patient with an evisceration.

Soft-Tissue Injuries Scalp Injuries Facial Wounds Use caution when applying direct pressure to scalp wound. If skull fractured, you do not want to push broken pieces into skull. Facial Wounds Ensure an open and clear airway. Control bleeding by direct pressure. Apply dressing and bandage.

Soft-Tissue Injuries Eye Injuries Do not remove impaled objects. Do not try to put eye back into socket. Do not apply pressure directly to injured eyeball. Foreign objects washed from eye. Cover both patient's eyes. Critical Thinking: Why would you want to cover both eyes if only one eye is injured? continued on next slide

Soft-Tissue Injuries Eye Injuries Ear Injuries Thermal (heat) burns, light burns, and chemical burns Ear Injuries Cuts Tears Avulsions Internal injuries Critical Thinking: What should you do with an ear that has been completely torn off the body?

Figure 18.20 For foreign objects in the eye, flush with water from a medial to lateral direction.

Soft-Tissue Injuries Nose Injuries/Nosebleeds Maintain open airway. Control bleeding. Direct patient to lean slightly forward. Pinch the patient's nostrils shut. Critical Thinking: Why is it important to position the patient for drainage? continued on next slide

Soft-Tissue Injuries Nose Injuries/Nosebleeds Do not pack the patient's nostrils. Do not allow the patient to blow his/her nose. If unresponsive, put patient on side with head turned to allow for drainage. Critical Thinking: Why is it important to position the patient for drainage?

Soft-Tissue Injuries Mouth Injuries Maintain open airway. Control bleeding. Direct patient to lean slightly forward. Cut lips/internal cheek Place dressing between lip/cheek and gum. Critical Thinking: How would you position an unresponsive patient with bleeding from the mouth? continued on next slide

Soft-Tissue Injuries Mouth Injuries Avulsed lips Do not pack mouth Apply pressure bandage. Keep avulsed lip cool in sterile dressing. Do not pack mouth Use caution and keep patient from swallowing dressing.

Soft-Tissue Injuries Neck Wounds Difficulty speaking Airway obstruction Swelling or bruising Pain on swallowing or speaking Trachea pushed off to one side Cuts or puncture wounds Critical Thinking: Why is it important to bandage only the injured side of the neck and secure it in place without wrapping dressing around the entire neck?

Soft-Tissue Injuries Injury to the Genitalia Blunt trauma Very painful, but little can be done by EMR. Control bleeding with direct pressure. May be result of rape, self-inflicted, or abuse

Work it Out – EMS Book Page 846, questions 1-9 Vocabulary: Coagulation Inflammation Compartment Syndrome Necrotic Ecchymosis Tourniquet Embolism Laceration Fasciotomy Incision Hematoma Puncture Hemorrhage Avulsion Hemostatic Dressing Amputation Evisceration