1 Soft Tissue Injuries Treatment Procedures

2 Skin Anatomy and Physiology Body’s largest organ Three layers –Epidermis –Dermis –Subcutaneous tissue

3 Skin Anatomy and Physiology Complex system, variety of functions –Sensation –Control of water loss –Protection against microbes –Temperature control

4 Soft Tissue Injuries Closed Open

5 Closed Injury Associated with blunt trauma Skin remains intact Damage occurs below surface Types –Contusions –Hematomas

6 Contusion Produced when blunt force damages dermal structures Blood, fluid leak into damage area causing swelling, pain Presence of blood causes skin discoloration called ecchymosis (bruise)

7 Hematoma “Blood lump” Larger blood vessel damaged Causes mass of blood to collect in the injured area Fist-sized hematoma = 10% volume loss

8 With Closed Soft Tissue Injury How much blood is tied up in that injury rather than circulating in the vessels? What could the force the caused the soft tissue trauma have done to underlying organs?

9 Closed Injury Management Rest Ice Compression Elevate Splint When in doubt assume underlying fractures are present

10 Open Injury Skin broken Protective function lost External bleeding, infection become problems

11 Open Injury Types Abrasions Lacerations Punctures Avulsions Amputations

12 Abrasion Loss of portions of epidermis, upper dermis by rubbing or scraping force. Usually associated with capillary oozing, leaking of fluid “Road rash”

13 Laceration Cut by sharp object Typically longer than it is deep May be associated with severe blood loss, damage to underlying tissues Types –Linear –Stellate

14 Punctures Result from stabbing force Wound is deeper than it is long Difficult to assess injury extent Object producing puncture may remain impaled in wound

15 Avulsions Piece of skin torn loose as a flap or completely torn from body Result from accidents with machinery and motor vehicles Replace flap into normal position before bandaging Treat completely avulsed tissue like amputated part

16 Amputations Disruption of continuity of extremity or other body part Part should be wrapped in sterile gauze, placed in plastic bag, transported on top of cold pack Do NOT pack part directly in ice Do NOT let part freeze

17 Open Wound Management Manage ABCs first Control bleeding Prevent further contamination, but do not worry about trying to clean wound Immobilize injured part Mange hypoperfusion if present

18 Special Considerations Impaled objects Eviscerations Open chest wounds Neck wounds Gunshot wounds

19 Impaled Objects Do NOT remove Stabilize in place Exception –Object in cheek –Remove, dress inside and outside mouth

20 Eviscerations Internal organs exposed through wound Cover organs with large moistened dressing, then with aluminum foil or dry multi-trauma dressing Do NOT use individual 4 x 4’s Do NOT attempt to replace organs

21 Open Chest Wound May prevent adequate ventilation Cover with occlusive dressing Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax) If tension pneumo develops lift dressing corner to relieve pressure

22 Neck Wounds Risk of severe bleeding from large vessels Risk of air entering vein and moving through heart to lungs Cover with occlusive dressing Do NOT occlude airway or blood flow to brain Suspect presence of spinal injury

23 Gunshot Wound Special type of puncture wound Transmitted energy can cause injury remote from bullet track Bullets change direction, tumble Impossible to assess severity in field or ER Patient must go to OR