Soft Tissue Injuries OEC Chapter 18

Objectives List four functions of the skin List the layers of the skin List and describe three types of closed soft-tissue injuries List and describe nine types of open soft-tissue injuries Describe the emergency care for the following injuries: Closed soft-tissue injury Open soft-tissue injury Amputation Impaled object

Objectives cont… Describe and demonstrate three methods for controlling external bleeding Compare and contrast a dressing and a bandage Demonstrate the proper procedure for applying each of the following: Dressing Bandage Compression dressing Tourniquet

Anatomy & Physiology

The Skin Important functions of the skin: Protective barrier Regulates body temperature Maintains water balance Synthesizes vitamin D Epidermis: The outer layer of the skin that acts as a watertight protective covering Dermis: Inner layer of skin that contains hair follicles, sweat glands, nerve endings, and blood vessels Subcutaneous Tissue: composed almost entirely of fat; insulates the body and stores energy Sweat glands in dermis help with body temp regulation Amount of subcutaneous tissue varies from body part to body part

Bleeding & Clotting Arteries Pulsating spurts of blood Bright red Veins Steady, slow flow Darker red Capillaries Slow, oozing flow Arteries High arterial pressure causes the blood to come out in spurts Bright red because of higher O2 content Veins Blood flows under less pressure Darker red due to lower oxygen content Capillaries - Oozes because of small size of vessels and low pressure of blood

Bleeding & Clotting Blood vessels constrict to minimize blood loss Platelets and plasma proteins bind together to form temporary “plug” Additional platelets and plasma proteins form scab White blood cells fight infection Platelets temporarily seal the hole in the vessel along the inner wall Inflammatory response leads to swelling in the area Scab acts s a barrier that keeps out bacteria and other contaminants BLOOD THINNING MEDICATIONS Anticoagulants – slow the normal clotting process in patients with certain medical conditions More difficult to control the bleeding in these patients Can find out if they’re taking blood thinners through SAMPLE

Types of Soft Tissue Injuries

Closed Injuries Damage to structures beneath the skin or a mucous membrane while the overlying skin remains intact Contusions Outer layer of skin is not disrupted Cells within dermis are injured; small blood vessels torn Ecchymosis Hematomas Extravascular collection of blood within the body’s tissues or in a body cavity Subungual hematoma Contusions Usually from a blunt force Extent and severity can vary Ecchymosis: blue/black skin discoloration – bruise Hematomas In severe cases, can lead to hemorrhagic shock Subungal hematoma: occurs beneath the nail bed Compartment Syndrome Leads to great amounts of pressure that can cause tissue damage and cut off blood flow Requires rapid transport to prevent loss of limb Crush Injuries When an extensive force strikes the body suddenly or a force is continually applied over an extended period of time Compartment Syndrome: swelling of injured muscles within their connective tissue coverings

Open Injuries Abrasion: caused when a body part scuffs or grates across a rough, abrasive surface Incision: a cut with clean, smooth edges Laceration: a cut with jagged edges Avulsion: incomplete separation of the soft-tissue layers in which the injured tissue is left dangling as a flap Amputation: complete or nearly complete separation of a body part or limb Puncture: injury involving the penetration of soft tissue Impaled object: an object that causes a puncture wound and remains embedded in the patient’s body Abrasions are usually only on the epidermis Incisions and lacerations can be superficial or can extend deep into the tissue Punctures can cause severe bleeding if they occur in the chest/abdomen or near an artery

More Open Injuries Open Crush Injury: compression injury in which a great amount of force is applied to the body High-Pressure Injection: the introduction of a liquid or gas into the body from a pressurized source Mechanical tattooing: occurs when foreign debris such as dirt, rocks, or tar is ground into a wound or the adjacent skin

Burns Lesions of the skin caused by thermal or frictional heat, chemicals, electricity, or nuclear radiation See chapter 19

Assessment & Management

Assessment Despite the often impressive superficial damage, it is important to use the same approach used with any other trauma or medical emergency Scene size-up Primary assessment: ABCDs Secondary assessment Be suspicious of hidden injuries and damage to underlying structures Assess and manage for shock

Management Emphasis on controlling external bleeding and preventing further contamination Controlling external bleeding Direct pressure: primary method; place a dressing on the wound and apply firm pressure over the wound Dressings: Place the dressing over the wound and apply firm pressure Once applied, do not remove original dressing Pressure dressing: a dressing that closes blood vessels by compressing the wound Tourniquet: applied only when hemorrhaging cannot be controlled by other methods Make sure to ensure BSI and use standard precautions Dressings Once a dressing has been applied, don’t remove – can damage tissue and disrupt clotting If new dressing is needed, apply directly on top Tourniquet Major artery may have been punctured May need to be used to control bleeding while other ABCDs are being addressed Risk of losing the patient’s limb Use if patient is at risk of exsanguination – bleeding to death Write the time the tourniquet was applied on a piece of tape and put it on the patient’s forehead

Treatment of Specific Soft-Tissue Injuries Contusions Rest Ice Compression Elevation Splint Open Injuries Important to reduce risk of wound contamination/infection Control bleeding Irrigate the wound Cover with a dressing Secure the dressing with a bandage Splint all wounds in extremities and elevate

Treatment of Specific Soft-Tissue Injuries Avulsions Control bleeding Cleanse the injury Replace the flap in its original position Apply a sterile compression bandage Amputations Control bleeding For incomplete amputations, immobilize and splint. Never detach partial amputation For complete amputations, preserve all amputated parts Wrap in saline-moistened gauze and place in a plastic bag Put plastic bag in a container with ice Transport amputated part with patient Amputation Objective is to keep amputated part cool without allowing it to freeze Do not place it directly in the ice Also do not submerge in water – could damage the tissue

Treatment of Specific Soft-Tissue Injuries Impaled Objects After controlling bleeding, the primary goal is to stabilize the object – try to leave impaled object in patient Manually stabilize the object Remove or cut all clothing around the impaled object Control bleeding Apply bulky dressing around the object. It may be necessary to shorten the object Keep the object from moving during transportation

Dressing & Bandaging Universal dressing: sterile, soft, highly absorbent, individually wrapped dressing that provides padding and protection Bandage: a strip or roll of gauze or other material used for wrapping or binding a body part Used to hold a dressing or splint in place Always leave fingers and toes exposed to check for CSMs Bandaging could potentially restrict circulation, which is why it’s important to leave toes/fingers exposed

Special Types of Dressings & Bandages Pressure Dressings Occlusive Dressings Stabilizing Dressings Hemostatic Dressings Pressure dressing is used to maintain direct pressure on a bleeding wound Occlusive dressings: cover sucking chest wounds and open neck wounds Prevent air and liquids from entering/exiting the wound Stabilizing dressing used to secure an impaled object in place Layers of thick dressing wrapped around the object Doughnut Hemostatic dressings contain a topical hemostatic agent that promotes clotting