1. Lesson 3 WOUNDS – Soft Tissue Injuries

2. the most common injuries (trauma) in a first aid setting are soft injuries with bleeding & shock Result in a wound a break in the skin, the underlying tissue, and/or other body membranes Injuries to soft tissues vary from: contusions (bruises) lacerations (serious cuts), and... puncture wounds Two main threats with these injuries are: bleeding & infection

3. Wounds are classified according to their: 1. general condition 2. size 3. location 4. and by the agent that caused the wound

4. 1. general condition If the wound is new, first aid consists mainly of : - controlling bleeding - treating for shock, and... - reducing the risk of infection If the wound is old and infected, the first aid consists of: keeping the victim quiet elevating the injured part applying a dressing If the wound contains foreign objects: First aid may consist of removing the objects if not deep Do not remove impaled objects or objects embedded in the eyes, chest, or skull.

5. 2. size Generally, large wounds are more serious than small ones and they usually involve: - severe bleeding - more damage to tissues and organs, and... - a greater degree of shock However, small wounds are sometimes more dangerous since they may become infected more readily due to neglect The depth of a wound is important because it may lead to a complete perforation of an organ or the body, with the additional complication of an entrance and exit wound.

6. 3. location Since a wound can cause serious damage to deep structures, as well as the skin and tissues below it, the location is an important consideration. i.e.) A knife wound in the chest is likely to puncture a lung and cause difficulty breathing. The same kind of wound in the abdomen can cause a life- threatening infection, internal bleeding, or puncture the intestines, liver, or other vital organs. In the arm, this type of wound would not be as serious yet could cause very serious bleeding, infection, and later effects. i.e.) a bullet wound to the head may cause brain damage, if not death, - but one to the leg may cause no serious damage.

7. As the first line of defense against most injuries, soft tissues are most often damaged. There are two types of soft tissue injuries: Closed and Open An open wound is one in which the skin surface has been broken. A closed wound is where the skin surface is unbroken but underlying tissues have been damaged.

8. A blunt object that strikes the body will damage tissues beneath the skin minor damage  contusion, or bruise extensive damage  will be more serious contusion ecchymosis = discoloration edema = swelling pain First aid consists of applying ice or cold packs to reduce swelling and relieve discomfort.

9. Hematoma the result of a severe contusion tearing of large blood vessels pooling of large amounts of blood below the skin With large hematomas Suspect broken bones – especially if noticeable deformity (R). I.C.E. First aid consists of (R). I.C.E. I applying Ice or cold packs to reduce swelling and relieve pain C direct pressure (manual Compression) to help control internal bleeding Splinting /immobilization E Elevation of the part if possible R Rest for healing/recovery

10. Physiological effects from: Upon any trauma to body tissue, blood vessels will be damaged causing bleeding the body’s natural response to injury is that of dilating arteries to allow more blood flow to a damaged area to: Increase many things that are in the blood to the area so to respond and meet homeostasis oxygen and nutrients for repair proteins/chemicals for attack and/or repair All of this influx of materials actually overwhelm the tissues and congest the area interfering with repair & healing – and actually causing more cell destruction This response causes the signs of swelling & redness and the symptom of pain

11. Physiological effects from: to guard against frostbite... never apply ice or cold packs directly to the skin Also, ice or cold left on an area for more than 20 mins. will cause a reverse effect. The body will respond to this cold as homeostatic imbalance and send blood to the area to warm the area – which could cause more swelling Leave cold treatments on for no more than 20 mins. at a time

12. Wounds where the protective layer of the skin has been damaged Can cause serious internal and external bleeding Can result in contamination and infection There are six basic types of wounds – based on the way the skin and tissue has been broken

13. Abrasions Caused when the skin is rubbed or scraped off i.e.) rope burns, floor burns, skinned knees/elbows Can easily become infected because dirt and germs are usually ground into the tissues Normally minimal bleeding or oozing of fluids

14. Amputations (from trauma) Non-surgical removal of fingers, toes, hands, feet, arms, legs, or ears from the body. Bleeding is heavy and normally needs a tourniquet to control the blood flow. Three types of amputation: 1. complete - body part is completely torn off (severed) 2. partial - more than 50% of the body pat is torn off 3. de-gloving - skin and tissues are torn away from body part

15. Amputations (from trauma) If the victim has an amputation... 1. Establish and maintain the airway, breathing, and circulation (ABC’s) 2. Control bleeding with direct pressure, elevation, indirect pressure, or tourniquet Only as a last resort Never remove or loosen a tourniquet once it has been applied 3. Apply dressing to the stump with a compressive wrap to replace direct pressure 4. Treat for shock 5. Request medical assistance immediately

16. Avulsions Injury in which the skin is torn completely away from a body part or is left hanging as a flap. Usually, there is severe bleeding If possible, obtain the part that has been torn away, Rinse with water Wrap in a dry sterile dressing Seal in a plastic bag Send it on ice with the victim If the skin is still attached, fold the flap back into its normal position

17. Incisions Commonly called cuts Wound made by a sharp cutting instrument such as : knives, razors, broken glass Tend to bleed freely because blood vessels are cut cleanly, w/o jagged edges Edges are smooth with little damage to the surrounding tissues Least likely to become infected

18. Lacerations Is torn, rather than cut Have ragged, irregular edges and torn tissue underneath Are usually made by a blunt object i.e.) dull knife Many wounds caused by machinery accidents are lacerations with complications of crushed tissues Are frequently contaminated with dirt, grease, or other materials that are ground into the wound Very likely to become infected

19. Punctures Caused by objects that enter the skin while leaving a surface opening nails, needles, wire, knives, bullets Small puncture wounds tend to not bleed freely Large puncture wounds may cause severe internal bleeding Possibility of infection is great in all puncture wounds Especially if penetrating object is contaminated Perforation wound variation of a puncture result in penetration of an object entering, passing through, and exiting the body

20. Causes: Although it is not necessary to know what object or method has caused a wound... It is helpful. Knowing what caused the wound and how it occurred can help determine its general condition, possible size, type, and seriousness. This info. will help provide the appropriate first aid to the victim.

21. Treatment of: F.A. treatment for all wounds consist of control bleeding, treat for shock, and prevent infection. If multiple wounds, treat those that appear to be life- threatening first. This info. will help provide the appropriate first aid to the victim.