1. SOFT-TISSUE INJURIES

2. State Standards
24) Research and evaluate National Trauma Triage Protocol. Identify and perform skills to manage life threatening injuries based on assessment findings of a patient with trauma emergencies, utilizing rubrics from textbooks, National HOSA guidelines, or clinical standards of practice in the following areas:
a. Internal and external bleeding
b. Chest trauma such as sucking chest wound and impaled objects in chest
c. Abdominal trauma such eviscerations and impaled objects d. Orthopedic trauma such as fractures, dislocations, amputations
e. Soft tissue trauma, burns, dressings, and bandages
f. Head, facial, neck and spine trauma such as head injuries, scalp injuries, and injuries to spine
g. Environmental emergencies such as submersion and exposure to heat and cold
h. Multi-system trauma

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

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

5. 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

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

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

8. 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

9. 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

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

11. 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.

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

13. 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.

14. 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.

15. 18.3.1 Control any obvious bleeding.
continued on next slide

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

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

18. 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

19. 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.

20. 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

21. 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.

22. 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.

23. 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

24. 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?

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

26. 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

27. 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?

28. 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

29. 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.

30. 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?

31. 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

32. Think About It
You respond to a warehouse and find a 19-year-old male right lateral recumbent moaning loudly. Coworkers report that he was pinned against the wall by a fork-lift.
What are your concerns?
How will you proceed?
Teaching Tip: Guide students through the assessment and treatment of a crush injury with internal bleeding.

33. Activity **We have now covered all of our objectives***
Create an educational brochure for the community that details how to care for the following soft tissue injuries. Include drawings and safety precautions, and how to care for amputated body parts.
Eye injuries
Amputations
Nosebleeds
Neck bleeding
Penetrating injuries
***We will practice treatments as well
Exit ticket: Explain why you would not remove a penetrating object.
How should you care for an amputated body part?