1. SOFT TISSUE INJURIES

2. OBJECTIVES Trainees should be able to:
Describe the different types of soft tissue injuries
Describe the principles of sterile dressing
Explain field care for various types of injuries
Apply proper First Aid for soft tissue injuries

3. SCOPE INTRODUCTION TO WOUNDS TYPES OF SOFT TISSUE INJURIES
CLOSED WOUNDS
OPEN WOUNDS
PRINCIPLES OF STERILE DRESSING
FIELD CARE MANAGEMENT (PRACTICAL)
CONCLUSION

4. A break in the continuity of soft tissue (flesh)
WHAT IS A WOUND?
A break in the continuity of soft tissue (flesh)
Types of wounds :
Open Wound
Closed Wound

5. CLOSED WOUNDS INTRODUCTION Damage to tissue beneath the skin
No break in the skin
SIGNS
Swelling and pain
Black & blue mark
TYPES
Contusion
Hematoma
ecchymosis- a discoloration of the skin resulting from bleeding underneath, typically caused by bruising 5

6. WARNING!
The following slides contain (OR may contain) pictures of shocking nature

7. CONTUSION Commonly described as a ‘bruise’
Capillaries beneath skin ruptured by a blunt blow e.g. punch
Bleeding under skin
Blood leaking into tissues causes bruising
Skin occasionally splits
ecchymosis- a discoloration of the skin resulting from bleeding underneath, typically caused by bruising 7

8. CONTUSION

9. HEMATOMA Force impacts on arteries and veins close to skin
Bleeding (internal) & swelling
Blood collects under the skin

10. OPEN WOUNDS Break in the skin Risk of infection
Open wounds can be classified according to the object that caused the wound, and the severity of the wound. Some examples of open wounds are:
Small cuts / Grazes
Incisions / Incised Wound
Lacerations
Abrasions
Penetration Wounds (Impaled Objects)

11. Small Cuts and Grazes

12. Procedure for Treatment of Small Cuts and Grazes
Wash your hands thoroughly, and put on disposable gloves if available.
Apply pressure with a clean piece of cloth to stop the bleeding
If the wound is dirty, clean the wound by rinsing lightly under running tap water
The best way to remove superficial pieces of glass or grit is with tweezers if you have them.
Wipe away the water with a piece of clean cloth/ tissue paper.
Do not cough or sneeze over the wound and avoid touching the wound directly.
If there is a special risk of infection, advise the casualty to see a doctor.

13. 1) Peel open the finger-sized plaster as shown:
Peel open here (top & bottom)
Or tear from the side

14. 2) Peel open the plaster from the top and remove it from its packaging :
Peel open here (top & bottom)
Or tear from the side (might be easier

15. 3) Remove adhesive strip from package
Sterile Pad.
Shield Protectors
3) Remove adhesive strip from package
4) Remove the two shield protectors
from the center of the plaster.
Do not touch the sterile pad.

16. 5) Place the sterile pad on the wound and fix the adhesive plaster firmly on both sides of the wound.
Secure adhesive bandage firmly

17. 6) Inform your parent/guardian

18. Pointers to take note of
Use each plaster only once.
Store the plaster in a cool dry place.
Do not use if package is damaged.
Do not use after expiry date.

19. Pointers to take note of
A cut might become infected if it is not washed and cleaned.
If the bleeding is severe and cannot be stopped, send the victim to a doctor immediately.

20. ABRASION Also described as a ‘graze’ Superficial wound
Top layers of skin scraped off
Raw, tender area left behind
Embedded foreign particles may result in infection
Minor capillary bleeding

21. LACERATION Rough tears to the skin caused by crushing/ripping forces
May bleed less profusely than clean-cut wounds
However, more tissue damage and bruising is likely
High risk of infection as they are often contaminated by germs

22. INCISION Results from a clean cut from a sharp edge
(E.g. Broken glass)
Profuse bleeding may result as blood vessels at wound edges are cut straight across

23. AVULSION Forceful tearing of full thickness of the skin
Wound margins jagged
Remaining tissue may appear shredded

24. PRACTICE TIME!

25. PARTS of FAD
Longer End
STERILE PADDING
Shorter End

26. PRINCIPLES OF STERILE DRESSING
Wear gloves
Hygiene purpose
Prevent infection to the wound
Face and give assurance to casualty
Calm him down as he’s in panic
Expose wound
Support injured limb
So as not to aggravate the injury
Open FAD as close to wound as possible
To minimize infection

27. PRINCIPLES OF STERILE DRESSING
Do not touch sterile pad
Hygiene purpose
Prevent infection
Do not drop long end of FAD
Cover wound completely
Tie knot onto pad
Add pressure to the wound  Prevent further blood loss
Immobilize the injured limb
So as not to aggravate the injury

28. FIELD CARE MANAGEMENT HEAD PRIMARY DRESSING1. 2. 3. 4. 5. 6. 7. 8.
Use FAD 14/15. Place sterile pad on wound, apply firm & direct pressure on it throughout procedure.
The other side before the ear.
Follow through (slightly below chin), covering the rest of the sterile pad. (Do not choke victim by tying too tight)
Criss-cross the bandages when pad is fully covered.
Wrap the remaining bandage round his head (above eyebrow).
Tie a reef knot.
Twirl the ends together and tuck it underneath the wrap.
Tidy up the dressing.
Tuck shorter side of the bandage behind ear.

29. FIELD CARE MANAGEMENT HEAD SECONDARY DRESSING1. 2. 3. 4. 5. 6.
Wrap round head, cross ends of bandage (at the back) and tie a reef knot once they’re brought to the front.
Tuck the excess sheet beneath the wrap.
Tuck the dressing in neatly.

30. FIELD CARE MANAGEMENT EYE
PRIMARY DRESSING
SECONDARY DRESSING
Use FAD 13. Place sterile pad on wound, apply firm & direct pressure on it throughout procedure. 1. 2.
Cross method. 1. 2. 3. 4.
Cover both eyes to ‘blind’ both sides so as not to aggravate the pain in the injured eye
Shorter side goes above ear.
Do not cover the other eye.
Longer side below.

31. FIELD CARE MANAGEMENT SHOULDER PRIMARY DRESSING
Use FAD 15. Place sterile pad on wound, apply firm & direct pressure on it throughout procedure.
PRIMARY DRESSING 1. 2. 3. 4.
Avoid wrapping the shorter end of the dressing.
Shorter end of bandage remains behind. Longer end will be doing the wrapping.
Wrap around sterile pad (front to back, under the armpit)
When sterile pad is firmly in place, wrap the bandage across chest. 5. 6. 7. 8.
And round to the back.
Tie a reef knot directly onto the wounded area.
Tuck ends of remaining bandage in neatly.

32. FIELD CARE MANAGEMENT SHOULDER SECONDARY DRESSING1. 2. 3.
Apex of triangular bandage facing casualty’s neck.
Wrap bandage round upper arm. Secure bandage in place with tying a reef knot.
Tuck apex underneath tee shirt (below the primary dressing).
Immobilize injured limb to prevent aggravation. 1. 2.

33. FIELD CARE MANAGEMENT LEG PRIMARY DRESSING1. 2. 3. 4.
Place FAD 15 on the wound. Wrap round the sterile padding with the longer end of the bandage.
Once sterile padding is covered, tie a reef directly over the wounded area.

34. FIELD CARE MANAGEMENT LEG SECONDARY DRESSING1. 2. 3.
Using a broad bandage, wrap it over the FAD and tie a reef knot on the wounded area (similar to FAD shown earlier)

35. AMPUTATION
Forceful tearing of a limb from the body

36. AMPUTATION
DECAPITATION

37. PRACTICE TIME!

38. AMPUTATION VICTIM Put on disposable gloves if possible.
As with other open wounds, the first aider should attempt haemorrhage control for amputation with direct pressure and elevation.
You should avoid use of tourniquet if possible because the resultant damage can interfere with the reimplantation attempts.
Reassure the victim.
Raise the severed limp up.
Apply sterile dressing ,or an non-fluffy clean pad

39. AMPUTATION
Amputated part:
Put on glove and wrap the severed part with plastic bag
Wrap the package in gauze or soft fabric and place in a container full of crushed ice
Mark the container with time of injury and casualty name . Pass the container to the emergency personnel yourself.
DO NOT allow the amputated part to come into contact with moisture.

40. FIELD CARE MANAGEMENT AMPUTATION PRIMARY DRESSING1. 2. 3. 4.
Raise amputated limb to reduce blood loss.
Place FAD 14 or 15 directly on the amputated limb.
Wrap around the limb as shown in the diagrams with the longer end of the bandage.
Tie both the shorter and the longer ends of the bandage. 5.

41. FIELD CARE MANAGEMENT AMPUTATION SECONDARY DRESSING1. 2. 3.
Using a broad triangular bandage wrap amputated limb.
Twirl excess bandage and tuck it into the wrap.
If the bleeding cannot be stopped by the first layer of FAD, add another layer of FAD on top of the first layer.

42. IMPALED OBJECT Punctured wound Small entry site
Deep track of internal damage
High risk of infection as germs and dirt are carried far into body

43. PRACTICE TIME!

44. FIELD CARE MANAGEMENT IMPALED OBJECTS Control Bleeding
Stabilize object
Pad around object
Immobilize injured limb
DO NOT REMOVE OBJECT THAT IS EMBEDDED IN THE WOUND

45. 2 narrow-fold bandages to be looped in opposite directions.
IMPALED OBJECT
FIELD CARE MANAGEMENT 1. 2. 3. 4.
Unwrap 2 FAD 13 and place them upright- locking the impaled object in position.
2 narrow-fold bandages to be looped in opposite directions.
Tie the ends of one bandage together with the ends of the other bandage.
Be wary of the impaled object- make sure it is not being shifted when you’re attending to it. 5. 6.

46. EVISCERATION
Abdominal organs protrude through wound

47. PRACTICE TIME!

48. FIELD CARE MANAGEMENT EVISCERATION
Cover protruding organ with moist gauze
Use occlusive dressing to cover wound completely
If possible, place casualty supine with knees bent
DO NOT PUSH ORGANS BACK INTO PLACE

49. Protruding Intestines (Evisceration)
FIELD CARE MANAGEMENT
PRIMARY DRESSING 1. 2. 3. 4.
Place FAD 15 on the wound. Wrap round the moistened sterile padding with the longer end of the bandage.
Using a triangular (narrow) bandage make a ring pad (donut shape) and place it round the protruding intestines.
In supine position, knees have to be bent to prevent the stretching/tensing of the intestines. 5. 6.

50. FIELD CARE MANAGEMENT Protruding Intestines (Evisceration)
SECONDARY DRESSING 3. 1. 2.
Fold the triangular bandage into half, and wrap it round the FAD. 4. 5.

51. RECAP TIME!

52. Question 1
Q 1: Name the wound.

53. Question 2
Q 2: Name the wound.

54. Conclusion
It is important for trainees to be able to differentiate the types of soft tissue injuries and to be able to provide proper first aid dressing.