1. Chapter 12 SOFT TISSUE INJURIES

2. Soft Tissue Injuries - Closed Wounds Bruises (Ecchymosis) Contusions Hematomas Internal Lacerations Internal Punctures Rupture of Internal Organs

3. Soft Tissue Injuries - Care Most do not require medical care Direct pressure, elevation, cold compress Be aware of other possible internal injuries If complaint of severe pain or inability to move affected area - EMS BSI High flow O 2 if serious injury

4. Soft Tissue Injuries - Open Wounds Abrasions (road rash, mat burns, rug burns) –Ooze, painful –Risk of infection due to debris in wound Lacerations (incision vs. laceration) –Difficult to determine degree of underlying injury –May bleed profusely

5. Soft Tissue Injuries - Open Wounds Punctures –Typically caused by nails, knives,etc. –Often no serious external bleeding but internal may be profuse –Contamination can be a serious problem –Two types Penetrating Perforating

6. Soft Tissue Injuries - Open Wounds Avulsions –Flaps of skin &/or tissue torn loose or off degloving (ring avulsion) extruded avulsion (avulsed eye) –May bleed profusely –Can have extensive tissue damage

7. Soft Tissue Injuries - Open Wounds Amputation –Feet, toes, hands, fingers or entire limbs –Bleeding - minimal to profuse –Tissue damage may be extensive –Includes Crush injuries –can cause “tourniquet shock” Degloving amputations

8. Care Minor Open Wounds –Superficial, minimal bleeding –Wash area thoroughly with soap & water –Cover with sterile dressing & apply direct pressure to control bleeding –Once bleeding controlled, apply antibiotic ointment –Dress and bandage (band-aid)

9. Care Major Open Wounds –Cover with a sterile (clean) dressing –Follow steps for controlling bleeding –Assess pulse or capillary refill, motor function, sensation distal to injury This should be done both before and after a bandage has been applied –Oxygen if available –Activate EMS when necessary

10. You May Need Stitches IF Bleeding from an artery or uncontrolled Wounds –Involve muscles, tendons, ligaments –Involve joints –Gape widely, involve thumb or palm of hand –Are large, involve deep punctures or deeply embedded objects –Human or animal bites –If unattended, scar would be conspicuous

11. Care for Specific Types of Injuries Puncture Wounds –Always check for entrance and exit wounds –Treat all gunshot and knife wounds as if serious –Impaled Objects Do Not remove (unless it is a perforating wound to the cheek and is causing airway obstruction) Stabilize object with bulky dressings Immobilize the spine when the head, neck or chest is impaled If eye is involved- also cover the uninjured eye

12. Care for Specific Types of Injuries Avulsions –Fold flap back into place –Preserve avulsed flaps (parts) when possible Wrap in dry sterile dressing Place in plastic bag, place in a second bag Keep cool without freezing –Do Not immerse in ice, cold water, or saline –Avulsed eye cover with moist dressing and a cup, bandage both eyes

13. Care for Specific Types of Injuries Amputations –Wrap amputated part in sterile dressing –Place in a plastic bag –Place in a second plastic bag –Keep as cool as possible without freezing –Control bleeding as previously described

14. Specific Injuries - Scalp & Face First Concern - airway and breathing Do Not attempt to clear the surface of a scalp wounds Do not apply finger pressure if any change of a fracture Do not remove impaled objects unless it is through the cheek and causing an airway obstruction

15. Specific Injuries - Mouth Teeth –Place in milk –Do Not put back in socket –Do Not rub tooth in order to clean it –Control bleeding by having patient bite GENTLY on rolled gauze pad

16. Specific Injuries - Eye(s) Do Not apply direct pressure if globe is cut Foreign Objects –Minor Flush with water gently for up to 20 minutes –Major Do Not remove object Do Not probe into the eye socket Reduce eye movement (bandage both eyes)

17. Specific Injuries - Ears External Ear Injuries –Treat based on type of injury and extent of bleeding Internal Ear Injuries –Blood, bloody fluid or CSF draining from ears Do Not pack external ear canal –Foreign objects - Do Not attempt to remove –“Clogged” or “stopped up” ears Do not probe into the ears

18. Specific Injuries - Nose Nosebleeds –Previously covered –Do Not pack nostrils –If victim is unconscious Slightly elevated head or place in recovery position –CSF - Do Not pack nostrils –Foreign objects - Do Not remove object –Avulsions - safe part as previously described

19. Specific Injuries - Neck Signs of Neck Wounds Difficulty speaking, loss of voice Obvious swelling or bruising of neck Tracheal deviation Depressions to neck Obvious cuts or punctures Care –Direct pressure, also use an occlusive dressing if large veins are involved

20. Specific Injuries - Abdominal Lay victim on their back with knees flexed – Do Not flex if signs of pelvic, lower extremity or spinal fractures Do Not touch any exposed internal organs Do Not push organs back in Cover with an occlusive dressing –Cover occlusive dressing with a towel –Do Not remove any impaled objects

21. Specific Injuries - Genitalia Two types of injuries –Blunt trauma –Cuts Do Not remove impaled objects Save avulsed parts Use cold compress with blunt trauma (for pain)