Types of Closed Soft-Tissue Injuries
- Contusion
- Bruise; an injury that causes bleeding beneath the skin but does not break the skin.
- Epidermis remains intact but cells within dermis are damaged.
- Buildup of blood produces blue or black discoloration and is called Ecchymosis.
2. Hematoma
- Blood that has collected within damaged tissue or in a body cavity. Occurs whenever a large blood vessel is damaged and bleeds rapidly.
- Can result from soft-tissue injury, fracture, or any injury to a large blood vessel.
- Crushing Injury
- Occurs when great amount of force is applied to body.
- Extent of damage depends on how much force is applied and amount of time over which it is applied.
- 2 types:
- Crush syndrome: When area of body trapped for longer than 4 hours and arterial blood flow is compromised.
- Compartment syndrom: When watery fluid leaks into area between cells causing pressure and may become great enough to compress tissue and cause further damage.
Types of Open Soft-Tissue Injuries
- Abrasions
* Wound of the superficial layer of skin caused by friction. Usually does not penetrate through to dermis. Also known as “Road Rash”, “Road Burn”. - Laceration
- Jagged cut caused by shart object or a blunt force that tears the tissue. Incision is instead a sharp smooth cut.
- Depth can vary and can be either linear or stellate and can occur along with other types of soft-tissue injury.
- Avulsion
- Injury that separates various layers of soft tissue between the subcutaneous layer and fascia so that they become either completely detached or hang as a flap.
- Often accompanied by heavy bleeding. If you can, replace flat avulsed flap in original position if not contaminated. If an avulsion is complete, you shoudl wrap the seperated tissue in sterile gauze and take it with you.
3a. Amputation
* Part of body completely severed. Can be scalp, ear, nose, penis, lips, etc.
4. Penetrating wound
* INjury resulting from a sharp, pointed object such as a knife, ice pick, spinter or bullet. Usually leaves small entrance wounds.
Procedure for Penetrating Wounds
- Always count the number of penetrating injuries especially with gunshot wounds.
- Entrance wounds are often smaller than exit wounds.
- For Gunshot Wounds:
- Amount of energy transmitted by gunshot is directly related to the speed of the bullet thus it is important to try and find out what type of gun was used.
- Carefully document cirucmstances since you may be called to court.
Three factors affecting MOI of Blast Injuries
- Primary Blast Injury
* Due Entirely to blast itself; damage to body caused by pressure generated by the explosion. - Seconary Blast Injury
* Damage results from victime being struck by flying debris propelled by force of blast. - Tertiary blast injury
* Victim is thrown or hurled by force of explosion into an object or into ground.
Factors in Determining Decision For Immediate Transportation
- Poor Initial General Impression
- Altered Level of Consciousness
- Dyspnea
- Abnormal Vital Signs
- Shock
- Severe Pain
Signs and Symptoms of Open Soft Tissue Injury
- Bleeding
- Breaks in the skin
- shock
- Hemorrhage
- Disfigurement
- Pain
- Burning at injury site
- Conditions such as anemia, hemophilia, medications, etc may interfere with bleeding control.
RICES mnemonic
Rest: Keep Patient as quiet/comfortable as possible
Ice: Using ice/cold pack slows bleeding.
Compression: Apply pressure over injury site
Elevation: Raise injured part just above patients heart
Splinting: Decreases bleeding and reduces pain
-Use this mnemonic for dealing with closed soft-tissue injuries.
Treating Open Soft-Tissue Wounds
- All open wounds are to be assumed contaminated and present risk of infection. Apply sterile dressings, and **do not try to remove material from an open wound. **
- Splint if possible since this will help to control bleeding and it will typically reduce pain.
Treating Abdominal Wounds
- Usually is an **Evisceration: **organs protruding through a wound in the abdomen.
- Do not touch or move exposed organs. Instead cover with sterile guze mositened with sterile saline solution. Keep them moist and warm.
- If patient’s legs and knees are uninjured and you do not suspect spinal injury, flew legs to relive pressure on the abdomen.
- Patients with these issues require immediate transport.
Treating Injuries with Impaled Objects
-**Do NOT ATTEMPT TO REMOVE OBJECT UNLESS IT IMPALED THROUGH CHEEK OR CAUSING AIRWAY OBSTRUCTION. **
-Control bleeding with direct pressure and apply bulky dressing to stabilize object.
- Manually secure object by incorporating it into the dressing.
- Protect implaed object from being bumped or moved during transport by taping a rigid item such as a plastic cup, section of a plastic water bottle, or supply container over the stabilized object and its bandaging.
- If object is very long, cut off/shorten the exposed portion and then secure it.
Treating Neck Injurires
- Open neck injuries can cause air to be sucked into a blood vessel and cause air embolism so these are important to treat.
- Control bleeding by covering with an occlusive dressing. Apply manual presssure but do not compress both carotid vessels at the same time.
- Secure pressure dressing over the wound by wrapping roller guaze loosely around the neck and then firmly through the opposite axilla.
Treating Small Animal Bites and Rabies
- Small animal bites should be considered contaminated and potentially infected.
- Place a dry, sterile dressing, over the wound and promptly transport. Splint if necessary.
- You should generally not enter a scene involving such an animal unelss animal has been secured by police, or animal control officer.
Treating Human Bites
-Any wound made by a human mouth or even by the scrapping of a human tooth can result in serious spreading infection.
- Apply dry sterile dressing
- Promptly immoblilize the are with a spling or bandage.
- Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy.
Complications of Burns
- Burning of skin destroys barrier meant to protect body and body becomes at high risk for infection, hypothermia, hypovolemia, and shock.
- Burns to airway are of significant importance because the loose mucosa in the hypopharynx can sweel and lead to complete airway obstruction.
- Circumferential burns of the chest can compromise breathing.
The Five factors to determine severity of Burn
- What is the depth of the burn?
- What is the extent of the burn?
- Are any cirtical areas (face, upper airway, hands, feet, genitalia) involved at all? This includes circumferential burns that go all around a body part.
- Does the patient have any preexisting medical conditions or other injuries?
- Is the patient younger than 5 years or older than 55 years?
-If you answer “Yes” to any of the last three questions, you should upgrade the classification of the burn.
What Constitutes a severe burn in adults?
- Full thickness burns involving the hands, feet, face, upper airway, genitalia, or circumferential burns or other areas.
- Full thickness burns covering more than 10% of the body’s total surface area.
- Partial Thickness burns covering more than 30% of body’s total surface area.
- Burns associated with respiratory injury (smoke inhalation for example)
- Burns complicated by fractures
- Burns on patients younger than 5 years or older than 55 years that would be classified as “moderate” on young adults.
What Consititues a Moderate Burn in an Adult?
- Full thickness burns involving 2%-10% of the body’s total surface area (excluding hands, feet, face, genitalia, and upper airway)
- Partial-Thickness Burns covering 15%-30% of the body’s total surface area.
- Superficial burns covering more than 50% of teh body’s total surface area.
What constitutes a Minor Burn in an Adult?
- Full thickness burns covering less than 2% of teh body’s total surface area.
- Partial Thickness burns covering less than 15% of the body’s total surface area.
- Superficial burns covering less than 50% of teh body’s total surface.
