Soft Tissue Injuries Temple College EMS Professions 1

Soft Tissue Injuries Temple College EMS Professions 1

Skin Anatomy and Physiology • Body’s largest organ • Three layers – Epidermis – Dermis – Subcutaneous tissue 2

Skin Anatomy and Physiology • Complex system, variety of functions – Sensation – Control of water loss – Protection against microbes – Temperature control 3

Soft Tissue Injuries • Closed • Open 4

Closed Injury • • Associated with blunt trauma Skin remains intact Damage occurs below surface Types – Contusions – Hematomas 5

Contusion • Produced when blunt force damages dermal structures • Blood, fluid leak into damage area causing swelling, pain • Presence of blood causes skin discoloration called ecchymosis (bruise) 6

Hematoma • “Blood lump” • Larger blood vessel damaged • Causes mass of blood to collect in the injured area • Fist-sized hematoma = 10% volume loss 7

With Closed Soft Tissue Injury • How much blood is tied up in that injury rather than circulating in the vessels? • What could the force the caused the soft tissue trauma have done to underlying organs? 8

Closed Injury Management • • • Rest Ice Compression Elevate Splint When in doubt assume underlying fractures are present 9

Open Injury • Skin broken • Protective function lost • External bleeding, infection become problems 10

Open Injury Types • • • Abrasions Lacerations Punctures Avulsions Amputations 11

Abrasion • Loss of portions of epidermis, upper dermis by rubbing or scraping force. • Usually associated with capillary oozing, leaking of fluid • “Road rash” 12

Laceration • Cut by sharp object • Typically longer than it is deep • May be associated with severe blood loss, damage to underlying tissues • Types – Linear – Stellate 13

Punctures • • Result from stabbing force Wound is deeper than it is long Difficult to assess injury extent Object producing puncture may remain impaled in wound 14

Avulsions • Piece of skin torn loose as a flap or completely torn from body • Result from accidents with machinery and motor vehicles • Replace flap into normal position before bandaging • Treat completely avulsed tissue like amputated part 15

Amputations • Disruption of continuity of extremity or other body part • Part should be wrapped in sterile gauze, placed in plastic bag, transported on top of cold pack • Do NOT pack part directly in ice • Do NOT let part freeze 16

Open Wound Management • Manage ABCs first • Control bleeding • Prevent further contamination, but do not worry about trying to clean wound • Immobilize injured part • Mange hypoperfusion if present 17

Special Considerations • • • Impaled objects Eviscerations Open chest wounds Neck wounds Gunshot wounds 18

Impaled Objects • Do NOT remove • Stabilize in place • Exception – Object in cheek – Remove, dress inside and outside mouth 19

Eviscerations • Internal organs exposed through wound • Cover organs with large moistened dressing, then with aluminum foil or dry multi-trauma dressing • Do NOT use individual 4 x 4’s • Do NOT attempt to replace organs 20

Open Chest Wound • May prevent adequate ventilation • Cover with occlusive dressing • Monitor patient for signs of air becoming trapped under pressure in chest (tension pneumothorax) • If tension pneumo develops lift dressing corner to relieve pressure 21

Neck Wounds • Risk of severe bleeding from large vessels • Risk of air entering vein and moving through heart to lungs • Cover with occlusive dressing • Do NOT occlude airway or blood flow to brain • Suspect presence of spinal injury 22

Gunshot Wound • Special type of puncture wound • Transmitted energy can cause injury remote from bullet track • Bullets change direction, tumble • Impossible to assess severity in field or ER • Patient must go to OR 23

Power. Point Source • Slides for this presentation from Temple College EMS: http: //www. templejc. edu/dept/ems/p ages/powerpoint. html 24