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Page 1: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Soft-Tissue Injuries

Page 2: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Soft tissues• Skin• Fatty tissues• Muscles• Blood vessels• Fibrous tissues• Membranes• Glands• Nerves

Page 3: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Major functions of the skin• Protection• Water balance• Temperature regulation• Excretion• Shock absorptionLayers• Epidermis• Dermis• Subcutaneous

Page 4: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Closed woundsInternal injury, impact from blunt objectTypes• Contusion• Hematoma

Larger blood vessels• Crush injury

severe bleeding and shock

Page 5: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Patient Assessment• MOI and presence of shockCare• Standard precautions• ABCs and O2• Splint painful, swollen, deformed extremities• Be observant for vomiting• Monitor for shock• Rapid Transport

Page 6: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Open Wounds

• Abrasions

• Lacerations

• Punctures

penetrating

perforating; entrance and exit wound

• Avulsions

Page 7: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Amputation

• Crush injuries

Care

• Standard precautions

• Initial assessment

ABCs

Severe bleeding

Page 8: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Expose the wound• Clean• Control bleeding• If serious, care for shock• Prevent further contamination• Bandage after bleeding controlled• Keep pt. still and reassure

In addition

Page 9: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Abrasions and lacerations*Check PMS *Distal injury• Puncture Wounds*May go to bone*May cause serious internal bleeding*GSW can fx. Bone, causing extensive sof-

tissue and injury to organs

Page 10: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

*Immobilize the spine when patient’s head is injured

*Transport• Impaled Objects*Do not remove or put pressure on the object*Stabilize*If needed contact medical direction*Care for shock*Keep Pt. at rest

Page 11: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

*Transport carefully and ASAP• Objects impaled in the cheek*If possible remove

same direction it entered*If not possible turn for drainage*Suction as needed*Dress outside, taking care material doesn’t

enter airway

Page 12: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

*Monitor mental status*O2*Care for shock• Eye Injury; puncture/impaled object*Stabilize; cup or cone*Dress and bandage uninjured eye*O2 *Care for shockReassure and provide emotional support

Page 13: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Avulsions

*Clean

*Gently fold the skin back in position

*Control bleeding

*Dress using bulky pressure dressing

Page 14: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

*Saving an avulsed part

• Amputations

*Control bleeding

bulky pressure dressing

*Amputated parts

Page 15: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Wounds to the neck

*Bleeding control

*Remember the characteristics of bleeding

arterial

venous

*Danger of air embolism

Page 16: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Care• Airway• Place gloved hand over wound• Occlusive dressing• Place dressing over occlusive dressing• If needed apply direct pressure

do not apply pressure to both carotids at the same time

Page 17: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Once bleeding is controlled

bandage; do not restrict airway, or arteries and veins when doing so

• If MOI indicates, immobilize

Page 18: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Chest InjuriesPericardial TamponadeFlail chestSucking chest woundSpontaneous pneumothoraxPneumothoraxSubcutaneous Emphysema

Page 19: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Chest Injuries

Blunt trauma

Penetrating trauma

Compression

• Flail Chest

Paradoxical motion

Page 20: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Pt. Assessment• MOI• Signs of shock and hypoxia• Pt. may become fatiguedCare• Initial assessment• Airway management and O2• Stabilize with bulky dressing• Carefully monitor

Page 21: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Open Chest Injuries;

*Skin of chest wall is broken

*Considered to be life-threatening

*Assess for perforating puncture wound and treat accordingly

Page 22: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Sucking chest woundCare• May be gasping for air• BLS as indicated• Seal• O2• Care for shock• Rapid transport on injured side if possible

Page 23: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Pneumothorax

• Diminished lung sounds

• JVD

• Tracheal deviation

• Shock

Spontaneous pneumothorax

Page 24: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Hemothorax and hemopneumothorax

Vessels rupture

Extensive bruising of face and neck

May have bulging eyes, JVD, broken blood vessels in face

Signs of shock

Page 25: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Traumatic Asphyxia

Sudden compression of the chest

• Severe pressure on the heart and lungs forcing blood out of the right atrium and up into the jugulars

• Bulging eyes, distended neck veins, and broken blood vessels in the face

Page 26: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Cardiac Tamponade

• Blood in the pericardial sac

• JVD

• Signs of shock

• Narrowing pulse pressure

Page 27: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Aortic injury and dissection• Injury

penetrating trauma• Dissection

blunt trauma; deceleration injury• May complain of pain in chest, abd or back• Signs of shock• Different pulse/b/p in Right/left arm/leg• Do not palpate any pulsating mass

Page 28: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Subcutaneous emphysema

Page 29: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Abdominal injuries• EviscerationSigns and symptoms of abdominal injuries• Pain; mild – intolerable• Cramps• Nausea• Weakness• Thirst• Obvious lacerations and puncture wounds

Page 30: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Laceration and puncture wounds to the middle and lower back or chest wounds near the diaphragm

• Large bruised area• Intense bruise on the ABD• Signs of shock• coughing or vomiting of blood• Rigid or tender ABD• ABD distension• Lies still with legs drawn

Page 31: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Care• Monitor for and manage vomiting• Airway• Position on back with legs flexed• O2• Care for shock• NPO• Monitor vs

Page 32: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Control external bleeding and dress all wounds

• Do not touch or replace eviscerated parts

• Do not remove any impaled objects

• Leave patients legs in place

Page 33: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Burns

Patient Assessment

Classified in three ways

• Agent and source

• Depth

• Severity

Page 34: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Agent and source

• Never assume

• Gather information

scene size-up

bystanders

patient interview

Page 35: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Depth

Superficial {1st degree}

• Epidermis

• Reddening

• Possibly swelling

Page 36: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Partial thickness burn

• Dermis

• Intense pain

• Noticeable reddening

• Blisters

• Mottled appearance

Page 37: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Full thickness

• All layers

• Charred black or brown or areas that are brown or white

Page 38: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Layers:• Epidermis: Outermost most layer• Dermis: Deeper layer of the skin; contains sweat and

sebaceous glands, hair follicles, blood vessels, and nerve endings

• Subcutaneous: The third layer of human skin is called the subcutaneous (meaning “under the skin”) fatty layer. It is made up of fat cells, connective tissue, and blood vessels. It also contains hair roots, from which hair growth takes place. The fat in this layer supplies nutrients to the other two layers. It also cushions the body and protects it from the cold.

Page 39: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Severity• Agent or source• Body region

groin, genitalia, buttocks can be serious• Circumferential burns can be very serious• Depth• Extent of burn

rule of nines• Age

infants, children <5 and adults >55 are at greatest risk for death

Page 40: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Other illnesses and injuries

heart disease, respiratory dis., diabetes

Classifying burns by severity

• Order and type of care, order of transport and destination

• Infants at higher risk of shock, airway compromise and hypothermia

Page 41: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Treating specific types of burnsThermal burns• Dry, sterile dressing• Never apply ointment, spray or butter• Never break blisters• Do not apply ice• Keep clean• Keep pt. warm

Page 42: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Chemical burns• Scene safety• Requires immediate care• Flush; copious amts. Of water at least 20 min.• Remove all jewelry and clothing

without contaminating other areas of body

without contaminating yourself

Page 43: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• If dry chemical, brush off

• Apply sterile dressing or burn sheet

• Treat for shock

• Transport

Chemical burns to eyes

• Immediately flush

avoid flushing contaminate to other eye

Page 44: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Flush medial to lateral

• Flush for at least 20 minutes

• After washing, cover eyes with moistened pads

• If reoccurring burning or irritation, flush another 5 minutes

Page 45: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Specific chemical burnsMixed or strong acidsUnidentified substances• Continue flushing even if pt. c/o no

pain/discomfortDry lime• Brush• Take care not to contaminate eyes

Page 46: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Flush only after lime has been brushed away from body; should be done quickly and continuously

Carbolic acid

embalming fluid; herbicides

• Do not mix with water

• If available use alcohol for initial flush

then flush with water

Page 47: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Sulfuric acid

• Heat is produced but preferable to flush other than leaving on skin

Hydrofluoric acid

• Even if burns aren’t evident, flush

• Rapid transport to find neutralizing agent

Page 48: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Inhaled vapors

• High concentration O2

• Rapid transport

Page 49: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Electrical Injuries

Electrical current

Lightning

• Skin is burned where current entered and where it flows to the ground

• Tissue damage along the path

• Chemical Δs takes place in nerves, heart and muscle

Page 50: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Scene safety

Make sure source of electricity is still active until a qualified person tells you otherwise

Do not attempt rescue unless trained and have necessary equipment and personnel

Page 51: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Pt. Assessment• Burns {entrance and exit wounds}• Paralysis

disrupted nerve pathways• Muscle tenderness, with or without muscle

twitching• Respiratory distress, or failure, or arrest• Irregular heartbeat or cardiac arrest

Page 52: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Elevated B/P or hypotension with s/s of shock

• Restless or irritability if conscious

• Loss of consciousness

• Visual difficulties

• Fractures and dislocations from severe muscle contractions or from falling

• Seizures; in severe cases

Page 53: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Care• Airway care

may be swelling• Cardiac arrest management• Care for shock• O2• Care for spinal; head injuries and fractures• Serious pts should be fully immobilized

Page 54: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

• Elevate electrical burns

• Cool the burn areas and any smoldering clothing the same as for a flame burn

• Apply dry, sterile dressing to burn sites

• Rapid transport

Page 55: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Dressing and bandaging

• Dressing

• Bandage

Dressing open wounds

• Standard precautions

• Do not remove unless to control bleeding

Page 56: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.

Bandaging

• Not too tight, not too loose

• Do not cover tips of fingers or toes

• When bandaging a joint, do not bend once wrapped

Page 57: Soft-Tissue Injuries. Soft tissues Skin Fatty tissues Muscles Blood vessels Fibrous tissues Membranes Glands Nerves.