Soft Tissue Injuries

1. Soft Tissue Injuries Treatment Procedures

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

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

4. Soft Tissue Injuries • Closed • Open

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

6. 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)

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

8. 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?

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

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

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

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

13. 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

14. 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

15. 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

16. 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

17. 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

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

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

20. 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

21. 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

22. 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

23. 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