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Soft Tissue Injuries

Treatment Procedures

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Skin Anatomy and Physiology

• Body’s largest organ

• Three layers– Epidermis

–Dermis

– Subcutaneous tissue

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Skin Anatomy and Physiology

• Complex system, variety of functions– Sensation

–Control of water loss

– Protection against microbes

– Temperature control

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Soft Tissue Injuries

• Closed

• Open

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Closed Injury

• Associated with blunt trauma

• Skin remains intact

• Damage occurs below surface

• Types–Contusions

–Hematomas

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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)

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Hematoma

• “Blood lump”

• Larger blood vessel damaged

• Causes mass of blood to collect in the injured area

• Fist-sized hematoma = 10% volume loss

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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?

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Closed Injury Management

• Rest

• Ice

• Compression

• Elevate

• Splint

When in doubt assume underlying fractures are

present

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Open Injury

• Skin broken

• Protective function lost

• External bleeding, infection become problems

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Open Injury Types

• Abrasions

• Lacerations

• Punctures

• Avulsions

• Amputations

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Abrasion

• Loss of portions of epidermis, upper dermis by rubbing or scraping force.

• Usually associated with capillary oozing, leaking of fluid

• “Road rash”

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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

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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

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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

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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

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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

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Special Considerations

• Impaled objects

• Eviscerations

• Open chest wounds

• Neck wounds

• Gunshot wounds

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Impaled Objects

• Do NOT remove

• Stabilize in place

• Exception–Object in cheek

–Remove, dress inside and outside mouth

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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

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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

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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

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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