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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