CHAPTER 27

Soft-Tissue Injuries

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Injuries

Soft Tissue Soft Tissue Anatomy & Anatomy & PhysiologyPhysiology

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Open andOpen andClosed WoundsClosed Wounds

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Closed WoundsClosed Wounds

Closed Wound

Key Term

Internal injury with no open pathway

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Internal injury with no open pathway

from the outside to the injured site

Types of Closed Wounds

Contusion

Hematoma

Crush Injury

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Crush Injury

Closed Wound Closed Wound –– ContusionContusion

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Emergency Care ofClosed Wounds

Take appropriate BSI precautions.

Manage airway; apply oxygen.

If shock is suspected, treat it.

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If shock is suspected, treat it.

Splint painful, swollen, or deformed

extremities.

Transport.

Open Wound

Key Term

An injury in which the skin is

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An injury in which the skin is

interrupted, or broken, exposing

the tissue underneath

Types of Open Wounds

Abrasions & Lacerations

Avulsions

Punctures

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Amputation

Crush

Open Wounds Open Wounds –– Abrasions & LacerationsAbrasions & Lacerations

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Open Wound Open Wound –– LacerationLaceration(Smooth Edges)

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Open Wound Open Wound ––Laceration Laceration (Jagged Edges)

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Open Wound Open Wound –– AvulsionAvulsion

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Open Wound Open Wound –– PuncturePuncture

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Entrance and Exit WoundsEntrance and Exit Wounds

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Open Wound Open Wound –– AmputationAmputation

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Crush injuries may cause both open and Crush injuries may cause both open and closed wounds.closed wounds.

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Emergency Care ofOpen Wounds

Take BSI precautions.

Manage airway; apply oxygen.

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Expose the wound.

Control bleeding.

Continued…

Emergency Care ofOpen Wounds

Bandage & prevent contamination.

Keep patient calm, quiet.

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Treat for shock; transport;

reevaluate.

Specific Injuries

Amputations

Neck Wounds

Impaled Objects

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Chest Wounds

Abdominal Wounds

Amputations

Monitor airway; administer oxygen.

Control bleeding.

Do not complete partial

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Do not complete partial

amputations.

Treat for shock.

Continued…

Amputations

Wrap the amputated part in sterile

dressing.

Wrap part in plastic. Keep cool.

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Transport with patient if possible.

Open Neck Wound

May cause air embolism.

Cover with occlusive dressing.

Do not compress both carotids at

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Do not compress both carotids at

same time.

Cover wound with gloved hand.Cover wound with gloved hand.

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Place occlusive dressing over wound.Place occlusive dressing over wound.

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Place dressing over occlusive dressing.Place dressing over occlusive dressing.

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Bandage. Do not compress both carotids Bandage. Do not compress both carotids or restrict breathing.or restrict breathing.

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Impaled Object

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Impaled Object

Do not remove object unless:

Through the cheek

Interferes with chest compression

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Interferes with chest compression

Interferes with transport (relative)

Emergency Care of an Impaled Object

Manually stabilize object.

Expose area.

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Control bleeding.

Stabilize with bulky dressing.

Bandage.

Impaled Object Impaled Object –– CheekCheek

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Impaled Object in the EyeImpaled Object in the Eye

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Signs of Chest Wounds

Wound or trauma to the chest.

Sucking sound.

Patient may be short of breath or

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Patient may be short of breath or

gasping for air.

Chest wounds may cause damage to lungs.Chest wounds may cause damage to lungs.

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Lung Lung

Chest Wall

Emergency Care of Chest Wounds

Manage airway.

Expose area.

If open wound, apply occlusive

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If open wound, apply occlusive

dressing.

Administer oxygen.

Place in position of comfort (if no

spine injury suspected).

Occlusive DressingOcclusive Dressing

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Flutter Valve Flutter Valve –– InspirationInspiration

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Flutter Valve Flutter Valve –– ExhalationExhalation

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Manual StabilizationManual Stabilization

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Use bulky dressings and bandage toUse bulky dressings and bandage tostabilize.stabilize.

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Closed Abdominal Wounds

Monitor airway; administer oxygen.

Be alert for vomiting.

Flexing patient’s knees may reduce

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Flexing patient’s knees may reduce

pain.

Treat for shock.

Transport.

Monitor airway; administer oxygen.

Do not touch or try to replace

exposed organs.

Abdominal Evisceration(Open Abdominal Wounds)

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exposed organs.

Cover exposed organs & wound

with dressing moistened with sterile

saline.Continued…

Treat for shock; maintain warmth.

Transport.

Abdominal Evisceration(Open Abdominal Wounds)

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Transport.

Abdominal EviscerationAbdominal Evisceration

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Expose the wound.Expose the wound.

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Cover with sterile dressing.Cover with sterile dressing.

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BurnsBurns

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BurnsBurns

Source

Depth

Conditions That May Affect Burn Severity

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Extent and regions burned

Age of patient

Preexisting medical conditions

Sources of Burns

Thermal

Chemical

Electrical

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Electrical

Light

Radiation

Layers of the SkinLayers of the Skin

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Reddened skin

Pain at burn site

Superficial Burn(1st Degree Burn)

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Involves only epidermis

Partial-Thickness Burn(2nd Degree Burn)

Intense pain

White to red skin

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Blisters

Involves epidermis and dermis

Full-Thickness Burn(3rd Degree Burn)

Dry, leathery skin (white, dark

brown, or charred)

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Loss of sensation (little pain)

All dermal layers may be involved

Classifying Classifying BurnsBurnsby Depthby Depth

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Classifying Burns by DepthClassifying Burns by Depth

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Full-Thickness

Partial-Thickness

Superficial

Body Surface Area

A burn equivalent to the size of the patient’s hand is equal to 1% body

surface area (BSA).

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Rule of Nines Rule of Nines ––AdultAdult

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Rule of NinesRule of Nines––Child and InfantChild and Infant

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Burns with respiratory injury

Full-thickness burns > 10% BSA

Determining Burn Severity:Critical BurnsCritical Burns

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Partial-thickness burns > 30% BSA

Burns with painful, swollen, or

deformed extremity

Moderate burns in young or elderly

Burns to face, hands, or feet

Determining Burn Severity:Critical BurnsCritical Burns

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Burns to genitalia

Burns encircling any body part (arm,

chest, etc.)

Determining Burn Severity:Moderate BurnsModerate Burns

Full-thickness burns 2-10% BSA

Superficial burns > 50% BSA

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Superficial burns > 50% BSA

Determining Burn Severity:Minor BurnsMinor Burns

Full-thickness burns < 2% BSA

Partial-thickness burns < 15% BSA

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Greater surface area relative to

total size

Greater fluid and heat loss

Burns in Infants and Children

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Higher risk for shock

May be a result of abuse

Infants and Children

Burn Severity

Critical Any full-thickness burns

Partial thickness >20% BSA or involving hands, feet, face,

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involving hands, feet, face, genitalia

Moderate Partial-thickness, 10-20% BSA

Minor Partial-thickness, <10% BSA

Emergency Care of Burns

Body substance isolation,

protective gear.

Stop the burning process with

water or saline.

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water or saline.

Remove smoldering clothing and

jewelry.

Prevent further contamination.

Continued…

Emergency Care of Burns

Monitor the airway for closure.

Cover burn area with dry, sterile

dressing.

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Do not use ointments/lotions.

Do not break blisters.

Transport following local protocols.

Chemical Burns

Protect yourself from exposure.

Wear appropriate protective gear.

Activate Hazmat team if necessary.

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Activate Hazmat team if necessary.

Emergency Care ofChemical Burns

Brush dry powders off the skin

before flushing.

Flush with large amounts of water.

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Flush with large amounts of water.

Do not contaminate uninjured

areas while flushing.

Continue flushing during transport.

Electrical Burns

Do not touch a patient who is in

contact with an electrical source.

Contact trained personnel for rescue.

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Emergency Care ofElectrical Burns

Administer oxygen.

Watch for cardiac or respiratory

arrest.

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arrest.

Internal injuries often more severe

than external ones.

Treat soft-tissue injuries.

Electrical burns may have entry and exit Electrical burns may have entry and exit wounds.wounds.

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Dressings andDressings andBandagesBandages

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BandagesBandages

Purpose

Stop the bleeding

Protect wound from further damage

Prevent contamination and

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infection

Dressings

Sterile, directly cover wound

Gauze pads

Universal (trauma dressing)

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Occlusive

Bandages

Hold dressings in place

Roller gauze

Triangular bandage

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Triangular bandage

Tape, air splints

Dressings and BandagesDressings and Bandages

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Dressing/Bandage: ForeheadDressing/Bandage: Forehead

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Dressing/Bandage: ElbowDressing/Bandage: Elbow

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Dressing/Bandage: HandDressing/Bandage: Hand

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Dressing/Bandage: ShoulderDressing/Bandage: Shoulder

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Bandaging & DressingTechnique

Use BSI precautions.

Expose area.

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Cover wound; control bleeding.

Bandage securely.

Reevaluate.

1. Distinguish between open and

closed wounds

2. Describe the emergency care for:

Review Questions

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2. Describe the emergency care for:

Open chest wound

Impaled object

Amputation

3. List and differentiate between the

3 depths of burns.

4. Describe the emergency care for

Review Questions

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4. Describe the emergency care for

chemical, electrical burns.

5. What is the difference between a

dressing and a bandage?

What is your general impression

STREET SCENESSTREET SCENES

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of the patient?

What priority would you assign to

her?

What interventions are appropriate at

STREET SCENESSTREET SCENES

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What interventions are appropriate at

this time?

Would you change the priority of

transport of this patient based on what

you now know? Why or why not?

What interventions are appropriate

STREET SCENESSTREET SCENES

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What interventions are appropriate

for this patient?

Sample Documentation

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