Soft Tissue Injuries

Chapter 7

Wounds

• Any injury to the soft tissue is called a wound• Two types of wounds:– Open– Close

• Closed wounds do not involve the tearing of the skin– Bruises – Usually non-life threatening– Violent force can cause deeper bruising and

damage blood vessels / organs

Internal Bleeding

• Signs and Symptoms

• Tender, Swollen, Bruised or Hard (Rigid) areas of the body such as the abdomen

• Rapid / Weak Pulse• Cool or Moist Skin• Vomiting Blood / Coughing up Blood• Excessive Thirst• Extremity below the injury is blue or pale

When to call?

• Patient complains of severe pain• Serious force caused the injury• Blue / Pale Extremity• Tender Abdomen / Rigid Area• Vomiting Blood / Coughing up Blood• Decreased LOC, Confused, Drowsy, etc.

Care for Closed Wounds

• Most cases are not serious and can be treated with ice and rest.

• When applying ice:– Be sure to have a barrier between the ice and skin– Apply for 20 minutes and then remove for at least 20

minutes before reapplying– Elevate the injured area if possible

• Take the time to be sure the injury is not more serious. Ask questions! Poke and Prod

Open Wounds

• Skin break can be minor or severe. Bleeding will vary, pain will vary.

• Four main types of Open Wounds:– Abrasions– Lacerations– Avulsions– Punctures

Abrasions

• Most Common• Usually caused by

something rubbing the skin away

• Minimal Bleeding• High Opportunity for

infection from dirt and debris

Lacerations

• Cut in the skin• Deep lacerations can cut

layers of fat, muscle, damage nerves and blood vessels

• Bleeding will vary, shallow lacerations = more bleeding, Deeper may not bleed as much unless there is vessel damage

Lacerations (con’t)

Avulsions

• Very serious• Portion of the soft tissue is

completely torn away• If body part is completely

torn away – amputation• Bleeding may be hard to

control due to the violent tearing, twisting, crushing of the extremity

Punctures

• Pointed object causes a hole in the soft tissue

• Nails, wood, glass, bullets, etc.

• Minimal bleeding unless blood vessel damage

• High risk of infection• Items that remain in the

wound is considered embedded

Punctures (con’t)

• A note about embedded objects –

LEAVE THE OBJECT IN PLACE – DO NOT

PULL IT OUT

When to call?

• Any major open wound – – Heavy bleeding– Deep wound– Violent Nature– Signs of Shock– Loss of Consciousness

What to do while waiting

• General Care includes1. Care for bleeding2. Prevent Infection3. Dress the wound4. Monitor ABC’s and Treat for Shock

Preventing Infection

• Clean the area – Warm Water and Soap• Irrigate with large amounts of water• If the wound is deep, requires medical attention, or

heavy bleeding – don’t worry about cleaning as much as stopping the bleeding

• Signs of Infection:– Tenderness around the wound site– Red / Swollen tissue– Warm to touch / Throbbing– Fever and Chills (more serious infections)– Nausea

Stitches or Not?

• If ever in doubt – Yes• If the wound involves and artery or the bleeding

can’t be stopped• Wounds that show muscle, bone, involve joints,

wide gapes, hands and feet• Human or Animal Bits (depth)• Face wounds• If the skin does not fall together or the wound is

over ½ inch long

Dressings and Bandages

• Dressings are pads placed directly on the wound

• Porous• Sterile• May have non-stick

surface• Occlusive – complete

seal to prevent air and water from the wound

• Bandages are any material used to wrap or cover any part of the body

• Hold the dressings in place

• May be used to apply pressure

• Support limbs or body parts

Dressings and Bandages (con’t)

• Any bandage applied snugly to create pressure is known as a pressure bandage

• 2x2• 4x4• Trauma Dressing• Roller Bandages• Bandage Compress

Guidelines for Bandaging

• Check for feeling in extremities, warmth, color, etc.

• Elevate the injury if possible• Secure one end of the bandage – continue to

wrap until the wound is completely covered• Tie or Tape in place• Do not cover fingers or toes – Check after

wrapping for feeling, warmth, color, etc.• Apply additional dressing if blood soaks through

Minor Wound Care

• Don’t forget your protection• Apply Direct Pressure and Elevate• Wash the wound, irrigate for about 5 minutes• Apply ointment to minor wounds when no

allergies or sensitivities• Cover the wound with a sterile dressing /

bandage

Major Wound Care

• Protection• Cover the wound with a dressing, press hard

and elevate• DO NOT REMOVE A DRESSING. If blood soaks

through add more dressings• Watch for Shock

Tourniquets

• VERY LAST RESORT• Should only be used in delayed care situations• If you have to apply one:– Apply just above the wound– If using a manufactured tourniquet follow those

directions– Wrap , then insert stick or something straight and firm

and twist until the bright red bleeding stops– Note the time it was applied for EMS– DO NOT EVER REMOVE OR LOOSEN IN THE FIELD.

Injuries to Muscles, Bones and Joints

SED 205 – First Aid & CPR

Background• Our skeleton is made up of muscles, bones, tendons

and ligaments• Muscles are soft tissues that can shorten and lengthen.

Connected to bones by tendons• Bones are hard / dense, rich blood supply and a lot of

nerves. Connected to each other at joints by ligaments• Children’s bones are harder to break – more flexible,

but if they damage the growth plate, it can have lasting effects

• Elderly folks bones are more brittle and break easily the older they get Osteoporosis

Our Muscles

Approx 640+ skeletal muscles in the human body

Muscles

Bones

• 206 Bones in the human body

• Key bones related to life-threatening injury:– Femur– Humerus– Pelvic Girdle– Ribs

Bones

Joints, Ligaments and Tendons

• Where two or more bones come together = joint

• Ligaments hold the bones in the proper place at the joint

• Specified range of motion – beyond this you get injury

• Tendons tie muscles to bones

• Specified range of motion and elasticity

• Susceptible to strains especially in the back, neck, and back of leg

Main bone and muscle injuries

• Fractures• Dislocation• Sprain• Strain

Fractures

• Open Fracture:– Open wound– Bone tears through skin

surface– Object entering skin that

breaks bone (bullet)– Serious Injury

• Closed Fracture– Does NOT break the skin

surface– Still serious – Internal

bleeding, swelling, etc.

Complete break, chip, or crack in a bone. A fall, blow, or even twisting can lead to a fracture

Dislocation

• More obvious than fracture – forms bump, ridge or hollow that does not normally exist

• When a bone moves away from another bone at the joint – tearing ligaments

• Joint no longer functions

Sprain

• Tearing of the ligaments at the joints. – Mild – just swelling,

quick recovery– Severe – Tearing of

ligament, can also involve or be a part of a fracture

– Most often occurs at ankle, wrist and knee

Strain

• Stretching or tearing of tendon

• Most often caused by lifting a heavy object

• Usually occurs in neck, back, and back of legs

What to look for…

• PAIN• Significant bruising /

swelling• Significant deformity• Normal use is not

present• Protruding bone

fragments• Feel bones grinding, or

heard snap / pop

• Injured area is cold to the touch, numb, or tingly

• Mechanism of injury– Falling in the floor versus

being hit by a bus

• Suspect possibility of serious injury for any of these signs

When to call

• When in doubt• Obvious deformity• Moderate / Severe swelling• Grinding Noise• Snap or Pop was heard• Open fracture• Cold / Numb• Head / Neck / Spine• Trouble Breathing• Unsafe to transport to

hospital without EMS

• While you wait…RICE

– Rest – No Moving– Immobilize – Stabilize the

injured area without moving it

– Cold – Apply ice to help with swelling, Control ANY bleeding

– Elevate – Only if this doesn’t cause more pain. Get the injured area higher than the heart level to help with swelling and bleeding

Splinting an Injury

• Anatomic Splint– Using the person’s body

as a splint

• Soft Splint– Folded blanket, towel,

pillow, etc.

• Rigid Splint– Padded boards,

Magazines, etc.

• The Ground– Injured leg or arm laying

on the ground for support

• After you have splinted the injury, you should apply ice and elevate if possible

Applying Anatomic Splint - SKILL

• Get Consent• Support the injured part• Check Circulation• Position Bandages• Align body parts• Tie Bandages• Recheck Circulation

Applying a soft splint

• Get Consent• Support the injured part• Check Circulation• Position Bandages• Wrap with Soft Object• Tie Bandages Securely• Recheck Circulation

Applying a rigid splint

• Get consent• Support the injured part• Check circulation• Place Splint• Secure Bandages• Recheck Circulation

Applying Sling & Binder

• Get Consent• Support injured part• Check circulation• Position Sling• Secure Sling• Bind with Bandage• Recheck Circulation

Head, Neck and Spinal Injuries

• Life threatening• Permanent life-altering

damage• 12,000 annually• Mostly men over 40• Car Crash, Falls,

Violence, Sports

• Head / Neck injuries:– Paralysis– Speech Problems– Memory Problems– Can’t see these injuries,

so always suspect them with violent accidents

Brain Injury

• Head injury can cause blood vessels to rupture in the brain, blood leaks out and causes pressure / swelling, pressure on brain = brain injury

• First sign is altered LOC

What to look for…

• Determine the mechanism of injury– Car crash– Fall– Diving– Fight

• If unconscious – always treat for head / neck injury

• If…– Motor Vehicle Crash– Fall from height greater

than standing– Wearing safety helmet

that is cracked or broken– Complains of head /

neck / back pain– Not fully alert– Tingling or Numbness– Over 65 or Under 3

What to do…

• MINIMIZE Movement• Control C-Spine with

head immobilization trick

• If wearing a helmet – LEAVE IT ON

• If breathing stops or they are bleeding this takes precedent

• Concussion– Temporary loss of brain

function– Signs can appear quickly

or be delayed– Mood changes– Cognitive disturbance– Sensitivity to light and

noise– Headache– Memory Loss– Nausea Vomiting

What to do…

• Support the head and neck• Maintain an open airway• Control bleeding• Do NOT apply direct

pressure• If clear fluid is leaking from

ears or a scalp wound, cover it with loose gauze

• Monitor

Chest Injuries

• Broken ribs are painful, but rarely life threatening

• Shallow breathing• Try to support the area

with their hand or arm• Serious injuries may

cause trouble breathing

• If trouble breathing they may– Have ashen or blue skin– Cough up blood

– These are all serious and should result in a call to 911 ASAP

When to call and What to do

• Call when in doubt• Trouble breathing• Coughing up blood• Numbness / Tingling• Spinal injury as well

• If they are standing, DON’T TRY TO LAY THEM DOWN. Keep them still and support the head / neck

• Monitor breathing and LOC

Pelvic Injuries

• Risk of damage to major arteries

• Signals include– Severe pain– Nausea– Bruising– Weakness– Tender Abdomen– Loss of sensation in legs– Altered LOC

• Don’t move the person• Try to keep them lying

flat or in the position you find them

• Watch for signs of shock indicating internal bleeding