Soft Tissue Injuries

1. ChapterChapter
Soft Tissue Soft Tissue
InjuriesInjuries
Twenty-TwoTwenty-Two

2. ChapterChapter
‡ Open vs. closed wounds
‡ Treatment of various types of
open and closed wounds
‡ Care of specific injuries
(amputations, impaled objects,
neck wounds, chest injuries, burns)
‡ Principles of dressing and
bandaging
Twenty-TwoTwenty-Two
CORE CONCEPTSCORE CONCEPTS

3. Soft TissuesSoft Tissues

4. CCLOSEDLOSED
WOUNDSWOUNDS

5. Closed WoundClosed Wound
Internal injury with no open pathway Internal injury with no open pathway
from the outside to the injured sitefrom the outside to the injured site
KKEY TERMEY TERM

6. Closed WoundsClosed Wounds
‡ ContusionContusion
‡ HematomaHematoma
‡ Crush injuryCrush injury
(Continued)(Continued)

7. Closed Wound ContusionClosed Wound Contusion

8. Patient Patient ASSESSMENTASSESSMENT
Closed WoundsClosed Wounds
Signs and SymptomsSigns and Symptoms
Assess for:Assess for:
‡ Mechanism of injuryMechanism of injury
‡ Complaints of pain or tendernessComplaints of pain or tenderness
‡ Bruising or discoloration of the skinBruising or discoloration of the skin
‡ SwellingSwelling
‡ DeformityDeformity

9. Patient Patient CARECARE
Closed WoundsClosed Wounds
Emergency Care StepsEmergency Care Steps
‡ Take appropriate BSI precautions.Take appropriate BSI precautions.
‡ Manage airway; apply oxygen.Manage airway; apply oxygen.
‡ If shock is suspected, treat it.If shock is suspected, treat it.
(Continued)(Continued)

10. Patient Patient CARECARE
Closed WoundsClosed Wounds
Emergency Care StepsEmergency Care Steps
‡ Splint painful, swollen, or deformedSplint painful, swollen, or deformed
extremities.extremities.
‡ Transport.Transport.

11. OOPENPEN
WOUNDSWOUNDS

12. Open WoundOpen Wound
An injury in which the skin is An injury in which the skin is
interrupted (broken), exposing interrupted (broken), exposing
the tissue underneaththe tissue underneath
KKEY TERMEY TERM

13. AbrasionsAbrasions
LacerationLaceration
(Smooth Edges)(Smooth Edges)

14. LacerationLaceration
(Jagged Edges)(Jagged Edges)
AvulsionAvulsion

15. PuncturePuncture
Open Wound:Open Wound:
AmputationAmputation

16. Entrance and Exit WoundsEntrance and Exit Wounds

17. Crush injuries can cause Crush injuries can cause
open and closed wounds.open and closed wounds.

18. Patient Patient ASSESSMENTASSESSMENT
Open WoundsOpen Wounds
Signs and SymptomsSigns and Symptoms
Assess for:Assess for:
‡ Bleeding severityBleeding severity
‡ Amputations or avulsionsAmputations or avulsions
‡ Open wounds to chest or neck that mayOpen wounds to chest or neck that may
require an occlusive dressing require an occlusive dressing
‡ Open wounds to abdomen that may haveOpen wounds to abdomen that may have
caused an evisceration of abdominal organs caused an evisceration of abdominal organs

19. Patient Patient CARECARE
Open WoundsOpen Wounds
Emergency Care StepsEmergency Care Steps
‡ BSI precautions:BSI precautions:
• GlovesGloves
• Eye protectionEye protection
• GownGown
• Hand washingHand washing
(Continued)(Continued)

20. Patient Patient CARECARE
Open WoundsOpen Wounds
Emergency Care StepsEmergency Care Steps
‡ Expose the wound.Expose the wound.
‡ Clean the wound surface.Clean the wound surface.
‡ Control bleeding.Control bleeding.
‡ Treat for shock.Treat for shock.
(Continued)(Continued)

21. Patient Patient CARECARE
Open WoundsOpen Wounds
Emergency Care StepsEmergency Care Steps
‡ Prevent further contamination.Prevent further contamination.
‡ Bandage dressing in place, afterBandage dressing in place, after
bleeding is controlled. bleeding is controlled.
‡ Keep patient lying still.Keep patient lying still.
‡ Reassure the patient.Reassure the patient.

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

23. Patient Patient ASSESSMENTASSESSMENT
Chest WoundsChest Wounds
Signs and SymptomsSigns and Symptoms
‡ Wound or trauma to the chestWound or trauma to the chest
‡ Sucking soundSucking sound
‡ Gasping for airGasping for air
(possible open wounds)(possible open wounds)

24. Patient Patient CARECARE
Chest WoundsChest Wounds
Emergency Care StepsEmergency Care Steps
‡ Apply occlusive dressings to open Apply occlusive dressings to open
wounds.wounds.
‡ Place in position of comfortPlace in position of comfort
(if no spine injury suspected)(if no spine injury suspected)..

25. Flutter Valve InspirationFlutter Valve Inspiration

26. Flutter Valve ExhalationFlutter Valve Exhalation

27. Patient Patient CARECARE
Closed Chest WoundClosed Chest Wound
Emergency Care StepsEmergency Care Steps
‡ Monitor airway; administer oxygen.Monitor airway; administer oxygen.
‡ Suspect damage to underlying organs.Suspect damage to underlying organs.
‡ Suspect and treat for shock.Suspect and treat for shock.

28. Patient Patient CARECARE
Impaled ObjectImpaled Object
Emergency Care StepsEmergency Care Steps
‡ Do not remove object unless:Do not remove object unless:
• Through the cheek.Through the cheek.
• Interferes with chest compression.Interferes with chest compression.
• Interferes with transport.Interferes with transport.
(Continued)(Continued)

29. Patient Patient CARECARE
Impaled ObjectImpaled Object
Emergency Care StepsEmergency Care Steps
‡ Manually stabilize object.Manually stabilize object.
‡ Expose area.Expose area.
‡ Control bleeding.Control bleeding.
‡ Stabilize with bulky dressing.Stabilize with bulky dressing.
‡ Bandage.Bandage.

30. Impaled Object CheekImpaled Object Cheek

31. Manually stabilizeManually stabilize
object in place.object in place.
Use bulky dressingsUse bulky dressings
and bandage to and bandage to
stabilize.stabilize.

32. Impaled Object in the EyeImpaled Object in the Eye

33. Patient Patient CARECARE
Closed Abdominal WoundClosed Abdominal Wound
Emergency Care StepsEmergency Care Steps
‡ Monitor airway; give oxygen.Monitor airway; give oxygen.
‡ Be alert for vomiting.Be alert for vomiting.
‡ Flexing patient’s knees may reduce pain.Flexing patient’s knees may reduce pain.
‡ Treat for shock.Treat for shock.
‡ Transport.Transport.

34. Patient Patient CARECARE
Emergency Care StepsEmergency Care Steps
‡ Do not touch exposed organs.Do not touch exposed organs.
‡ Do not try to replace organs.Do not try to replace organs.
‡ Cover exposed organs/wound withCover exposed organs/wound with
dressing moistened with sterile saline.dressing moistened with sterile saline.
Abdominal EviscerationAbdominal Evisceration

35. Abdominal EviscerationAbdominal Evisceration
Expose the wound.Expose the wound.

36. Cover with sterile dressing.Cover with sterile dressing.
Follow local protocols.Follow local protocols.

37. Tell new EMT-Bs that the old textbooks
describe using aluminum foil as the
airtight dressing for eviscerations. Today,
plastic wrap is preferred as an occlusive
dressing, because the sharp edges of the
aluminum foil may cause further damage
to abdominal organs.
PPRECEPTOR RECEPTOR PPEARLEARL

38. Patient Patient CARECARE
AmputationsAmputations
Emergency Care StepsEmergency Care Steps
‡ Wrap the amputated part in Wrap the amputated part in
sterile dressing.sterile dressing.
‡ Wrap part in plastic. Keep cool.Wrap part in plastic. Keep cool.
‡ Transport part with patientTransport part with patient
if possible.if possible.
(Continued)(Continued)

39. Patient Patient CARECARE
AmputationsAmputations
Emergency Care StepsEmergency Care Steps
‡ Monitor airway; administer oxygen.Monitor airway; administer oxygen.
‡ Control bleeding.Control bleeding.
‡ Do not complete partial amputations.Do not complete partial amputations.
‡ Treat for shock.Treat for shock.

40. Patient Patient CARECARE
Open Neck WoundOpen Neck Wound
Emergency Care StepsEmergency Care Steps
‡ May cause air embolism.May cause air embolism.
‡ Cover with occlusive dressing.Cover with occlusive dressing.
‡ Do not compress both carotids at Do not compress both carotids at
same time.same time.

41. Cover wound Cover wound
with gloved hand.with gloved hand.
Place occlusivePlace occlusive
dressing over wound.dressing over wound.

42. Place dressing Place dressing
over occlusive over occlusive
dressing.dressing.
Bandage. Do not Bandage. Do not
compress bothcompress both
carotids or restrict carotids or restrict
breathing.breathing.

43. BBURNSURNS

44. Patient Patient ASSESSMENTASSESSMENT
Burn Depth: SuperficialBurn Depth: Superficial
Signs and SymptomsSigns and Symptoms
‡ Reddened skinReddened skin
‡ Pain at burn sitePain at burn site
‡ Involves only epidermisInvolves only epidermis

45. Patient Patient ASSESSMENTASSESSMENT
Burn Depth: Partial-ThicknessBurn Depth: Partial-Thickness
Signs and SymptomsSigns and Symptoms
‡ Intense painIntense pain
‡ White to red skinWhite to red skin
‡ BlistersBlisters
‡ Involves epidermis and dermisInvolves epidermis and dermis

46. Patient Patient ASSESSMENTASSESSMENT
Burn Depth: Full-ThicknessBurn Depth: Full-Thickness
Signs and SymptomsSigns and Symptoms
‡ Dry, leathery skinDry, leathery skin
‡ Loss of sensationLoss of sensation
‡ All dermal layers/tissue may beAll dermal layers/tissue may be
involved involved
(white, dark brown, or charred)(white, dark brown, or charred)
(little pain)(little pain)

47. SuperficialSuperficial Full-Full-
ThicknessThickness
Partial-Partial-
ThicknessThickness
Classifying Burns by DepthClassifying Burns by Depth

48. Skin
Reddened
Blisters Charring
Classifying Burns by DepthClassifying Burns by Depth

49. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
Body Surface AreaBody Surface Area
A burn equal to the size of the A burn equal to the size of the
patient’s hand is equal to 1% BSA. patient’s hand is equal to 1% BSA.

50. Rule of Nines AdultRule of Nines Adult

51. Rule of Nines Child and InfantRule of Nines Child and Infant

52. Tell new EMT-Bs that an alternative way to
determine the BSA estimate is the “Rule of Palm,”
which uses the patient’s palm surface area as a
unit of measurement. The patient’s palm is
considered equal to approximately 1% of the BSA.
Using this method, you can mentally estimate a
burn area on any age patient. For example, if the
burn area is equal to “7 palm surface areas,” the
burn would be estimated at 7% BSA.
PPRECEPTOR RECEPTOR PPEARLEARL

53. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
‡ Burns to these areas are Burns to these areas are
• Face, upper airwayFace, upper airway
• Hands and feetHands and feet
• GenitaliaGenitalia
considered serious:considered serious:
(Continued)(Continued)

54. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
• Preexisting medical conditionsPreexisting medical conditions
• Age of patientAge of patient
‡ Conditions That May Affect Severity:Conditions That May Affect Severity:
• Less than 5Less than 5
• Greater than 55Greater than 55
(Continued)(Continued)

55. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
‡ Full-thickness burns involving face,Full-thickness burns involving face,
hands, feet, or genitaliahands, feet, or genitalia
‡ Burns complicated by respiratoryBurns complicated by respiratory
injuryinjury
(Continued)(Continued)
‡ Full-thickness burns greater than Full-thickness burns greater than
10% BSA 10% BSA

56. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
‡ Partial-thickness burns greaterPartial-thickness burns greater
Critical BurnsCritical Burns
than 30% BSAthan 30% BSA
‡ Burns complicated by painful,Burns complicated by painful,
swollen, or deformed extremityswollen, or deformed extremity
(Continued)(Continued)

57. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
‡ Moderate burns in young orModerate burns in young or
Critical BurnsCritical Burns
elderly patientselderly patients
‡ Burns encircling any body partBurns encircling any body part
(arm, chest, etc.)(arm, chest, etc.)
(Continued)(Continued)

58. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
‡ Full-thickness burns 2–10% BSAFull-thickness burns 2–10% BSA
‡ Superficial burns greater thanSuperficial burns greater than
Moderate BurnsModerate Burns
50% BSA50% BSA
(Continued)(Continued)

59. Patient Patient ASSESSMENTASSESSMENT
Burn SeverityBurn Severity
Signs and SymptomsSigns and Symptoms
‡ Full-thickness burns less thanFull-thickness burns less than
Minor BurnsMinor Burns
2% BSA2% BSA
‡ Partial-thickness burns less thanPartial-thickness burns less than
15% BSA15% BSA
(Continued)(Continued)

60. Patient Patient ASSESSMENTASSESSMENT
Breathing AdequacyBreathing Adequacy
Signs and SymptomsSigns and Symptoms
‡ Greater surface area in relationGreater surface area in relation
Infants and ChildrenInfants and Children
to total sizeto total size
‡ Greater fluid and heat lossGreater fluid and heat loss
‡ Higher risk for shockHigher risk for shock
‡ May be a result of abuseMay be a result of abuse

61. Infants and ChildrenInfants and Children
Burn SeverityBurn Severity
Critical Any full-thickness burns
Partial-thickness >20% BSA or
involving hands, feet, face,
genitalia
Moderate
Partial-thickness, 10––20% BSA
Minor Partial-thickness, <10% BSA

62. Patient Patient CARECARE
BurnsBurns
Emergency Care StepsEmergency Care Steps
‡ Use BSI, protective gear.Use BSI, protective gear.
‡ Stop the burning process with waterStop the burning process with water
or saline.or saline.
‡ Remove smoldering clothing Remove smoldering clothing
and jewelry. and jewelry.
(Continued)(Continued)

63. Patient Patient CARECARE
BurnsBurns
Emergency Care StepsEmergency Care Steps
‡ Monitor the airway for closure.Monitor the airway for closure.
‡ Prevent further contaminationPrevent further contamination
(from chemicals)(from chemicals)..
‡ Cover burn area with dry, Cover burn area with dry,
sterile dressing.sterile dressing.
(Continued)(Continued)

64. Patient Patient CARECARE
BurnsBurns
Emergency Care StepsEmergency Care Steps
‡ Do not use ointments/lotions.Do not use ointments/lotions.
‡ Do not break blisters.Do not break blisters.
‡ Transport.Transport.
‡ Follow local transport protocols.Follow local transport protocols.

65. Chemical BurnsChemical Burns
‡ Protect yourself from exposure.Protect yourself from exposure.
‡ Wear appropriate protective gear.Wear appropriate protective gear.
‡ Activate hazmat team if necessary. Activate hazmat team if necessary.

66. Patient Patient CARECARE
Chemical BurnsChemical Burns
Emergency Care StepsEmergency Care Steps
‡ Brush dry powders off skinBrush dry powders off skin
before flushing.before flushing.
‡ Flush with large amounts of water.Flush with large amounts of water.
‡ Do not contaminate uninjured areasDo not contaminate uninjured areas
while flushing.while flushing.
‡ Continue flushing en route to hospital.Continue flushing en route to hospital.

67. Electrical BurnsElectrical Burns
‡ Do not touch a patient who is inDo not touch a patient who is in
contact with electrical source.contact with electrical source.
‡ Contact trained personnelContact trained personnel
for rescue.for rescue.

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

69. Special Areas of ConcernSpecial Areas of Concern
Burns to the eyesBurns to the eyes
‡ Do not attempt to open burned eyelids.Do not attempt to open burned eyelids.
‡ Assure burn is thermal, not chemical.Assure burn is thermal, not chemical.
‡ Apply dry, sterile dressing to both eyes toApply dry, sterile dressing to both eyes to
prevent simultaneous movement. prevent simultaneous movement.
‡ Flush chemical burns with water for at Flush chemical burns with water for at
least 20 minutes while en route to hospital. least 20 minutes while en route to hospital.
‡ Flush from medial to lateral side of eyeFlush from medial to lateral side of eye
(to avoid injury to other eye)(to avoid injury to other eye)..
(Continued)(Continued)

70. Special Areas of ConcernSpecial Areas of Concern
Burns of the hands and toesBurns of the hands and toes
‡ Remove all jewelry.Remove all jewelry.
‡ Separate all digits with dry, Separate all digits with dry,
sterile dressings to prevent sterile dressings to prevent
digits from adhering to digits from adhering to
each other. each other.

71. Patient Patient CARECARE
Electrical BurnsElectrical Burns
Emergency Care StepsEmergency Care Steps
‡ Administer oxygen.Administer oxygen.
‡ Watch for respiratory, cardiac arrest.Watch for respiratory, cardiac arrest.
‡ Internal injuries are often more severeInternal injuries are often more severe
than external ones.than external ones.
‡ Treat soft tissue injuries.Treat soft tissue injuries.
‡ Transport patient as soon as possible.Transport patient as soon as possible.

72. PurposesPurposes
‡ Stop bleeding.
‡ Protect wound from further
‡ Prevent contamination and
damage.
infection.
Dressing and BandagingDressing and Bandaging

73. ‡ Sterile, directly covering woundSterile, directly covering wound
‡ 4 4 xx 4 gauze 4 gauze
‡ Universal or combinationUniversal or combination
‡ OcclusiveOcclusive
DressingsDressings

74. ‡ Hold dressings in placeHold dressings in place
‡ Roller gauzeRoller gauze
‡ Triangular bandageTriangular bandage
‡ Tape, air splintsTape, air splints
BandagesBandages

75. Dressings and BandagesDressings and Bandages

76. Dressing/Bandage:Dressing/Bandage:
ForeheadForehead
Dressing/Bandage: Dressing/Bandage:
ElbowElbow

77. Dressing/Bandage:Dressing/Bandage:
HandHand
Dressing/Bandage:Dressing/Bandage:
ShoulderShoulder

78. 1. What is the difference between an open 1. What is the difference between an open
wound and a closed wound? wound and a closed wound?
• AmputationsAmputations
• Impaled objectsImpaled objects
• Neck woundsNeck wounds
• Chest injuriesChest injuries
• BurnsBurns
2. What is the treatment for:2. What is the treatment for:
RREVIEW QUESTIONSEVIEW QUESTIONS