CH 32 Soft-Tissue Trauma

What is the largest organ of the body?

The skin

What should be searched for before treating soft-tissue trauma?

Other injuries or conditions

What are the three main causes of soft-tissue injury?

Blunt injury, penetrating injury, burns

Is death from soft-tissue injury common?

No, it is uncommon

What are two serious complications that can arise from soft-tissue injuries?

Uncontrolled bleeding and local or systemic infections

What role does the skin play in homeostasis?

Protects underlying tissue, aids in temperature regulation, prevents excessive water loss, acts as a sense organ

What happens when significant damage occurs to the skin?

The patient may become vulnerable to bacterial invasion, temperature instability, and fluid balance disturbances

What is the outermost layer of the skin called?

Stratum corneum

What is the primary function of the dermis?

Provides tough, highly elastic connective tissue and contains specialized structures

What structures are found within the dermis?

Nerve endings, blood vessels, sweat glands, hair follicles, sebaceous glands

What is the function of subcutaneous tissues?

Insulates, protects, and stores energy as fat

What is deep fascia?

A thick, dense layer of fibrous tissue below subcutaneous tissue

What are skin tension lines?

Arrangements of skin over body structures that create tension affecting wound healing

What is a characteristic of closed wounds?

Soft tissue is damaged, but skin is not broken

What is a contusion?

A characteristic closed wound where soft tissue is damaged without skin breakage

What distinguishes open wounds from closed wounds?

Open wounds have a disruption in the skin

What is compartment syndrome?

A condition caused by external or internal factors that restrict circulation within a compartment

What are some causes of compartment syndrome?

Tight bandages, splints, casts, or increased material within a compartment due to injury

What types of trauma can result from explosions?

Soft-tissue trauma, abdominal trauma, skeletal trauma, blast lung

What is the first step in the wound healing process?

Hemostasis, where vessels, platelets, and clotting cascade work to stop bleeding

What occurs during the inflammation phase of wound healing?

White blood cells enter the area to combat pathogens and remove foreign material

What is epithelialization in wound healing?

The process where new epithelial cells move to the outer layer of skin to replace those lost in injury

What is collagen synthesis?

The formation of collagen, a tough, fibrous protein essential for scar tissue

What factors can alter the wound healing process?

Infection, abnormal scarring, excessive bleeding, and slow healing

What are high-risk wounds?

Wounds from human and animal bites or injuries involving foreign bodies or organic matter

What should you not do with an impaled object in the field?

Do not remove it

What is a hypertrophic scar?

A type of abnormal scar formation characterized by excessive collagen formation.

What is a keloid scar?

A type of abnormal scar that extends beyond the original wound site due to excessive collagen formation.

What causes pressure injuries?

Pressure injuries occur from being bedridden or from prolonged pressure that deprives tissues of oxygen.

What types of wounds require closure?

Open injuries affecting cosmetic areas, gaping wounds, wounds over tension lines, degloving injuries, ring injuries, and skin tears.

What is the time frame for closing open injuries?

Open injuries should be closed within 24 hours.

What are the three types of wound closure?

Primary closure, secondary intention, and delayed primary closure.

What can any break in the skin lead to?

Infection.

What factors increase the risk of infection?

Larger and deeper penetrations into the skin.

What are some visible signs of infection?

Erythema, pus, warmth, edema, local discomfort, and red streaks.

What are systemic signs of infection?

Fever, shaking, chills, joint pain, and hypotension.

What is the focus of patient assessment in skin trauma?

Identifying threats to the EMS crew and the patient.

What is the first step in scene size-up?

Address safety first.

What does the XABCDEs acronym stand for?

External bleeding, mental status (AVPU), airway, breathing, circulation.

What should be done to control severe hemorrhage?

Apply a tourniquet.

What is included in the transport decision?

Transport patients and obtain a complete set of baseline vital signs and SAMPLE history.

What should be asked during history taking?

Events leading to injury, last tetanus booster, and prescribed or over-the-counter medicines.

When should a secondary assessment be conducted?

When there is a significant mechanism of injury, adequate time, and the patient is in stable condition.

What is the purpose of frequent reassessments during transport?

To evaluate vital signs, check interventions, and monitor the patient.

What does RICES stand for in the treatment of closed wounds?

Rest, Ice, Compression, Elevation, and Splinting.

What are general principles for treating open wounds?

Control bleeding by the most effective method and keep the wound as clean as possible.

What is the purpose of bandaging and dressing wounds?

To cover the wound, control bleeding, and limit motion.

What complications can arise from improperly applied dressings?

Continued bleeding, damage to structural elements, and complications from tight dressings.

What are the characteristics of capillary bleeding?

Slow flow, bright or dark red color.

What is venous bleeding characterized by?

Slow, steady flow with a darker color.

What is arterial bleeding characterized by?

Spurts of bright red blood.

What should be done to apply direct pressure to a bleeding wound?

Use a sterile dressing and apply a gloved hand over the bleeding area.

Why should motion be limited in an injured extremity?

Motion disrupts the clotting process.

What is a tourniquet used for?

To control severe bleeding from an extremity injury below the axilla or groin when other methods are ineffective.

What are hemostatic agents?

Agents that assist with clot formation and can be used with direct pressure to control bleeding.

What should be done with dressings before applying hemostatic agents?

Remove all other dressings before applying hemostatic agents.

What basic measures should be used in wound management in a prehospital setting?

Dress and bandage wounds that look infected or are not healing properly, and consider pain control measures.

How should scalp injuries be managed?

Apply direct pressure, determine the extent of the injury, and balance bleeding control against the risk of further damage.

What is the first step in managing facial injuries?

Reassure the patient and apply direct pressure to control bleeding.

What should not be done when managing ear or mastoid injuries?

Do not place a dressing in the ear canal.

What type of dressings should be used for neck injuries?

Use occlusive dressings that do not interfere with blood flow or air movement through the trachea.

How should shoulder injuries be dressed?

Apply direct pressure and use a sling and swathe.

What is the purpose of truncal dressings?

To cover open wounds with occlusive dressing, taping only three sides, and assess breath sounds.

How should genitalia injuries be managed?

They should be managed by someone of the same gender while protecting the patient's privacy.

What position should the hand be placed in when dressing hand and wrist injuries?

In a position of function, with fingers left exposed.

What should be assessed when managing elbow and knee injuries?

Assess distal neurovascular status and immobilize the joint for larger wounds.

What is the first step in managing ankle and foot injuries?

Control bleeding with direct pressure.

What may be included in pain control measures?

Cold compress and analgesics.

What is an abrasion?

A superficial wound that occurs when part of the epidermis is lost due to being rubbed or scraped.

What are the characteristics of lacerations?

Cuts from sharp instruments or blunt force that produce jagged wounds and can injure structures beneath the skin.

What should be prioritized in the management of lacerations?

The first priority is to control bleeding.

What defines a puncture wound?

An injury resulting from a piercing object that can injure underlying tissues and organs.

What should be done if an object is embedded in a puncture wound?

Immobilize the object and transport the patient.

What is the principal danger of an avulsion?

Loss of blood supply to the avulsed skin flap.

What should be done if an avulsion wound is contaminated?

Provide irrigation to clean the wound.

What is the management protocol for impaled objects?

Do not remove the object, use direct compression around it, and stabilize with bulky dressing.

What should be monitored for in puncture wounds?

Monitor for edema and treat swelling with ice.

What is the recommended action if an impaled object interferes with airway control?

Removal of the object may be necessary.

What should be done if a wound is contaminated?

Provide irrigation.

How should a skin flap be managed after an avulsion?

Gently fold and align the skin flap back as close to its normal position as possible.

What type of dressing should be used for an avulsion?

Cover it with a dry, sterile compression dressing.

What is an avulsion?

An avulsion involving the complete or partial loss of a body part.

What should be done if a body part is completely amputated?

Try to preserve it in optimal condition.

How should an amputated part be prepared for transport?

Rinse off any debris, wrap it loosely in saline-moistened sterile gauze, seal it in a plastic bag, and place it in a cool container.

What should never be done with an amputated part?

Never warm it, place it in water, or put it directly on ice or use dry ice.

What is a major concern with dog bites?

Rabies.

What should be documented after a bite incident?

When the bite occurred, type of animal, and what led to the biting incident.

What is the first step in managing high-pressure injection injuries?

Question the patient about the nature of the injury.

What are the signs to check for in high-pressure injection injuries?

Inspect for visibly damaged tissue, palpate for signs of edema, and check for crepitus at the injury site.

What should be done with open wounds from high-pressure injection injuries?

Gently irrigate with normal saline or sterile water, dress and bandage the injuries.

What is the risk associated with facial and neck injuries?

They may involve airway or large blood vessels, leading to airway compromise or exsanguination.

What should be assessed in facial and neck injuries?

Airway patency, protection, and oxygen.

What is the XABCDE approach used for?

To manage life-threatening bleeding.

What are the four steps to assess thoracic injuries?

Inspection, palpation, auscultation, and percussion.

What is myositis?

Inflammation of the muscle caused by injury, infection, or overuse.

What causes gangrene?

Clostridium perfringens.

What are the symptoms of tetanus?

Painful muscle contractions and muscle stiffness.

What is necrotizing fasciitis?

Tissue death from bacterial infection requiring early intervention.

What is paronychia?

The most common infection of the hand in the United States, which can spread if untreated.

What is flexor tenosynovitis of the hand?

An infection usually caused by penetrating trauma, presenting with swelling, redness, and limited mobility.