Soft Tissue Injuries

What are the three layers of the skin?

Epidermis, dermis, and hypodermis.

What is the main role of the epidermis?

It forms the outer protective barrier, helping block foreign substances and reduce water loss.

What cells produce melanin in the epidermis?

Melanocytes.

What is the main role of the dermis?

It provides strength and flexibility and contains vessels, nerves, glands, follicles, and connective tissue.

What are the two layers of the dermis?

Papillary layer and reticular layer.

What is the hypodermis mainly composed of?

Adipose tissue and loose connective tissue.

What are key functions of the hypodermis?

Insulation, cushioning, energy storage, anchoring skin, and passage of vessels and nerves.

What connects muscle to bone?

Tendons.

What connects bone to bone?

Ligaments.

What is fascia?

A continuous connective-tissue network that surrounds and supports muscles, organs, nerves, and blood vessels.

What is a closed soft tissue injury?

An injury in which the skin remains intact but underlying tissues are damaged.

What commonly causes closed soft tissue injuries?

Blunt trauma such as falls, blows, or collisions.

What are the main closed-wound categories emphasized in this course?

Contusions, hematomas, and crush injuries.

What is a contusion?

A bruise caused by rupture of small blood vessels beneath intact skin.

What findings are common with a contusion?

Pain, swelling, tenderness, and discoloration.

What is a hematoma?

A larger localized collection of blood beneath the skin or within tissue.

What is a crush injury?

Tissue damage caused by prolonged compression or pressure.

What major complication of crush injury is emphasized?

Compartment syndrome.

What is compartment syndrome?

Dangerous pressure buildup in a confined tissue compartment that compromises blood flow and nerve function.

What findings suggest compartment syndrome?

Severe pain, swelling/tightness, numbness or tingling, weakness, pallor, and possibly loss of pulse.

Why is compartment syndrome an emergency?

Ongoing pressure can cause tissue necrosis and permanent limb damage.

What is a sprain?

Stretching or tearing of a ligament.

What is a strain?

Overstretching or tearing of muscle fibers or tendons.

What is an open wound?

A soft tissue injury in which the skin barrier is broken.

What are the major risks of open wounds?

Bleeding and infection.

What open-wound categories are emphasized?

Abrasions, lacerations, punctures, avulsions, amputations, burns, and bites.

What is an abrasion?

A superficial scrape caused by friction that removes the outer skin layers.

What is a laceration?

A tear, split, or cut in the skin.

What is an avulsion?

Full-thickness tissue loss in which skin and sometimes deeper tissue are torn away and wound edges cannot be approximated.

What is a puncture wound?

A wound caused by a pointed object that penetrates deeply through a relatively small surface opening.

Why can puncture wounds be deceptive?

The small entry wound can hide major deep injury.

Can you reliably determine puncture depth or trajectory from external inspection?

No.

What mechanisms can cause burns?

Thermal, chemical, electrical, and radiation exposure.

How are burns classified by depth?

Superficial, partial-thickness, and full-thickness.

What tissue does a superficial burn involve?

The epidermis only.

What are the classic features of a superficial burn?

Redness, pain, mild swelling, and no blisters.

What tissue does a partial-thickness burn involve?

The epidermis and part of the dermis.

What finding strongly distinguishes partial-thickness burns from superficial burns?

Blistering.

What symptoms are common in partial-thickness burns?

Redness, pain, swelling, and blisters.

What tissue does a full-thickness burn involve?

The full epidermis and dermis, sometimes extending into deeper tissues.

What does a full-thickness burn commonly look like?

White, brown, charred, dry, or leathery.

Why may a full-thickness burn be less painful at its center?

Nerve endings may be destroyed.

What makes electrical burns especially dangerous?

They may cause deep internal injury and cardiac arrhythmias despite limited surface damage.

What is TBSA?

Total body surface area burned.

What tool does this course use to estimate adult burn TBSA?

The Rule of Nines.

In the adult Rule of Nines, what percentage is the head and neck?

9%.

In the adult Rule of Nines, what percentage is each arm?

9%.

In the adult Rule of Nines, what percentage is each leg?

18%.

In the adult Rule of Nines, what percentage is the perineum?

1%.

Which burn depths are counted in TBSA calculations in this course?

Partial-thickness and full-thickness burns, not superficial burns.

Why is the Rule of Nines less precise in children?

Children have different body proportions, especially a larger head and smaller legs.

What burn-assessment tool may be more precise for children?

The Lund and Browder chart.

What is the difference between venom and poison?

Venom is actively injected by a bite or sting; poison is absorbed or ingested by another route.

What are the four venom-effect categories emphasized?

Cytotoxic, neurotoxic, myotoxic, and hemotoxic.

Why are animal bites medically concerning?

They can cause serious bacterial infection and may transmit rabies.

What is an abscess?

A localized collection of pus, usually from bacterial infection.

What is an ulcer?

An open sore caused by breakdown of skin or mucous membrane.

What is a stage 1 pressure injury?

Intact skin with non-blanchable redness.

What is a stage 2 pressure injury?

Partial-thickness skin loss appearing as a blister or open sore.

What is a stage 3 pressure injury?

Full-thickness skin loss extending into subcutaneous fat.

What is a stage 4 pressure injury?

Full-thickness tissue loss extending into muscle or bone.

What is cellulitis?

A bacterial infection of the skin and underlying tissues.

What four local signs are emphasized for cellulitis?

Redness, warmth, swelling, and pain.

What is necrosis?

Premature death of living cells or tissue.

What findings may suggest necrosis?

Blackened/discolored tissue, numbness, cold tissue, and foul odor.

What is the first step in assessing soft tissue injuries?

Ensure scene safety and use appropriate BSI.

What should the primary assessment focus on?

Airway, breathing, circulation, and immediate treatment of life-threatening hemorrhage.

What does DCAP-BTLS stand for?

Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, and Swelling.

What does CSM stand for?

Circulation, Sensation, and Motor function.

When should distal CSM be assessed?

Before and after interventions involving an injured extremity.

How is distal circulation assessed?

Check distal pulse, skin color and temperature, and capillary refill.

What special concern exists with a circumferential extremity burn?

Swelling can impair distal circulation.

What extra assessment is important for facial burns?

Airway and eye assessment.

What are the main goals of dressing and bandaging?

Control bleeding and reduce contamination.

Is definitive wound cleaning and debridement an EMT goal?

No. EMTs provide gross decontamination only; definitive cleaning/debridement is for later care.

What gross wound decontamination does this course allow?

Brush away non-embedded debris and rinse with sterile water.

Should EMTs disinfect or debride wounds?

No.

What takes priority when a patient has multiple injuries?

Life threats and critical injuries over minor soft tissue injuries.

How can closed-wound swelling be treated?

Cold packs/ice wrapped to prevent direct skin contact and positioning/elevation as appropriate.

What is the first treatment priority for an open wound?

Control bleeding.

What should be done with an impaled object?

Stabilize it in place; do not remove it.

How should puncture wounds of the chest or back be dressed in this course?

With an occlusive dressing because of pneumothorax risk.

What is the first step in burn treatment?

Stop the burning process.

How should thermal burns be cooled according to this course?

With cool—not cold—water or saline-soaked dressings, while avoiding overcooling.

What should be placed over a burn after cooling?

Dry sterile dressings.

What inhalation-injury findings should be monitored in burn patients?

Facial burns, stridor, wheezing, respiratory distress, and abnormal respiratory rate.

What should be monitored after any bite or sting?

Vital signs and signs of systemic reaction or anaphylaxis.

How does this course say to remove a bee stinger?

Scrape it out with a straight-edged object.

What does this course recommend for snakebite positioning?

Immobilize the limb and keep it at or below heart level.

Should ice be applied to a snakebite?

No, according to this course.

What may help pain from some marine envenomations?

Hot-water immersion, depending on the creature and protocol.

What are systemic infection warning signs?

Fever, tachycardia, altered mental status, and worsening overall condition.

What is the EMT priority when infection or necrosis is suspected?

Recognize severity, protect the area, monitor for sepsis, educate, and transport for definitive care.

Why are elderly patients prone to skin tears?

Aging causes thinner skin, reduced collagen, and reduced elasticity.

Why should adhesive dressings be used cautiously in older adults?

Fragile skin can tear when adhesive is removed.

Why do children lose heat quickly during burns?

They have a larger surface-area-to-mass ratio and less developed thermoregulation.

How do anticoagulants affect soft tissue injuries?

They increase bleeding and hematoma risk.

How can long-term corticosteroids affect wounds?

They can thin the skin, delay healing, suppress inflammation, and mask infection signs.

What is the key documentation rule for suspected abuse?

Document objective findings and follow reporting procedures without making unsupported allegations.

A patient has a purple swollen area after blunt trauma with intact skin. What type of injury is likely?

A contusion or hematoma.