Soft-Tissue Injuries

Closed Injuries:

  • Contusion causes bleeding beneath skin without breaking it (bruise)

  • Hematoma is the collection of blood within the damaged tissue/body cavity

  • Crushing injury occurs when a significant amount of force is applied to the body

  • Crush Syndrome can develop when an area of the body is trapped longer than 4 hours.

  • Compartment syndrome results from the swelling that occurs whenever tissues are injured.

  • Severe closed injuries can also damage internal organs.

  • Crush VS Compartment:

    • Crush: 4 hours, myoglobin. IV N. Saline, sodium bicarbonate

    • Compartment: 6-12 hours, pain out of proportion with injury

Open Injuries:

  • Abrasions, lacerations, avulsions, penetrating wounds

  • Abrasion: A wound of the superficial layer of the skin. Caused by friction when a body part rubs or scraps across a rough or hard surface

  • Laceration: A jagged cut

    • Incision is a sharp, smooth cut

  • Avulsion: Separates various layers of soft tissue so that they become either completely detached or hang as a flap. Wrap in moist bandage and stuff

  • An amputation is an injury in which part of the body is completely severed, while a penetrating wound is an injury resulting from a piercing object.

    • “Golden Hour” of being able to reattach amputated thing

  • Blast Injuries:

    • Primary blast injury: Damage caused by the blast wave and sudden pressure changes

    • Secondary Blast Injury: Damage results from flying debris

    • Tertiary Blast Injury: Victim is thrown by explosion, perhaps into an object

RICES mnemonic:

  • Rest, Ice, Compression, Elevation, Splinting

Treatment for Open Injuries:

  • Generally do direct, even pressure and elevation, prepare pressure dressings, splits, and/or tourniquets.

  • Assume all wounds are contaminated and have a risk of infection.

  • Splint extremity even if there’s no fracture

  • Abdominal Wounds

    • Sometimes organs will protrude, especially in evisceration

    • Cover wound in moistened sterile gauze secured with an occlusive dressing tapes on all 4 sides

  • Impaled Objects

    • Remove an impaled objects ONLY when it obstructs the airway, or if object is in chest and interferes with CPR.

  • Neck Injuries

    • Open neck injuries can be life threatening, so cover wound with an occlusive dressing.

    • Apply manual pressure but do not compress both carotid arteries at the same time.

  • Small-Animal Bites

    • Small animal’s mouth is heavily contaminated with virulent bacteria. Major concern is rabies.

    • Human bite that penetrated the skin is a serious injury.

      • Apply dry, sterile dressing, promptly immobilize the area with a splint or bandage, transport to ED

Burns:

  • Burn occurs when body receives more radiant energy than it can absorb.

  • Thermal burn occurs when the skin is exposed to temperatures higher than 111F

  • Severity:

    • Superficial, First Degree:

      • Involve only top layer of skin

    • Partial-thickness, Second Degree:

      • Involve the epidermis and some portion of the dermis. Blisters are present

    • Full-thickness, Third Degree:

      • Extend through all skin layers to bone

  • Rule of 9s:

    • Quick way to estimate the amount of surface area that has been burned, dividing the body into sections, each representing approximately 9% of the total body surface area. Proportions vary on stage of development

  • Rule of Palms: Patient’s Palm is 1% of patients body area.

Thermal Burns:

  • Just caused by heat, common burn

Inhalation Burns:

  • Occur when takes place in enclosed spaces without ventilation.

  • Consider ALS, give oxygen.

Chemical Burns:

  • Toxic substance contacts the body.

  • Management: Remove chemical from patient, brush dry chemicals off skin and clothing before flushing with water, remove patient’s clothing.

    • For liquid chemicals, immediately begin to flush the burned area with lots of water. Continue flooding for 15-20 minutes after the patient says the burning pain has stopped. If patient’s eye has been burned, hold the eyelid open while flooding the eye. Decontaminate first though

Electrical Burns:

  • Appears where the electricity enters and exits the body, exit wounds are possible.

  • Management: CPR and AED if needed, give oxygen and monitor, treat soft tissue injuries with dry, sterile dressings. Prompt transport.

Taser Injuries:

  • Just check for dysrhythmias and sudden cardiac arrest.

Radiation Burns:

  • Determine if there has been a radiation exposure and then whether ongoing exposure continues to exist.

  • 3 types of ionizing radiation:

    • Alpha: Little penetrating energy easily stopped by skin

    • Beta: Greater penetrating, but blocked by simple protective clothing

    • Gamma: Very penetrating; easily passes through the body and solid materials

  • Management: Decontaminate first, have other resources remove clothing, then XABCs and irrigate open wounds. Notify ED, limit duration of exposure.