Chapter 27 Notes Soft-Tissue Injuries

Skin Structure

  • Epidermis: The outermost layer of skin, which provides a tough protective barrier against environmental hazards, pathogens, and dehydration. It does not contain blood vessels and relies on the dermis for nutrients.

  • Dermis: The vascular internal layer that contains blood vessels, nerves, sweat glands, and hair follicles. It supports the epidermis and is rich in collagen and elastin, which provide strength and elasticity to the skin.

  • Collagen: A key protein in the dermis that provides structural support, stability to damaged tissue, and helps in the healing process by joining wound borders.

Types of Injuries

Closed Injury

  • Contusion: Also known as a bruise, it results from a direct blow that damages blood vessels without breaking the skin. Distinguishing between a contusion and other injuries is crucial for proper treatment.

  • Deformities: Structural changes that may indicate underlying damage, often arising from closed injuries.

Open Injury

  • Abrasions: Superficial wounds caused by scraping or rubbing away of the skin's surface. They may cause minor bleeding and are usually less severe but at risk for infection.

  • Lacerations: Irregular or jagged wounds caused by blunt trauma that tears the skin. These require careful cleaning and, often, stitching to promote healing.

  • Avulsions: A serious injury where skin or tissue is forcibly detached from the body. Immediate care is vital to save the affected tissue and prevent infection.

  • Amputation: The complete removal of a limb or part of a limb, necessitating urgent medical attention to control bleeding and preserve remaining tissue.

  • Stabbings and Shootings: Penetrating injuries that require identification and assessment of the wound to determine the extent of damage and necessary interventions.

Assessing Wounds

  • Identify and categorize all wounds present.

  • Count and assess the number of penetrating injuries.

  • Determine the type of weapon used, if applicable (gun, knife, etc.).

  • Blast Injuries: Involve different injury mechanisms:

    • Primary Blast Injury: Damage from the initial explosion pressure wave.

    • Secondary Blast Injury: Injuries caused by projectiles from the explosion.

    • Tertiary Blast Injury: When individuals are thrown against objects or the ground by the force of the explosion.

Primary Assessment

  • Identify life threats based on the patient's condition and transport priority.

  • Form a general impression of the patient’s overall status.

  • Look for indicators such as responsiveness, distress signals, and the presence of significant trauma.

  • Assess for hidden injuries, especially in the presence of severe bleeding, which is a critical life threat needing immediate control before airway management.

  • Manage the airway effectively to ensure adequate breathing and circulation.

  • Assess the patient for signs of shock, vital to preventing further deterioration.

Secondary Assessment

  • Conduct a thorough physical examination to gather more detailed information about the injuries.

  • Listen to breath sounds to check for normal and abnormal respiratory patterns.

  • Determine respiratory rate and assess for the quality of respiratory effort.

  • Assess for asymmetric chest wall movement which can indicate serious conditions like pneumothorax or hemothorax.

Emergency Medical Care

Closed Injuries

  • Be wary of extensive closed injuries due to the risk of hypovolemic shock caused by blood loss.

  • Treat any soft tissue closed injury using the RICES mnemic:

    • Rest: Allow the injured area to heal without stress.

    • Ice: Apply ice packs to reduce swelling and inflammation.

    • Compression: Use elastic bandages to decrease swelling.

    • Elevation: Keep the injured area elevated to minimize swelling.

    • Splinting: Immobilize the injury to prevent further damage.

Open Injuries

  • All open wounds should be treated as contaminated, requiring immediate care to prevent infection.

  • Control hemorrhaging by applying direct pressure and elevating the affected area when possible. If splinting is needed, it should also help control bleeding, even if a fracture is not present.

Burn Severity

  • Determine the severity of burns based on the depth:

    • Superficial (First Degree): Involves only the outer layer of skin, causing redness and pain but usually heals without scarring.

    • Partial-thickness (Second Degree): Affects both the epidermis and part of the dermis, with blistering and more substantial pain.

    • Full-thickness (Third Degree): Penetrates through the entire skin, potentially affecting underlying tissue, leading to numbness due to nerve damage.

  • Familiarize yourself with the Rules of Nines for assessing burn extent, which divides the body into sections to estimate the total body surface area affected by burns, essential for treatment and transport decisions.


Chemical Burns

  • Are caused by exposure to caustic substances, which can result in severe tissue damage. Immediate decontamination is crucial, including flushing the affected area with water for at least 15 to 20 minutes to minimize injury and prevent further damage.


Electrical Burns

  • These occur when an electrical current passes through the body, potentially causing both external and internal injuries. The severity of electrical burns can be deceptive, as the entry and exit wounds may appear minor, while extensive damage can occur beneath the skin. Monitoring for complications such as cardiac arrhythmias and muscle damage is vital.

  • The human body is a good conductor

  • There may be a large amount of deep tissue injury

  • The patient may go into cardiac or respiratory arrest from the electric shock

  • A burn injury appears where the electricity enters and exits the body.

  • Management

    • If indicated, begin CPR on the patient and apply an AED


Taser Injuries

  • Use of a taser has been associated with dysrhythmias and sudden cardiac arrest.


Radiation Burns

  • Three types of ionizing radiation:

    • Alpha particles: These are heavy, positively charged particles that can be stopped by paper or skin but can cause significant damage if ingested or inhaled.

    • Beta particles: These are lighter, negatively charged particles that can penetrate skin but are less harmful than alpha particles when outside the body.

    • Gamma rays: These are high-energy electromagnetic waves that can penetrate most materials, requiring dense substances like lead or several centimeters of concrete for protection.

  • Begin XABC’s to treat burns and trauma.

  • XABC's for burns:

    • eXamine the burn area for severity and extent of injury.

    • Assess the airway, breathing, and circulation to ensure the patient is stable.

    • Begin cooling the burn with running water for at least 10 minutes to minimize tissue damage.

    • Cover the burn with a sterile, non-adhesive dressing to protect the area from infection and further injury.


Bandages

  • Do not use elastic bandages to secure dressings

    • They can constrict blood flow and cause additional harm to the affected area.

  • Put direct pressure on any kind of open bleed ***REGISTRY***