Emergency Medical Care and Transportation of the Sick and Injured - Soft-Tissue Injuries

CHAPTER 27 - Soft-Tissue Injuries

General Overview and National EMS Education Standard Competencies

  • Emergency Medical Services (EMS) focus on essential skills for trauma management with special emphasis on soft tissue injuries.

  • Competencies (1 of 4): Basic emergency care delivery based on assessment findings for an acutely injured patient.

  • Competencies (2 of 4): Recognition and management of types of soft tissue trauma including:

    • Wounds

    • Burns

    • Recognizing issues with electrical, chemical, and thermal incidents.

  • Competencies (3 of 4): Pathophysiology, assessment, and management of different wound types:

    • Avulsions

    • Bite wounds

    • Lacerations

    • Puncture wounds

    • Incisions

  • Competencies (4 of 4): Extended considerations for burns, including chemical, electrical, thermal, radiation, and crush syndrome.

Introduction to Soft-Tissue Injuries

  • Commonality: Soft-tissue injuries range from minor cuts or scrapes to life-threatening internal trauma.

  • Priorities: Emergency responders must remain focused on airway management, alongside visible injuries.

  • Mechanisms of Soft-Tissue Injury: Include blunt trauma, penetrating trauma, barotrauma, and burns. Severity can lead to complications like hemorrhage or infection, which can often be mitigated by preventive measures.

Anatomy and Physiology of the Skin

  • Skin Functions:

    • First line of defense against external forces and infection.

    • Thickness varies across body areas and among age groups, being thinner in children, elderly, and on specific locales like eyelids and lips vs. scalp and soles.

  • Layers of Skin:

    • Epidermis: Tough, outer layer that protects against pathogens.

    • Dermis: Vascular inner layer supplying nutrients and elasticity.

  • Skin Conditions: A break in the skin can lead to increased risks of infection and loss of regulatory functions (temperature control, fluid balance).

Types of Soft-Tissue Injuries

  • Classification: 3 main categories:

    1. Closed injuries: No break in the skin; may include contusions, hematomas, crush injuries.

    2. Open injuries: Involves breaks in the skin; examples include abrasions, lacerations, avulsions, penetrating wounds.

    3. Burns: Result from exposure to heat, chemicals, electricity, or radiation.

Pathophysiology of Closed and Open Injuries

  • Main goal: Control bleeding to initiate the healing process.

  • Steps within wound healing include cessation of bleeding, inflammation, cellular migration, and new blood vessel formation, with collagen stabilizing the tissue.

Closed Injuries Defined

  • Contusion: Bleeding beneath the skin without a break.

  • Hematoma: Accumulation of blood within damaged tissues.

  • Crushing Injury: Severe force applied, can lead to crush syndrome if tissues are trapped more than 4 hours.

    • Compartment Syndrome: Swelling from injury, can cause permanent damage.

Open Injuries Defined

  • Types include:

    1. Abrasions: Superficial wounds; may ooze blood from capillaries.

    2. Lacerations: Jagged cuts that can penetrate deeper tissues.

    3. Avulsions: Layers of tissue completely separated or hanging as a flap.

    4. Penetrating wounds: Results from sharp objects; often complex due to risks of hidden injuries.

  • Blast Injuries:

    • Primary blast injury: Damage caused by the blast wave.

    • Secondary blast injury: Damage from projectiles.

    • Tertiary blast injury: Victim thrown into objects by the explosion.

Patient Assessment Strategies

  • Closed Injury Assessment: Difficult to observe; look for signs like bruising/swelling.

  • Open Injury Assessment: Visible and requires immediate attention. Use appropriate assessment techniques to identify and treat accordingly.

Scene Size-Up and Primary Assessment

  • Scene Safety: Assess for immediate dangers and mechanisms of injury (MOI).

  • General Impression: Establish the patient’s condition quickly to prioritize transport and care actions.

    • Circulation Check: Control significant bleeding before addressing the airway; perform all assessments methodically to ensure no injuries are overlooked.

    • Airway and Breathing Ensurance: Keep pathways clear and support as necessary.

    • Transport Decision Making: Based on vital signs and responsiveness, rapid transport is essential for those with life threats.

Reassessment and History Taking

  • Reassessment: Monitors changes in condition over time, ensuring effectiveness of prior interventions.

  • History Taking: Utilize tools such as SAMPLE and OPQRST for a comprehensive assessment. Gather from available sources if the patient cannot respond.

Emergency Medical Care Guidelines

  • Closed Injuries: Employ RICES mnemonic (Rest, Ice, Compression, Elevation, Splinting) for management.

  • Open Injuries: Follow standard precautions, control bleeding with direct pressure and occlusive dressings where necessary. Consider the risk of contamination with all open wounds.

Types of Burns and Their Management

  • Thermal Burns: Result from heat; severity increases with duration of exposure and temperature.

  • Chemical Burns: Severity correlated with chemical type and exposure duration; management requires immediate decontamination.

  • Inhalation Burns: Require rapid intervention due to airway risks.

  • Electrical Burns: Damage patterns differ and potentially fatal outcomes due to cardiac effects.

  • Radiation Burns: Managed with awareness of exposure sources and decontamination protocols.

Dressing and Bandaging Procedures

  • Dressings: Main functions are to control bleeding, protect the wound, and prevent contamination.

  • Types of Dressings: Includes universal dressings for large wounds and various gauze pads for smaller applications. Occlusive dressings seal off specific injuries from contaminants.

  • Bandages: Serve primarily to hold dressings in place; use wraps like roller bandages and adhesive tapes.

Case Studies and Review Scenarios

  • Clinical Application: Engage in practical scenarios to apply the knowledge of managing soft tissue injuries effectively using learned principles and assessment techniques.

This structured outline encapsulates all main points and detailed explanations from the provided transcript regarding soft tissue injuries, their assessment, and management within emergency medical care. Each section can be used comprehensively to understand soft tissue injury treatment and assessment in emergency scenarios. Q&A from case studies help reinforce practical application of knowledge.