Chapter Seven
Soft Tissue Injuries
Wounds
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Soft tissues are the layers of skin and the fat
and muscle beneath the skin’s outer layer.
Wounds are defined as:
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injury to the soft tissue of the body.
Closed Wounds
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Closed wounds occur when:
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the body is hit and the force of the blow damages
the soft tissue layers beneath the skin causing
internal bleeding.
This type of wound could be as simple as a
contusion (bruise) or as severe as internal
bleeding
Signals of Internal Bleeding
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Tender, swollen, bruised or hard areas of the body
such as the abdomen
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Rapid, weak pulse
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Skin that feels cool or moist or look pale or bluish
Vomiting blood or coughing up blood
Excessive thirst
An injured extremity that is blue or extremely pale
Becoming confused, drowsy, or unconscious
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Call 9-1-1 if…
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A person complains of severe pain or cannot
move a body part without pain.
You think the force that caused the injury was
great enough to cause serious damage.
An injured extremity is blue or extremely pale.
The person’s abdomen is tender and distended.
The person is vomiting blood or coughing up
blood.
The person shows signs of shock.
Care for Closed Wounds
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Help the person rest in a
comfortable position
Apply direct pressure on
the area
Apply ice early on
Elevate the injured area
only if it will not cause
more pain
Open Wounds
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Open wounds occur when there is a break in
the skin.
The four main types of open wounds are –
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Abrasions
Lacerations
Avulsions
Punctures
Abrasions
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Most common type of open
wound
Caused by something rubbing
roughly against the skin
Does not bleed very much
It is usually painful because
scrapes expose sensitive
nerve endings
Lacerations
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A cut in the skin commonly
caused by a sharp object
Deep lacerations can cut
through fat and muscle,
damaging both nerves and
blood vessels
Laceration can become
easily infected
Avulsions
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An injury in which a portion of the
skin and sometimes soft tissue is
partially or completely torn away
Bleeding is often significant
Punctures
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Usually caused by a
pointed object piercing the
skin
Do not bleed very much
unless a blood vessel has
been injured
Can carry germs deep
into the body
If the object remains in the
wound, it is called an
embedded object
Infection
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Signs & Symptoms
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Swollen and red
Warm to the touch
Injury will throb with pain
Wound may discharge pus
Person may become feverish and
ill
Care
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Wash the area with soap and
water
Irrigate with large amounts of
fresh running water
Do not wash major open wounds
Determining if the Person Needs
Stitches
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The wound edges of the skin do not fall together
The laceration involves the face
The wound is over ½ inch long
Bleeding from an artery or uncontrolled bleeding
Can see muscle, bone, involve joints, hands or
feet
Wounds from large or deeply embedded objects
Wounds from human or animal bites
If left unstitched, could leave conspicuous scars
Materials used when caring for an
open wound include 
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Disposable gloves – create a barrier between
you and the victim
Dressings – pads placed directly on the
wound to absorb blood and other fluids to
prevent infection
Occlusive dressings – prevents the wound
from being exposed to the air or water
Bandages – material used to wrap or cover
any part of the body, used to hold dressings
in place
General Guidelines Applying a
Roller Bandage
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Check for feeling, warmth and color below the
injury site before and after applying the
bandage.
Elevate the injury only if it doesn’t cause further
injury.
Do not cover fingers or toes with a bandage.
Apply additional dressing if blood soaks through
the first bandange.
Applying an Elastic Bandage
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Check for circulation of the limb beyond
where you will be placing the bandage.
Place the end of the bandage against the
skin and use overlapping turns.
Gently stretch the bandage as you wrap.
Check the snugness, a finger should easily
pass under the bandage.
Care for Minor Open Wounds
1.
2.
3.
4.
5.
Put on gloves
Apply direct pressure for
a few minutes to control
any bleeding
Wash the wound
thoroughly with soap and
water
Apply an antibiotic
ointment
Cover the wound with a
sterile dressing and a
bandage
Care for a Major Open Wound
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Call 9-1-1
Put on gloves
Control bleeding by –
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Covering the wound and
pressing firmly
Apply a pressure bandage
Adding more bandages if
necessary
Monitor life signs
Care for shock
Wash hands immediately
after giving care
Using Tourniquets When Help is
Delayed
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A tourniquet is a tight band placed around an
arm or leg to constrict blood vessels in order to
stop blood flow around the wound.
Use only as a last resort.
If used, a tourniquet should not be removed in
until the victim gets to the hospital.
Hemostatic Agents
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Substances that speed up clot formation by
absorbing excess moisture caused by
bleeding.
Can be a treated sponge or gauze pad,
powder or granular form.
Burns
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Burns are a special kind of soft tissue injury
Burns can be classified in two ways –
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The source of the burn
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Heat
Chemical
Electricity
Radiation
The depth of the burn
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Superficial (first degree)
Partial Thickness (second degree)
Full Thickness (third degree)
Depth Classifications
Top layer of skin
Red, dry skin
Pain, swelling
Usually heals within a week
Top layers of skin
Red, painful, blisters that may
open and weep clear fluid
Usually heals in 3 to 4 weeks
May scar
May destroy layers of skin and
underlying structures
Charred skin, tissue underneath
white, painful or painless
Healing may require medical care
Scarring likely
Critical Burns
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Critical burns require immediate medical attention
because they are potentially life threatening, disfiguring,
and/or disabling.
You should always call 9-1-1 if the burned person –
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Has trouble breathing or suspected burned airway
Has burns covering more than one body part
Has burns to the head, neck, hands, feet or genitals
Has a burn and is younger than 5 or older than 60
Has burns resulting from chemicals, explosions, or electricity
Caring for a Thermal Burn
1.
2.
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5.
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7.
Check the scene
Remove the person from the source of the burn
Check for life threatening conditions
Cool the burn with large amounts of cool running
water
Cover the burn loosely
Prevent infection
Minimize shock
Care for a Thermal Burn
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DO NOT –
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Apply ice or ice water
Touch a burn with anything except a clean
bandage
Remove pieces of clothing that stick to the burn
Try to clean a severe burn
Break blisters
Use ointment on a severe burn
Care for a Chemical Burn
1.
2.
3.
4.
5.
Important – chemical burns will continue to burn as
long as the chemical is on the body.
If the burn was caused by dry chemicals, brush off
the chemical using gloved hands before flushing
with water.
Flush the burn with large amount of running water.
Flush for at least 20 minutes.
Eyes burns should be flushed with water until EMS
arrive
If possible have the person remove contaminated
clothes.
Care for Electrical Burns
1.
2.
3.
4.
5.
Important – Never go near the victim until
you are sure he or she is no longer in
contact with the power source.
Call 9-1-1
Turn off the power source
Be prepared to give CPR or use an AED
Care for shock and thermal burns
Radiation (Sun) Burns
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Care for sunburn the same way you would
for any other burn.
Always cool the burn and protect the area
from further damage by keeping it out of the
sun.
Preventing Burns
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Follow safety practices that prevent fire
Follow manufacturer’s guidelines when
handling chemicals
Follow safety practices around electrical lines
and go indoors when lightning could strike
Wear appropriate clothing and use
sunscreen
Crush Injuries
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Call 9-1-1
Care for specific injuries found
Assume that internal injuries are present
Care for shock
Care for an Embedded Object
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Do not remove the object.
Place several dressings around it to keep it
from moving.
Bandage around the object to keep it from
moving.
Sucking Chest Wound
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This injury occurs when a puncture wound
penetrates the chest cavity and air passes in
and out of the wound.
Care for a Sucking Chest Wound
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Cover the wound with a large occlusive dressing
(closes the wound) and tape the dressing except for
one side.
The dressing will keep air from entering the wound
when the person inhales and allow the air to escape
when the person exhales.
Care for Abdominal Injury