Chapter 34
Bleeding and
Soft Tissue Trauma
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
34-1
Objectives
34-2
Anatomy of the Skin
• Body's first line of defense against
– Bacteria and other organisms
– Ultraviolet rays
– Harmful chemicals
– Cuts and tears
• Helps regulate body temperature
• Senses heat, cold, touch, pressure, and pain
34-3
Layers of the Skin
34-4
Bleeding
34-5
Wounds
• Wound
– Injury to the soft tissues
• Closed wound
– Soft tissues under the skin are damaged
– Skin surface is not broken
– Example: bruise
34-6
Wounds
• Open wound
– Skin surface is broken
34-7
Hemorrhage
• Bleeding
– Can occur from capillaries, veins, or
arteries
• The larger the blood vessel, the greater the
bleeding and blood loss
• Hemorrhage
– Excessive loss of blood from a blood
vessel
– Also called major bleeding
34-8
Blood Clotting
• If a blood vessel is cut or torn:
– Immediate contraction of blood vessel wall
– Platelets try to plug the torn vessel
– Clot begins to form at site of torn vessel
– Clotting usually complete within 6 to 10
min
34-9
Types of Bleeding
Arterial
• Arterial bleeding
– Life-threatening
– Bright red, oxygen-rich blood
– Spurts from the wound
34-10
Types of Bleeding
Venous
• Venous bleeding
– Flows as a steady stream
– Dark red or maroon
• Oxygen-poor blood
– Usually easier to control
than arterial bleeding
34-11
Types of Bleeding
Capillary
• Capillary bleeding
– Oozes slowly from the wound
– Dark red blood
– Usually not serious
– Often clots and stops by itself
34-12
Types of Bleeding
Arterial
Venous
Capillary
Color
Bright red
Dark red, maroon
Dark red
Blood
Flow
Spurts with each
heart beat
Flows steadily
Oozes slowly
Bleeding
Control
Difficult to control
Usually easier to
control than
arterial bleeding
Bleeding from deep
veins may be
hard to control
Often clots and
stops by
itself
27-13
External Bleeding
• External bleeding is bleeding
that you can see
– Blood flows through an
open wound
• Control bleeding manually
until bleeding stops
34-14
Emergency Care of External Bleeding
34-15
Scene Size-Up
• Make sure the scene is safe to enter
• Evaluate mechanism of injury / nature of
illness
• Personal protective equipment (PPE)
34-16
Remember!
• NEVER touch blood or body fluids with your
bare hands
• ALWAYS wear PPE during every patient
contact
• Wash your hands
• Throw away contaminated PPE in an
appropriate container
• Report the exposure immediately
34-17
Primary Survey
• Form a general impression
• Then, assess:
– Airway
– Breathing
– Circulation
• Look for major (severe) bleeding
• Control bleeding if present
34-18
Severity of Blood Loss
Adult
Child
Infant
Normal Blood
Severe Blood Loss
Volume
5000 to 6000 mL Loss of 1000 mL or
more
2000 mL
Loss of 500 mL or
more
800 mL
Loss of 100 to 200
mL or more
34-19
Controlling External Bleeding
•
Three methods:
1. Applying direct pressure to the wound
2. Applying a splint
3. Applying a tourniquet (if the bleeding is
severe and cannot be controlled with
direct pressure)
34-20
Direct Pressure
34-21
Pressure Bandage
34-22
Pressure (Air) Splint
34-23
Pneumatic Antishock Garment
34-24
Tourniquet
• Tourniquet
– A tight bandage that surrounds an arm or
leg
– Used to stop the flow of blood in the limb
– May be considered when direct pressure
has failed to control hemorrhage
34-25
Tourniquet
34-26
Tourniquet
34-27
Tourniquet
34-28
Tourniquet
34-29
Tourniquets
Precautions
• Always use a wide bandage
• Do not use:
– Wire
– Rope
– A belt
– Any material that may cut into skin and
underlying tissue
34-30
Tourniquets
Precautions
• Do not remove or loosen the tourniquet
unless directed to do so by a physician
34-31
Tourniquets
Precautions
• Be sure the tourniquet is in open view
– Do not cover it with a bandage, a sheet, or
the patient’s clothing
34-32
Tourniquets
Precautions
• Never apply a tourniquet directly over a joint
• Place it as close to the injury as possible
34-33
Internal Bleeding
34-34
Hollow Abdominal Organs
• Hollow abdominal
organs:
– Stomach
– Intestines
– Gallbladder
– Urinary bladder
• Hollow organ
rupture:
– Contents empty
into the
abdominal cavity
– Causes irritation
and pain
34-35
Solid Abdominal Organs
• Solid abdominal
• Examples:
organs:
– Liver
– Protected by bony
– Spleen
structures
– Kidneys
– Bleed when
injured
– Can result in a
large amount of
blood loss
34-36
Internal Bleeding
• Bleeding that occurs inside body tissues and
cavities
• Example: bruise
– Capillary bleeding
– Blood collects under the skin
34-37
Internal Bleeding
• Most common causes of internal bleeding:
– Injured or damaged internal organs
– Fractures
• Femur
• Pelvis
34-38
Internal Bleeding
• Sites where major bleeding is most likely to
occur:
– Abdominal cavity
– Chest cavity
– Digestive tract
– Tissues surrounding broken bones
34-39
Internal Bleeding
34-40
Signs and Symptoms
• Pain, tenderness, swelling, or bruising in the injured
area
• Weak, rapid pulse
• Pale, cool, moist skin
• Broken ribs or bruising on the chest
• Vomiting or coughing up bright red blood or dark,
“coffee-ground” blood
• Tender, rigid, and/or swollen abdomen
• Bleeding from mouth, rectum, vagina, or other body
opening
• Black (tarry) stools or stools with bright red blood
34-41
Emergency Care
•
•
•
•
Scene size-up, put on appropriate PPE
Primary survey
Vital signs, medical history
Manage the ABCs, give oxygen if indicated,
keep the patient warm
• Recovery position if no trauma
• Rapid transport to closest appropriate
hospital
• Reassess at least every 5 minutes
34-42
Soft-Tissue Injuries
34-43
Soft-Tissue Injuries
• Injuries that damage the layers of the skin
and the fat and muscle beneath them
• Open injury
– Skin surface broken
• Closed injury
– Skin surface intact
• Always wear PPE when dealing with softtissue injuries
34-44
Closed Soft-Tissue Injury
• Body is struck by a blunt object
• No break in the skin
• Tissues and vessels beneath skin surface
are crushed or ruptured
• Types
– Contusion
– Hematoma
– Crush injury without a break in the skin
34-45
Contusion (Bruise)
•
•
•
•
•
•
Most common type of closed wound
Outer skin layer (epidermis) intact
Small blood vessels in dermis are torn
Bleeding occurs in the area that was struck
Swelling, pain, and skin discoloration occur
Most heal and disappear within 2 to 3 weeks
34-46
Hematoma
• Localized collection of blood beneath skin
• Larger blood vessels torn
• Often occur with trauma of enough force to
break bones
• Larger amount of tissue damage than
contusion
34-47
Crush Injury
• May be open or closed
• Crushing force applied to body from blunt trauma
• Swelling and bruising often present
• Severe crush injury
– Extent of injury may be hidden
– May see only minimal bruising, but force of injury
may cause internal organ rupture
– Internal bleeding may be severe
– Can lead to shock
34-48
Closed Soft-Tissue Injuries
34-49
Compartment Syndrome
34-50
Compartment Syndrome
Possible Causes
• Compression injury
• Strenuous exercise
• Circumferential
burns
• Frostbite
• Constrictive
bandages, splints
•
•
•
•
•
Animal / insect bites
Bleeding disorders
Arterial bleeding
Soft-tissue injury
Fracture
34-51
Compartment Syndrome
34-52
“5 P’s” of Compartment Syndrome
• Pain on passive stretching of the muscle
• Paralysis (or weakness)
• Paresthesias
• Increased pressure
• Diminished peripheral pulses
34-53
Crush Syndrome
• Mine cave-ins
• Trench collapse
• Motor vehicle crash
(MVC)
• Landslide,
avalanche, rockslide
• Rubble from war,
earthquake
• Pinning under heavy
objects
• Severe beatings
34-54
Crush Syndrome
• Consider when three criteria exist:
1. Involvement of a large amount of muscle
2. Compression of the muscle mass for a
long period (usually 4–6 hours, although
it may be as little as 1 hour); and
3. Compromised local blood flow
34-55
Crush Syndrome
• Blood flow compromised
• Movement and sensation compromised
• Damaged cells leak toxic substances into the
bloodstream
• Hypovolemic shock develops
• Compartment syndrome develops
• Reperfusion injury
34-56
Closed Wounds
Management
• Scene size-up
– Assess mechanism of injury
– Put on appropriate PPE
• Primary survey
– Stabilize cervical spine if needed
– Treat for shock if signs of shock present or
internal bleeding suspected
• Physical exam, vital signs, medical history
• Splint bone or joint injuries
• Extremity injury – rest, ice, elevate
34-57
Closed Wounds
Management
• If signs of compartment syndrome are
present:
– Do not apply ice or elevate the extremity
– Splint the affected extremity for comfort
and protection only when necessary
34-58
Closed Wounds
Management
• If the patient is trapped, try to find out how
long the patient has been trapped
• Contact medical direction for instructions
34-59
Open Wounds
• Break occurs in the skin
• Open wound at risk of:
– External bleeding
– Infection
• Dressing the wound:
– Helps protect against infection
– Helps control bleeding
34-60
Open Soft-Tissue Injuries
Types
• Abrasions
• Lacerations
• Punctures
• Avulsions
• Amputations
• Open crush injury
34-61
Abrasion
• Outermost skin
layer damaged by
rubbing or scraping
• Little or no
bleeding
• Infection primary
concern
34-62
Laceration
• Cut or tear
– May occur by itself or with other
soft-tissue injuries
• Types
– Linear (regular)
– Stellate (irregular)
34-63
Laceration
34-64
Puncture Wound
• Skin pierced with a sharp, pointed object
• Increased risk of infection
• May have little or no external bleeding
• Internal bleeding may be severe
34-65
Puncture Wound
• Severity depends on:
– Location of injury
– Depth of wound
– Size of penetrating object
– Forces involved in creating the injury
34-66
Impaled Object
34-67
Entrance / Exit Wounds
• Gunshot and stab wounds are types of
puncture wounds that can go completely
through the body or body part
– Creates an entrance and exit wound
• Bullet entrance wound usually looks like a
puncture wound
• Exit wound is typically larger and more
irregular
• Carefully assess to find all wounds
34-68
Avulsion
• Piece of skin or tissue is torn loose or
pulled completely off
• Bleeding varies with extent and depth
of injury
34-69
Amputation
• Separation of a body part from the rest of
the body
34-year-old
with a
traumatic
amputation
caused by
a gear
34-70
Open Crush Injury
• Broken bone ends may stick out through
the skin
• Internal bleeding may be present
– Can be severe enough to cause shock
34-71
Open Injuries
Management
• Scene size-up
• Primary survey
– Stabilize cervical spine if needed
– Control bleeding, apply dressing
– Treat for shock if signs of shock present
• Physical exam, vital signs, medical history
• Splint bone or joint injuries
34-72
Special Considerations
34-73
Special Considerations
Soft-tissue injuries that require special
consideration:
– Penetrating chest
injuries
– Eviscerations
– Impaled objects
– Amputations
–
–
–
–
–
Neck injuries
Eye injuries
Mouth injuries
Ear injuries
Nosebleeds
34-74
Penetrating (Open) Chest Injuries
• A break in the skin over the chest wall
• Severity depends on wound size
• Sucking chest wound
– Life-threatening injury
– Can cause lung on injured side to collapse
34-75
Penetrating (Open) Chest Injuries
The front of this patient's chest showed visible bleeding but no
obvious injury. When the patient’s back was assessed, multiple
wounds were found. Remember, the back is part of the chest.
Never ever forget to check the back.
34-76
Penetrating (Open) Chest Injuries
34-77
Evisceration
•
•
•
•
Organ sticks out through an open wound
Do not touch or try to replace exposed organ
Remove clothing from around wound
Lightly cover exposed organs / wound with a
thick, moist dressing
• Secure dressing in place
• Position of comfort if no spinal injury
• Keep patient warm
34-78
Evisceration
34-79
Impaled Object
• Object remains embedded in an open wound
• Do not remove an impaled object
– Exceptions:
• Interferes with CPR
• Object in cheek interferes with patient’s airway
• Secure object to prevent movement
– Shorten only if necessary
• Control bleeding
• Stabilize object in place with bulky dressings
• Treat for shock if present
34-80
Amputation
• Control bleeding with
direct pressure
• Put amputated part in a
dry plastic bag or
waterproof container
– Seal bag or container
– Place bag/container in
water that has a few
ice cubes
• Immobilize injured area
• Treat patient for shock
34-81
Amputation
• DO NOT:
– Use dry ice to keep an amputated part
cool
– Allow the amputated part to freeze
– Place an amputated part directly on ice
or in water
34-82
Open Neck Injury
• The neck contains important blood vessels and
airway structures
– Swelling can cause an airway obstruction
– Penetrating injury can result in severe bleeding
– Risk of air being sucked into a torn blood vessel
• Air embolism
• Air can travel to heart, lungs, brain, or other
organs
• Air displaces blood and prevents tissue
perfusion
34-83
Open Neck Injury
• Possible causes of a neck injury include:
– Hanging
– Steering wheel impact
– “Clothesline” injuries in which a person
runs into a stretched wire or cord that
strikes his throat
– Knife or gunshot wounds
34-84
This patient is a 33-year-old man involved in a motor vehicle crash. He
wore no seat belt and hit the windshield of the car he was driving.
Despite the appearance of the injury, there were no injuries to the major
blood vessels, trachea, or esophagus. The patient underwent surgery
and was sent home 72 hours later.
34-85
Open Neck Injury
34-86
Eye Injuries
• Common injury
• Result of blunt and penetrating trauma
• Signs of eye injury:
– Swelling
– Bleeding
– Presence of a foreign object in the eye
– Pain
34-87
Foreign Body in the Eye
34-88
Foreign Body in the Eye
34-89
Impaled Object in the Eye
34-90
Eye
Chemical Burn
• Most urgent eye injury
• Damage depends on:
– Type and concentration of the chemical
– Length of exposure
– Elapsed time until treatment
34-91
Early Signs of a Chemical Burn
• Pain
• Redness
• Irritation
• Tearing
• Inability to keep
eye open
• A sensation of
“something in my
eye”
• Swelling of the
eyelids
• Blurred vision
34-92
Chemical Burn to the Eye
• Emergency care
– Ask patient to remove contact lenses, if
present
– Immediately flush the eye with water or
normal saline
– Continue flushing for at least 20 minutes
– Flush away from the unaffected eye
34-93
Mouth Injuries
• Can result in airway obstruction
• Signs and symptoms:
– Tenderness
– Bruising
– Swelling
34-94
Jaw Fracture
34-95
Mouth Injuries
Jaw Fracture
• Look in mouth for potential obstructions
– Teeth, blood, vomitus
• Suction as necessary
• Look for broken or missing teeth
– Preserve a knocked-out tooth
• Control bleeding
• Treat for shock if indicated
34-96
Ear Injuries
• Care for ear laceration as any other softtissue injury
• Care for avulsed ear as for amputated part
34-97
Burns
34-98
Burn Types
• Thermal (exposure to heat)
– Examples: flame, scald, flash
• Chemical
– Examples: acids, alkalis
• Electrical (including lightning)
• Radiation
34-99
Burn Severity
•
•
•
•
•
Depth
Extent
Location
Patient age
Conditions present
before the burn
• Associated factors
34-100
Burn Depth
• Superficial (first-degree)
burn
• Partial-thickness
(second-degree) burn
• Full-thickness (thirddegree) burn
34-101
Superficial (First-Degree) Burn
• Involves only epidermis
• Minor tissue damage
• Skin red, tender, very
painful
– No blistering
• Does not usually require
medical care
• Heals in ~2 to 5 days
34-102
Superficial (First-Degree) Burn
34-103
Partial-Thickness (Second-Degree) Burn
• Extends through epidermis into dermis
• Intense pain
• Some swelling
• Blistering may be present
• Skin pink, red, or mottled
• Heal in ~5 to 35 days
34-104
Partial-Thickness (Second-Degree) Burn
34-105
Full-Thickness (Third-Degree) Burn
• Destroys epidermis,
dermis
• Skin color varies
• Looks dry, waxy, or
leathery
• Numb – nerve endings
destroyed
• Rapid fluid loss
34-106
Full-Thickness (Third-Degree) Burn
34-107
Extent of Burn
Key Points
• Only partial-thickness and full-thickness burns are
included when calculating extent of a burn
• Extent of the burned area is important to determine
– The depth of the burn must also be considered, although
superficial burns are not included in the calculation of the
extent of a burn
34-108
Extent of Burn
Rule of Nines
• “Rule of Nines”
– Guide used to estimate body surface area
burned
– Divides adult body into 9%, or multiples of
9%, sections
– Modified for children and infants
34-109
Extent of Burn
Rule of Nines
Body Area
Head and neck
Front of trunk
Back of trunk
Each arm
(shoulder to fingertips)
Each leg (groin to toe)
Genitals
Adult
9%
18%
18%
9%
Child
18%
18%
18%
9%
Infant
18%
18%
18%
9%
18%
1%
13.5% 13.5%
1%
1%
34-110
Extent of Burn
Rule of Nines
34-111
Extent of Burn
Rule of Palms
• “Rule of Palms” can be used for:
– Small or irregularly shaped burns
– Burns scattered over the body
• Palm of patient’s hand equals 1% of patient’s
body surface area
34-112
Burns Best Treated in a Burn Center
• Second-degree burns involving over 10% total body
surface area (TBSA) in adults or 5% TBSA in
children
• Chemical burns
• All burns involving hands, face, eyes, ears, feet, or
genitals
• Circumferential burns of the torso or extremities
• Any third-degree burn in a child
• All inhalation injuries
• Electrical burns, including lightning injury
• All burns complicated by fractures or other trauma
• All burns in high-risk patients including older adults,
the very young, and those with preexisting
conditions such as diabetes, asthma, and epilepsy
34-113
Care for Thermal Burns
• If patient still in area of heat source,
move to safe area
• If clothing is in flames – stop, drop, and
roll
• Remove smoldering clothing and jewelry
– Cut around areas where clothing is
stuck to skin
34-114
Primary Survey
• Stabilize cervical spine if needed
• Was the patient in a confined space and
exposed to smoke, flames, or steam?
– How long was he exposed?
– Did he lose consciousness?
– Were hazardous chemicals involved?
– Be alert for potential airway problems
34-115
Inhalation Injury
•
•
•
•
Facial burns
Soot in the nose or mouth
Singed facial or nasal hair
Swelling of lips or inside
mouth
• Coughing
• Inability to swallow
secretions
• Hoarse voice
34-116
Physical Examination
• Check pulses in all extremities
– Circumferential burn can act as a
tourniquet
• After all immediate life-threats have been
managed, care for the burn itself
34-117
Physical Examination
•
•
•
•
Quickly determine burn severity
Vital signs
Medical history
Questions related to the burn:
– How long ago did the burn occur?
– How did it occur?
– What was done to treat the burn before
you arrived?
34-118
Treat the Burn
• Cool the burn with cold water
• Cover burned area with a dry dressing or sheet
• Keep patient warm
– Cover with clean, dry sheets
• Remove all jewelry
• Look for other injuries
– Treat and immobilize possible fractures
– Treat soft-tissue injuries if present
– Treat shock if present
• Keep burned extremities elevated above the heart
• Transport to closest appropriate facility
34-119
Treat the Burn
• Do not apply ice, butter, oils, sprays, lotions,
or ointments to a burn
• If a blister has formed, do not break it
– Loosely cover the blister with a sterile
dressing
• Do not place ice or wet sheets on a burn
• Do not transport a burn patient on wet
sheets, wet towels, or wet clothing
34-120
Infant / Child Considerations
• Larger BSA than adults in relation to total
body size
– Greater fluid and heat loss
• More likely to develop shock or airway
problems than adults
• Consider possibility of abuse when treating a
burned child
• Report all suspected cases of abuse to
appropriate authorities
34-121
Infant / Child Considerations
34-122
Older Adult Considerations
•
Mechanisms and severity of burn injury related to:
–
Living alone
–
Wearing loose-fitting clothing while cooking
–
Falling asleep while smoking
–
Declining vision, hearing, and sense of smell
–
Slowed reaction time
–
Problems with balance and/or memory
34-123
Chemical Burns
• Degree of injury is based on:
– Mechanism of action of the chemical
– Strength of the chemical
– Concentration and amount of the chemical
– How long the patient was in contact with the
chemical
– Body part in contact with the chemical
– Extent of tissue penetration
34-124
Care for Chemical Burns
• Scene size-up
– Gloves, eye protection, other PPE as
necessary
– Additional resources may be needed
before you can safely enter the area
34-125
Care for Chemical Burns
• General impression / primary survey
– Manage airway and breathing
– Stabilize cervical spine if needed
– Remove patient’s jewelry
– Remove clothing, including shoes and
socks
34-126
Care for Chemical Burns
• Stop the burning process
– Brush off dry chemicals
• Brush chemical away from the
patient
– Flush the burn with large
amounts of room
temperature water
• Use low pressure
• Flush for at least 20 minutes
• Treat other injuries, if present
34-127
Electrical Burns
•
Severity of an electrical injury is related to:
– Amperage (current flow)
– Voltage (current force)
– Type of current (AC/DC)
– Current pathway through the body
– Resistance of tissues to current
– Duration of contact
34-128
Electrical Burns
• Skin normally resists the flow of electric
current into the body
– Electricity entering the body is converted
to heat
– Current follows paths of least resistance
• Blood vessels, nerves, muscles
34-129
Care for Electrical Burns
• Make sure the power is off!
• Contact additional resources if needed
before entering the area
34-130
Care for Electrical Burns
•
Manage ABCs
•
Stabilize cervical
spine if needed
•
Watch closely for
respiratory and
cardiac arrest
–
Make sure an AED
is available
34-131
Care for Electrical Burns
•
•
Treat other injuries if present
Look for entrance and exit wounds
34-132
Dressing and Bandaging
34-133
Dressing and Bandaging
• Dressing
– Absorbent material placed directly over a
wound
• Bandage
– Used to secure a dressing in place
34-134
Dressing and Bandaging
• Functions of dressing and bandaging
wounds:
– Help stop bleeding
– Absorb blood and other drainage from the
wound
– Protect wound from further injury
– Reduce contamination and risk of infection
34-135
Dressings
• A dressing should be:
– Lint free
– Large enough to cover the wound
• Should extend beyond wound edges
– Sterile whenever possible
– Applied directly over the wound
• Do not slide it in place
34-136
Types of Dressings
34-137
Sterile Gauze Pads
• Loosely woven material
• Classified by size in inches
–2x2
–4x4
34-138
Trauma Dressing
• Thick dressing
• Various sizes
• Two layers of gauze
with absorbent cotton
in center
• Uses
– Large wounds
– Pad injured limb
inside a splint
34-139
Occlusive Dressing
• Made of nonporous material
• Used to cover open wound and make
airtight seal
– Chest wound
– Neck wound
34-140
Nonadherent Pads
• Gauze pads with special coating
• Used to cover leaking open wound but not
stick to it
34-141
Eye Pads
• Uses:
– Cover eyes after minor eye injury
– Cover small wound, such as a puncture
34-142
Bandages
34-143
Bandages
• Applied to keep a dressing in place
• Does not have to be sterile
• Before applying to an extremity:
– Remove patient’s jewelry
– Check pulse distal to the wound
34-144
Roller Gauze (Kling)
•
Secures dressing in place
– 1-inch roll for fingers
– 2-inch roll for wrists, hands, feet
– 3-inch roll for elbows, upper arms
– 4- to 6-inch roll for ankles, knees, legs
34-145
Roller Bandage
•
•
Soft, slightly elastic material
Available in various widths
34-146
Elastic Bandage
• Do not use to secure a dressing in place
• May act as a tourniquet if injured area swells
34-147
Triangular Bandage
• Large piece of muslin
• When folded, can be used as a
bandage or sling
34-148
Self-Adherent Wrap
• Elastic wrap coated with self-adhering
material
• Often used as a pressure bandage
34-149
Pressure Bandage
• Applied over a wound site to control
bleeding
• Cover the wound with a dressing
• Apply direct pressure until the bleeding is
controlled
• Secure the dressing in place with a bandage
• Assess the pulse distal to a bandage
34-150
Applying a Roller Bandage
34-151
Applying a Roller Bandage
34-152
Applying a Roller Bandage
34-153
Applying a Roller Bandage
34-154
Head or Ear Bandage
34-155
Upper Arm Bandage
34-156
Elbow Bandage
34-157
Wrist or Forearm Bandage
34-158
Knee Bandage
34-159
Foot or Ankle Bandage
34-160
34-161