Soft Tissue Injuries
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Skin Anatomy and Physiology
• Body’s largest organ
• Three layers
– Epidermis
– Dermis
– Subcutaneous tissue
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Skin Anatomy and Physiology
• Complex system, variety of functions
– Sensation
– Control of water loss
– Protection against microbes
– Temperature control
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Soft Tissue Injuries
• Closed
• Open
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Closed Injury
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Associated with blunt trauma
Skin remains intact
Damage occurs below surface
Types
– Contusions
– Hematomas
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Contusion
• Produced when blunt force damages
dermal structures
• Blood, fluid leak into damage area
causing swelling, pain
• Presence of blood causes skin
discoloration called ecchymosis
(bruise)
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Hematoma
• “Blood lump”
• Larger blood vessel damaged
• Causes mass of blood to collect in the
injured area
• Fist-sized hematoma = 10% volume
loss
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With Closed Soft Tissue Injury
• How much blood is tied up in that injury
rather than circulating in the vessels?
• What could the force the caused the soft
tissue trauma have done to underlying
organs?
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Closed Injury Management
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Rest
Ice
Compression
Elevate
Splint
When in doubt assume underlying
fractures are present
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Open Injury
• Skin broken
• Protective function lost
• External bleeding, infection become
problems
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Open Injury Types
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Abrasions
Lacerations
Punctures
Avulsions
Amputations
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Abrasion
• Loss of portions of epidermis, upper
dermis by rubbing or scraping force.
• Usually associated with capillary
oozing, leaking of fluid
• “Road rash”
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Laceration
• Cut by sharp object
• Typically longer than it is deep
• May be associated with severe blood
loss, damage to underlying tissues
• Types
– Linear
– Stellate
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Punctures
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Result from stabbing force
Wound is deeper than it is long
Difficult to assess injury extent
Object producing puncture may
remain impaled in wound
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Avulsions
• Piece of skin torn loose as a flap or
completely torn from body
• Result from accidents with machinery
and motor vehicles
• Replace flap into normal position before
bandaging
• Treat completely avulsed tissue like
amputated part
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Amputations
• Disruption of continuity of extremity
or other body part
• Part should be wrapped in sterile
gauze, placed in plastic bag,
transported on top of cold pack
• Do NOT pack part directly in ice
• Do NOT let part freeze
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Open Wound Management
• Manage ABCs first
• Control bleeding
• Prevent further contamination, but do
not worry about trying to clean wound
• Immobilize injured part
• Mange hypoperfusion if present
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Special Considerations
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Impaled objects
Eviscerations
Open chest wounds
Neck wounds
Gunshot wounds
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Impaled Objects
• Do NOT remove
• Stabilize in place
• Exception
– Object in cheek
– Remove, dress inside and outside
mouth
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Eviscerations
• Internal organs exposed through wound
• Cover organs with large moistened
dressing, then with aluminum foil or dry
multi-trauma dressing
• Do NOT use individual 4 x 4’s
• Do NOT attempt to replace organs
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Open Chest Wound
• May prevent adequate ventilation
• Cover with occlusive dressing
• Monitor patient for signs of air becoming
trapped under pressure in chest (tension
pneumothorax)
• If tension pneumo develops lift dressing
corner to relieve pressure
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Neck Wounds
• Risk of severe bleeding from large vessels
• Risk of air entering vein and moving
through heart to lungs
• Cover with occlusive dressing
• Do NOT occlude airway or blood flow to
brain
• Suspect presence of spinal injury
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Gunshot Wound
• Special type of puncture wound
• Transmitted energy can cause injury
remote from bullet track
• Bullets change direction, tumble
• Impossible to assess severity in field
or ER
• Patient must go to OR
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