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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Assessment
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Scene Size-up
Wear BSI.
 Do not touch equipment with
bloody gloves; wear several pairs.
 Beware of contaminating one
patient with another patient’s
blood.
 Wear eye protection.
 Consider MOI.

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Initial Assessment
Decide SICK/NOT SICK.
 There may be internal underlying
injuries.
 Injuries can affect airway and breathing.
 Provide spinal immobilization.
 Open chest wound? Evaluate for
bubbling or sucking sounds.

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Initial Assessment
Quickly place an occlusive dressing
over wound (SCW)
 Provide high-flow oxygen.
 Assess pulse and skin for shock.
 Control significant bleeding.

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Focused Exam
Focused physical exam
 Focus on isolated injury, complaint,
and affected body region.
 Rapid physical exam
 Perform if there is significant trauma
affecting multiple systems.
 Look for DCAP-BTLS.
 Be sure that spine is stabilized.

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Detailed Exam

Perform if patient is stable and time allows.
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Ongoing Assessment





Reassess all bandaging.
Reassess ABCs.
Communication and documentation
Include description of MOI and patient’s
position.
Describe location, size, depth of injury.

Provide accurate account of how you treated
injuries.
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Baseline Vitals/SAMPLE
Baseline vital signs
 Will help determine if patient is going into
shock
 SAMPLE history
 Anemia and hemophilia
 Medications that thin the blood (aspirin,
prescribed blood thinners)

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Soft Tissue Injuries
 Closed
 Open
 Burns
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Closed Injury
Associated with blunt trauma
 Skin remains intact
 Damage occurs below skin surface
 Types:
 Contusions
 Hematomas

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Contusion
Blunt force
damages dermal
structures
 Blood, fluid leak
into injury area
(pain/swelling)
 Ecchymosis

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Hematoma
Larger vessel
damage with mass
of blood collecting
at injury site
 Fist-sized = 10%
volume loss

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Closed Soft Tissue Injury
 Considerations:
 How
much blood is tied up in that
injury rather than circulating in the
vessels?
 What could the force that caused
the soft tissue trauma have done to
underlying organs?
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BLS Care
Request ALS if indicated
 O2, assist ventilations
 Maintain airway, breathing, c-spine
 RICE
 Maintain body temperature
 Monitor vital signs
 Calm and reasssure
 Transport

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Closed Injury Management
 Rest
 Ice
 Compression
 Elevation
 Splint
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Open Injury
 Skin
 Protective
 External
broken
function lost
bleeding, infection become
problems
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Open Injury Types
 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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Abrasion
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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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Lacerations
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Punctures
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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Puncture Wounds
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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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Avulsions
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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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Amputations
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Open Wound Management
Manage ABCs first
 Position of comfort
 Control bleeding
 Prevent further contamination, but do
not worry about trying to clean wound
 Immobilize injured part
 Mange hypoperfusion if present (O2)

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Special Considerations
Impaled objects
 Eviscerations
 Open chest wounds
 Neck wounds
 Gunshot wounds
 Crush Injuries
 Injection Injuries
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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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Imapled Objects
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Eviscerations
Internal organs exposed through wound
 Cover organs with large unmoistened
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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Eviscerations
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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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Open Chest Wounds
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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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Neck Wounds
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Gunshot Wounds
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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Gunshot Wounds
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Crush Injuries
MOI will determine
sverity of injury
 Do not be fooled by
signd of minimal
injury
 Beware of crush
syndrome
(rhabdomyolysis)

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Injection Injuries
Serious tissue injury
caused by high
pressure injections
 External injury may
look minor but
internal injury may be
very severe
 Treat like a puncture
injury
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Eye Injuries

Lacerations
Lacerations to the eyes
require very careful repair.
 Never exert pressure on
or manipulate the eye.
 If part of the eyeball is
exposed, apply a moist,
sterile dressing.
 Cover the injured eye
with a protective metal
eye shield.

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Eye Injuries

Blunt trauma

Blunt trauma can cause a
number of serious injuries.
̶
̶

A fracture of the orbit
(blowout fracture)
Retinal detachment
May range from a black
eye to a severely
damaged globe
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Eye Injuries

Hyphema

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Bleeding in the anterior
chamber of the eye
May seriously impair
vision
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Eye Injuries

Blowout fracture

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May occur from blunt
trauma caused by a
fracture of the orbit
Bone fragments may
entrap muscles that
control eye movement,
causing double vision.
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Eye Injuries

Retina detachment

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
Often seen in sports
injuries
Produces flashing lights,
specks, or floaters in field
of vision
Needs prompt medical
attention
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BLS Indicators
Conscious and alert
 Stable vital signs
 Soft tissue injuries limited to the
superficial layer of skin
 Single digit amputations
 Controlled bleeding by direct pressure
and/or elevation

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BLS Care
Request ALS if indicated
 O2, assist with ventilations
 Maintain airway, breathing, c-spine
 Control bleeding
 Maintain body temperature
 Monitor vital signs
 Calm and reassure
 Transport

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ALS Indicators
Significant head injury
 Signs/symptoms of shock
 Airway compromise
 Excessive, uncontrolled bleeding
 Altered LOC
 High index of suspicion based on MOI

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