Chapter 26
Soft Tissue Injuries
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State the major functions of the skin.
List the layers of the skin.
Establish the relationship between BSI and soft-tissue injuries.
State the types of open soft-tissue injuries.
Describe care of a patient with an open soft-tissue injury.
• Discuss care considerations for a patient with a penetrating chest
injury.
• Discuss care considerations for a patient with an open abdomen
wound.
• Differentiate the care of an open wound to the chest from an
open wound to the abdomen.
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List the classification of burns.
Define superficial burns.
List the characteristics of a superficial burn.
Define a partial-thickness burn.
List the characteristics of a partial-thickness burn.
Define a full-thickness burn.
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List the characteristics of a full-thickness burn.
Describe the emergency medical care for all types of burns.
List the functions of dressing and bandaging.
Describe the purpose of a bandage.
• Describe the steps in applying a pressure bandage.
• Establish the relationship between airway management and the
patient with chest injury, burns, and blunt and penetrating
injuries.
• Describe the effects of improperly applied dressings, splints, and
tourniquets.
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Describe the emergency care of a patient with an impaled object.
Describe the care of a patient with an amputation.
Describe the care for a chemical burn.
Describe the care for an electrical burn.
Anatomy of the Skin
Soft-Tissue Injuries
• Closed injuries
– Soft-tissue damage beneath the skin
• Open injuries
– Break in the surface of the skin
• Burns
– Soft tissue receives more energy than it can absorb
Closed Injuries
• Contusion
– Results from blunt force striking the body
• Hematoma
– Pool of blood that collects within damaged tissues or in a body cavity
• Crushing injury
– Occurs when a great amount of force is applied to the body for a long
period of time
Emergency Medical Care
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Ice slows bleeding.
Compression over an injury slows bleeding.
Elevation above the level of the heart reduces swelling.
Splinting decreases bleeding and reduces pain.
Open Wounds
• Abrasions
– Caused by friction
• Laceration
– Smooth or jagged cut
• Avulsion
– Separation of various layers of the skin
• Penetrating wound
– Results from a sharp pointed object
Emergency Medical Care
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Use proper BSI.
Apply direct pressure and elevation.
Secure dressing with pressure bandage.
Apply additional bandages if needed.
Splint the area to minimize movement.
Chest Wounds
• A penetrating wound to the chest may cause air to enter the
chest.
• This will result in air in the pleural space, known as a sucking
chest wound.
• Care includes providing oxygen and sealing the wound with an
occlusive dressing.
Abdominal Wounds
• An open wound in the abdomen may expose organs.
• An organ protruding through the abdomen is called an
evisceration.
• Do not touch protruding organs.
• Cover organs with a moist sterile dressing.
• Bandage wound with an occlusive dressing.
Penetrating Wounds
• Do not attempt to remove any embedded object.
• Control bleeding and immobilize object.
• Apply oxygen.
• Transport patient to the hospital carefully.
Amputations
• Immobilize a partial amputation with bulky dressings and a
splint.
• Wrap a complete amputation in a dry sterile dressing and place
in a plastic bag.
• Put the bag in a cool container filled with ice.
• Transport severed part with patient.
Neck Injuries
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An open neck injury can be life-threatening.
Air can get into the veins and cause an air embolism.
Cover the wound with an occlusive dressing.
Apply manual pressure.
Secure a pressure dressing loosely over the neck and firmly
around the opposite axilla.
Burns
• Burns account for over 10,000 deaths/year.
• Burns are the most serious and painful injuries.
• Proper care may increase survival and decrease long-term
disability.
• Remember to perform a complete assessment on burn patients
for other injuries.
Determining Burn Severity
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What is the depth of the burn?
What is the extent of the burn?
Are any critical areas involved?
Are there any pre-existing medical conditions or other injuries?
Is the patient younger than 5 years or older than 55 years?
Depth of Burns
1 of 3
• Superficial (first degree) burns
– Involve only top skin layer
Depth of Burns
2 of 3
• Partial-thickness (second-degree) burns
– Involve the epidermis and dermis
Depth of Burns
• Full-thickness (third degree) burn
– Extends through all layers of the skin
Extent of Burns
Emergency Care for Burns
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Follow proper BSI techniques.
Move the patient away from the burning area.
Immerse the affected area in cool sterile water.
Give oxygen if the patient has a critical burn.
Emergency Care for Burns
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1 of 2
2 of 2
Prevent body heat loss.
Estimate the burn’s severity.
Check for traumatic injuries.
Treat the patient for shock.
Provide prompt transport.
Chemical Burns
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Occurs whenever a toxic substance contacts the body
Strong acids or alkalis cause most chemical burns.
Eyes are particularly vulnerable.
Removing the chemical from the patient is a priority.
Care for Chemical Burns
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Remove the chemical from the patient.
If it is a powder chemical, brush off first.
Remove all contaminated clothing.
Flush burned area with large amounts of water for about 20
minutes.
• Transport to the hospital quickly.
Electrical Burns
• May result from high or low voltage energy
• Body is a great conductor of electricity.
• Make sure the power is off before touching patient.
• There will be two wounds (an entrance and an exit wound) to
bandage.
• Transport the patient and be prepared to administer CPR.
Gas Inhalation
• Poisonous gases can be as dangerous as smoke.
• Carbon monoxide and cyanide are common gases produced from
fires.
• If you suspect a person has inhaled either gas, move them to a
ventilated area.
• Administer high concentration oxygen.