Soft Tissue Injuries and Patient Assessment

Bomb Blast Patient Assessment

• A patient is brought in after a bombing.
• The patient's injuries are severe, showing extensive wounds and visible trauma.
• Initial treatment should focus on the immediate needs of the patient, prioritizing safety and life support, like checking the ABCs (airway, breathing, and circulation)

Soft Tissue Injuries

• Skin is the largest organ in the body.
• Protection from the environment and harmful organisms, like bacteria
• Regulates body temperature
• Senses heat, cold, touch, pressure, and pain and transmits this to the brain and spinal cord
• Skin has layers: epidermis, dermis, and subcutaneous.

Skin Layers

• Epidermis: Outermost layer, made up of dead cells, not sensitive to pain or bleeding
• Dermis: Deeper skin layer, contains sweat glands, hair follicles, blood vessels, and nerve endings, more sensitive
• Subcutaneous: Layer below the dermis, more sensitive to bleeding and pain

Injuries to the Skin

• Soft tissue injuries often appear worse than they are
• Injuries can be closed or open.

Closed Injuries

• Contusion (Bruise): Skin remains intact; damage to cells and blood vessels in the dermis; swelling, pain, and discoloration are typical
• Hematoma: Collection of blood beneath the skin; more tissue damage compared to contusion. May result in loss of liters of blood
• Crush injuries: Crushing force on the body; can rupture internal organs; can cause internal bleeding and shock

Open Injuries

• Abrasion: Damages the outermost layer of skin; painful, superficial injury; slight bleeding
• Laceration: Break in the skin of varying depth; can be linear or stellate; can occur along with other soft tissue injuries; caused by forceful impact; potentially severe bleeding
• Avulsion: Flaps of skin or tissue torn loose
• Penetration/puncture: Caused by sharp or pointed objects; may not have much external bleeding but severe internal bleeding is possible; exit wounds might be present. Includes gunshot wounds and stab wounds
• Amputation: Involves the extremities or other body parts; potential for massive bleeding or limited bleeding

Open Crush Injuries

• Damage to soft tissue and internal organs
• Painful, swollen, deformed extremities
• External bleeding may be minimal or absent; internal bleeding may be severe

Emergency Medical Care for Soft Tissue Injuries

• Body substance isolation
• Ensure a clear airway with artificial ventilation
• Treat for shock (hypoperfusion)
• Manage bleeding
• Expose the wound, control bleeding
• Prevent contamination
• Apply dry sterile dressing; secure in place
• Keep the patient calm and quiet
• Splint painful, swollen, and deformed extremities.

Dressings and Bandages

• Types of dressings include universal dressings, 4x4-inch gauze pads, adhesive dressings, and occlusive dressings
• Dressings and bandages help stop bleeding, protect the wound, prevent further contamination and infection

Specific Areas

• Forehead
• Shoulder
• Hip
• Hand
• Joint

Injuries Requiring Special Considerations

• Chest Injuries: Occlusive dressing for open wounds; administer oxygen if needed
• Abdominal Injuries: Evisceration (organs protruding through the wound) must be managed carefully. Do not replace protruding organs; cover with clean, moist dressing; secure in place. Flex the patient's hips and knees if possible.
• Impaled Objects: Do not remove unless through the cheek; removal could interfere with chest compressions or transport; manually secure the object, expose the wound area, control bleeding, stabilize with a bulky dressing.
• Amputations: Wrap the amputated part in a sterile dressing; wrap loosely in plastic and keep cool; transport with the patient. Do not try to reattach partial amputations but immobilize to prevent further damage

Large Open Neck Injury

• May cause air embolism
• Cover with an occlusive dressing
• Compress carotid artery carefully to stop bleeding.

Chemical Burns

• Remove dry powders
• Immediately flush with copious water
• Continue flushing the contaminated area en route to hospital
• Avoid contamination of uninjured areas

Electrical Burns

• Scene safety: do not touch the patient if there is any chance they are still in contact with the electrical source, unless trained to do so.
• Administer oxygen, closely monitor breathing and heart rate.
• Treat the soft tissue injuries, look for entrance and exit wounds.

Infant and Child Considerations

• Relative size: larger surface area; greater risk of fluid and heat loss
• Critical burns: burns greater than 20% of BSA
• Moderate burns: burns of 10-20% of the BSA
• Minor burns: Partial-thickness burn less than 10% of the BSA

Burns Severity

• Depth of burn
• Location (face, hands, feet, genitalia, upper airway)
• Pre-existing medical conditions
• Age (younger than 5, older than 55)
• Percentage of body surface area (BSA)

Moderate Burns

• Full-thickness: 2% to 10% of the body surface area (BSA)
• Partial thickness: 15% to 30% of the BSA
• Superficial: Greater than 50% of the BSA

Minor Burns

• Full-thickness: less than 2% of the BSA
• Partial-thickness: less than 15% of the BSA

Higher Risk

• Shock (hypoperfusion), airway problem, or hypothermia
• Child abuse - must be considered a possibility