Soft Tissue Injuries

Jul 8, 2024

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Chapter 30: Soft Tissue Injuries

What is Soft Tissue?

  • Everything on the outside of the body except for bones and liquids
    • Includes: skin, fatty tissues, muscles, blood vessels, connective tissue, membranes, glands, nerves

Functions of the Skin

  • Protection: Keeps harmful substances out
  • Water Balance: Retains or releases fluids (sweat)
  • Temperature Control: Releases fluids for cooling (sweat)
  • Excretion: Removing fluids
  • Shock Absorption: Layers of skin and fatty tissue reduce impact severity

Layers of the Skin

  1. Epidermis: Outside layer, mostly dead skin cells
  2. Dermis: Active layer - contains nerve endings, hair follicles, blood vessels, capillaries, sweat glands
  3. Subcutaneous: Contains veins, arteries, fatty tissue; depth impacts injury severity

Classifications of Wounds

  • Open Wounds: Break in the skin
  • Closed Wounds: No break in skin, internal damage

Types of Closed Wounds

  • Bruises/Contusions: Simple injury, discoloration
  • Hematoma: More tissue damage, larger blood vessels, swelling
  • Closed Crush Injury: External force causing internal damage
    • Solid organs bleed, causing shock
    • Hollow organs leak causing sepsis

Symptoms and Treatments for Closed Wounds

  • Potential for internal bleeding
  • Monitor ABCs (Airway, Breathing, Circulation)
  • Potential for shock in severe cases
  • Use splints to prevent further tissue damage
  • Ice packs to reduce pain and swelling

Types of Open Wounds

  • Abrasion: Surface scrape
  • Laceration: Tear or cut
  • Penetrating Trauma/Punctures: Object pierces skin
  • Avulsion: Tearing away of skin
  • Amputation: Complete removal of a body part
  • Other: Open crush injuries, bite wounds, blast injuries, high-pressure injections

Treatments for Open Wounds

  • Use standard precautions (gloves, protective gear)
  • Primary assessment: ABCs and severe bleeding
  • Control bleeding immediately
  • Clean wound thoroughly, bandage securely
  • Treat for shock, reassure patient
  • Monitor vital signs regularly

Specific Open Wound Care

  • Penetrating Trauma: Assess for additional wounds, avoid removing objects
  • Impaled Objects: Do not remove; stabilize with bulky dressings
  • Avulsions & Amputations: Clean, fold skin back, control bleeding; keep amputated parts moist

Burns

Types of Burns

  1. Superficial (First-Degree): Reddening, surface-only (e.g., sunburn)
  2. Partial Thickness (Second-Degree): Blistering, intense pain, dermis damage
  3. Full Thickness (Third-Degree): Blackened, charred, or white patches, damage through dermis to fatty/muscle tissue

Burn Severity Factors

  • Source: Chemical, electrical, thermal
  • Body Region: Face, hands, feet, genitals prioritize higher
  • Depth: Partial or full thickness
  • Extent: Percentage of body surface area
  • Age of Patient: Under 5 or over 55 more critical
  • Comorbidities: Conditions like diabetes increase risk

Estimating Burn Severity: Rule of Nines

  • Divide the body into areas representing 9% each for adults
    • Head: 9%
    • Each arm: 9%
    • Each leg: 18%
    • Front torso: 18%
    • Back torso: 18%
    • Genitalia: 1%
  • Adjust for children: Head 18%, Legs 14%
  • Palmer Method: Patient’s palm is approximately 1%

Treatment Protocols

  • Thermal Burns: Stop burning process, cool area, keep airway open, treat for shock
  • Chemical Burns: Flush with copious amounts of water, brush off dry chemicals first, sterile dressing
  • Radiation Burns: Treat similar to thermal, know exposure source
  • Electrical Injuries: Ensure safety, assess for entry and exit wounds, treat for cardiac arrest, airway breathing circulation, and spinal/head injuries

Bandaging and Dressing Wounds

  • Dressings: Material directly on wound to stop bleeding/prevent contamination (e.g., gauze, non-stick)
  • Bandages: Keep dressings in place
  • Dressings should stay in place; avoid lifting
  • Specific dressings: Universal, pressure, occlusive (for open chest, neck, abdominal wounds)

Applying Bandages

  • Expose wound, direct pressure, avoid too tight/loose
  • Do not cover fingertips/toes to monitor perfusion
  • Tape edges to secure
  • Self-adhering bandages: Ensure snug fit without restricting blood flow