Chapter 27: Soft Tissue Injuries

Introduction

• Emergency Medical Technicians (EMTs) frequently treat soft tissue injuries.
• Soft tissue injuries range from minor cuts and scrapes to serious internal injuries.
• EMTs must prioritize life-threatening conditions like airway obstructions over visible dramatic wounds.
• Soft tissue injuries include blunt injuries, penetrating injuries, barotrauma, and burns.

Anatomy and Physiology of the Skin

• Skin: Largest organ, first defense against infection.
• Layers:
  • Epidermis: Tough, external, watertight.
  • Dermis: Inner layer with hair follicles, sweat glands, sebaceous glands.
• Functions:
  • Protects against pathogens.
  • Regulates body temperature.
  • Contains nerve endings for environmental and sensation reporting.

Types of Soft Tissue Injuries

• Closed Injuries: Damage beneath skin; includes contusions, hematomas, and crush injuries.
• Open Injuries: Includes abrasions, lacerations, avulsions, and penetrating wounds.
• Burns: Thermal, chemical, electrical, or radiation.

Pathophysiology of Wound Healing

• Wound healing stages: Hemostasis, inflammation, cell proliferation, and tissue remodeling.
• Inflammation: White blood cells combat pathogens, mast cells release histamine.
• Cell Proliferation: New cells replace damaged ones, formation of collagen.

Closed Injuries

Contusions: Blood leaks into tissues, causing discoloration.

• Hematomas: Collection of blood in tissue, often due to blunt trauma.
• Crushing Injuries: Result from prolonged force/pressure on tissue.

Open Injuries

• Abrasions: Surface-level skin injuries.
• Lacerations: Jagged or smooth cuts.
• Avulsions: Tissue separated from the body.
• Penetrating Wounds: Caused by sharp objects, risk of deep tissue damage.

Complications

• Soft tissue injuries can lead to shock or infections if not managed appropriately.
• Infections: Result from breaches in skin barrier.
• Hemorrhage: Can lead to shock and death.

Emergency Medical Care

For Closed Injuries

• Follow RICE: Rest, Ice, Compression, Elevation.
• Monitor for signs of shock.

For Open Injuries

• Control bleeding with direct pressure, elevation, and tourniquets if necessary.
• Apply sterile dressings to minimize infection.

For Burns

• Initial Care:
  • Stop burning, cool the burn, cover with sterile dressing.
  • Monitor for airway complications, especially with facial burns.

Special Considerations

• Impaled Objects: Do not remove in the field unless obstructing airway.
• Neck Injuries: Risk of air embolism; cover with occlusive dressing.
• Bites: Animal bites can transmit infections; all bites should be evaluated medically.
• Chemical Burns: Wear protective equipment, wash off chemicals thoroughly.

Documentation and Transport

• Clearly document injury type, treatment provided, and patient's response.
• Prioritize transport to appropriate medical facilities depending on injury severity.

Conclusion

• EMTs must assess, treat, and manage soft tissue injuries promptly and effectively to reduce complications and improve patient outcomes.