Lecture: Soft Tissue Injuries (Chapter 28)

Overview

• Soft tissue injuries are a longer topic
• Skin is the body's first line of defense
• Injuries range from bruises to burns
• Exposure of deeper structures possible
• Importance of dressing and bandages

Mechanisms of Injury

• Blunt injury: Energy exchange exceeds tissue tolerance
• Penetrating injury: Object breaks through skin
• Burns: Can result in soft tissue injuries
• Trauma: Common cause of death, often due to hemorrhage or infection

Prevention of Soft Tissue Injuries

• Use gloves with abrasive materials
• Workplace safety measures
• Teach children to avoid sharp objects

Anatomy and Physiology Review

Skin Structure and Function

• Epidermis: Tough external layer, watertight covering
• Dermis: Inner layer with hair follicles, sweat glands, oil glands, blood vessels
• Functions: Protection, sensation, temperature regulation

Skin Tension Lines

• Static Tension: Limited movement areas
• Dynamic Tension: Areas over muscles, interferes with healing

Types of Soft Tissue Injuries

Closed Injuries

• Contusion (Bruise): Bleeding beneath skin
• Hematoma: Blood pool within damaged tissue
• Crush Injury: Substantial force application
• Crush Syndrome: Tissue necrosis, harmful products release
• Compartment Syndrome: Swelling, tissue compression

Open Injuries

• Abrasions: Friction, does not penetrate dermis
• Lacerations: Smooth or jagged cuts
• Avulsions: Layers of tissue separated
• Amputations: Complete avulsion
• Bite Wounds: Consider contaminated and infected
• Penetrating Wounds: Sharp or pointed object injury
• Blast Injuries: Multiple penetrating injuries

Infection and Complications

• Infection: High risk with breaks in skin
• Gangrene: Dead tissue due to interrupted blood supply
• Tetanus: Infection with clostridium tetani, muscle contractions
• Necrotizing Fasciitis: Bacterial infection causing tissue death

Assessment and Treatment

Closed Injuries

• Mnemonic RICES: Rest, Ice, Compression, Elevation, Splint
• Signs of Shock: Supine, IV, high flow O2, rapid transport

Open Injuries

• Control bleeding, contamination risk
• Chemical burns: Flush and decontaminate
• Dressing and Bandaging: Control bleeding, protect wound, prevent contamination

Specific Injuries

• Avulsions/Amputations: Replace tissue, wrap separated part
• Bite Wounds: Dry sterile dressing, antibiotics, tetanus prophylaxis
• Penetrating Wounds: Identify all wounds, priority care
• Burns: Stop burning, assess and treat breathing, support circulation, rapid transport

Burns

Types of Burns

• Thermal Burns: Heat exposure
• Flame Burns: Deep, from clothing catching fire
• Hot Liquid Burns: Scald injuries
• Contact Burns: From hot objects
• Steam Burns: Topical scalds
• Flash Burns: Explosions, lightning strikes

Inhalation Burns

• Carbon monoxide and cyanide poisoning risks
• Chemical Burns: PPE, hazmat team, flush with water

Electrical Burns

• Ensure power is off, assess heart rate for arrhythmias

Radiation Burns

• Types: Alpha, Beta, Gamma
• Protection: Time, Distance, Shielding

Rules for Burn Assessment

• Rule of Nines: Calculates Total Body Surface Area (TBSA) burned
• Rule of Palms: Uses patient's palm size for small/irregular burns

Treatment Priorities

• Stop burning process, assess and treat breathing, support circulation, rapid transport
• Burn Fluid Resuscitation: Parkland formula, fluid administration rates

Case Studies and Examples

• Discussed burn centers, burn units, and specific cases

Reassessment and Transport

• Monitor for signs of airway involvement
• Assess transport times, administer IV fluids

Conclusion

• Simple and easy tissue injuries overview
• Importance of proper assessment and treatment