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Ch. 7Ch. 7Soft-Tissue InjuriesSoft-Tissue Injuries

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7.1 Closed Injuries7.1 Closed Injuries

ContusionContusion HematomaHematoma Crush InjuriesCrush Injuries

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First Aid CareFirst Aid Care

1. If you suspect internal bleeding or the 1. If you suspect internal bleeding or the victim shows the signs and symptoms victim shows the signs and symptoms of shock, treat for shock.of shock, treat for shock.

2. Apply ice or cold compresses to help 2. Apply ice or cold compresses to help relieve pain and reduce swelling. relieve pain and reduce swelling.

3. Splint painful, swollen, or deformed 3. Splint painful, swollen, or deformed extremities to help control pain and extremities to help control pain and

swelling and prevent further injury. swelling and prevent further injury.

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VocabularyVocabulary

WoundWound- An injury to the skin and underlying - An injury to the skin and underlying musculature that disrupts the normal musculature that disrupts the normal continuity of the affected tissue, organ, or continuity of the affected tissue, organ, or bonebone

ContusionContusion- A bruise- A bruise

EpidermisEpidermis- The outermost layer of the skin- The outermost layer of the skin

DermisDermis- The second layer of skin, which - The second layer of skin, which contains the hair follicles, sweat glands, oil contains the hair follicles, sweat glands, oil glands, and nervesglands, and nerves

HematomaHematoma- A collection of blood beneath the - A collection of blood beneath the skin skin

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PROGRESS CHECKPROGRESS CHECK

1. A contusion is a ____________. 1. A contusion is a ____________. (closed fracture/ (closed fracture/ bruise/laceration)bruise/laceration)

2. A hematoma is ____________ under the skin.2. A hematoma is ____________ under the skin.

(blood/swelling/ecchymosis)(blood/swelling/ecchymosis)

3. Crushing injuries don’t break the skin but can cause 3. Crushing injuries don’t break the skin but can cause internal injury severe enough to cause ____________. internal injury severe enough to cause ____________. (hemorrhage/fracture/shock)(hemorrhage/fracture/shock)

4. Apply ____________ to reduce the pain and swelling 4. Apply ____________ to reduce the pain and swelling associated with closed injuries. associated with closed injuries. (cold (cold compresses/manual pressure/splints)compresses/manual pressure/splints)

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7.2 Open Injuries7.2 Open Injuries

AbrasionAbrasion LacerationLaceration AvulsionAvulsion Penetrating and Puncture WoundsPenetrating and Puncture Wounds AmputationsAmputations BitesBites

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First Aid CareFirst Aid Care

1. Expose the wound so you can see it clearly; 1. Expose the wound so you can see it clearly; if necessary, cut the victim’s clothing from if necessary, cut the victim’s clothing from around the wound.around the wound.

2. Control bleeding with direct pressure, using 2. Control bleeding with direct pressure, using your gloved hand and a dry, sterile your gloved hand and a dry, sterile compression bandage, if possible. compression bandage, if possible.

3. Prevent further contamination by keeping 3. Prevent further contamination by keeping the wound as clean as possible. the wound as clean as possible. AAvoid void touching the wound with anything that is not touching the wound with anything that is not clean. Leave the cleaning of the wound to clean. Leave the cleaning of the wound to medical personnel.medical personnel.

4. Apply a dry, sterile dressing to the 4. Apply a dry, sterile dressing to the wound and bandage it securely in place. wound and bandage it securely in place.

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Activate the EMS system if:Activate the EMS system if:

The wound has spurted blood, even if you have The wound has spurted blood, even if you have controlled the bleeding.controlled the bleeding.

The wound is deeper than the outer layer of The wound is deeper than the outer layer of skin.skin.

There is uncontrolled bleeding.There is uncontrolled bleeding. There is embedded debris, an embedded There is embedded debris, an embedded

object, or extensive contamination.object, or extensive contamination. The wound involves nerves, muscles, or The wound involves nerves, muscles, or

tendons.tendons. The wound involves the mouth, tongue, face, The wound involves the mouth, tongue, face,

genitals, or any area where a scar would be genitals, or any area where a scar would be disfiguring.disfiguring.

The wound is a human or animal bite.The wound is a human or animal bite.

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Cleaning Wounds and Preventing Cleaning Wounds and Preventing InfectionInfection

Wash the area around the wound with soap and Wash the area around the wound with soap and water.water.

Irrigate the wound with clean tap water; the water Irrigate the wound with clean tap water; the water must flow at moderate pressure and be clean must flow at moderate pressure and be clean enough to drink. enough to drink. Never scrub the wound— you can Never scrub the wound— you can damage the wounded tissues.damage the wounded tissues.

Gently pat the wound dry with sterile gauze and Gently pat the wound dry with sterile gauze and apply antibiotic ointment (such as Neosporin).apply antibiotic ointment (such as Neosporin).

Cover the wound with a sterile, nonstick dressing, Cover the wound with a sterile, nonstick dressing, and bandage in place.and bandage in place.

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PROGRESS CHECKPROGRESS CHECK

1. The greatest threat from an abrasion is ____________.1. The greatest threat from an abrasion is ____________.(infection/pain/blood loss)(infection/pain/blood loss)2. Linear lacerations heal better than stellate lacerations because 2. Linear lacerations heal better than stellate lacerations because

____________. ____________. (there is less blood loss/the edges are (there is less blood loss/the edges are smooth/infection is less likely)smooth/infection is less likely)

3. The most dangerous dog bites are those in areas with 3. The most dangerous dog bites are those in areas with few___________.few___________.

(nerve endings/blood vessels/underlying tissues)(nerve endings/blood vessels/underlying tissues)4. The greatest danger with an avulsion is compromised 4. The greatest danger with an avulsion is compromised

____________ in the flap. ____________ in the flap. (sensation/circulation/pain reception)(sensation/circulation/pain reception)5. The most serious bites are ____________ bites. 5. The most serious bites are ____________ bites.

(snake/dog/human)(snake/dog/human)6. Blood loss from an amputation may actually be slight, because 6. Blood loss from an amputation may actually be slight, because

the elastic blood vessels may ____________.the elastic blood vessels may ____________.(be crushed/retract into surrounding tissue/shut down)(be crushed/retract into surrounding tissue/shut down)

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7.3 Special Treatment 7.3 Special Treatment ConsiderationsConsiderations

Chest InjuriesChest Injuries Abdominal InjuriesAbdominal Injuries

1. Do not touch abdominal organs or try to 1. Do not touch abdominal organs or try to replace them in the abdomen.replace them in the abdomen.

2. Cover protruding abdominal organs with a 2. Cover protruding abdominal organs with a clean, moist, sterile dressing. clean, moist, sterile dressing.

3. Cover the moist dressing with an occlusive 3. Cover the moist dressing with an occlusive material, such as plastic wrap, to retain moisture material, such as plastic wrap, to retain moisture and warmth.and warmth.

4. Gently wrap the dressing in place with a 4. Gently wrap the dressing in place with a bandage bandage

or clean sheetor clean sheet

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Impaled ObjectsImpaled Objects

1.1. Remove the victim’s clothing if necessary to expose the Remove the victim’s clothing if necessary to expose the wound; cut it away without disturbing the impaled object.wound; cut it away without disturbing the impaled object.

2. Manually secure the impaled object to prevent any 2. Manually secure the impaled object to prevent any motion. motion.

3. Control bleeding with direct pressure, but do not exert 3. Control bleeding with direct pressure, but do not exert any pressure on the impaled object or on the edges of the any pressure on the impaled object or on the edges of the skin around the cutting edge of the object.skin around the cutting edge of the object.

4. Stabilize the impaled object with bulky dressings and 4. Stabilize the impaled object with bulky dressings and bandage in place. bandage in place.

5. Calm and reassure the victim as you monitor for shock.5. Calm and reassure the victim as you monitor for shock.6. Keep the victim at rest.6. Keep the victim at rest.7. Do not attempt to cut off, break off, or shorten an 7. Do not attempt to cut off, break off, or shorten an

impaled object unless transportation is not possible with impaled object unless transportation is not possible with it in place. it in place.

8. Activate the EMS system immediately.8. Activate the EMS system immediately.

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AmputationsAmputations

1. If possible, rinse the amputated part with clean 1. If possible, rinse the amputated part with clean water, but water, but do not scrub. do not scrub. Wrap the part in a dry Wrap the part in a dry sterile gauze dressing secured in place with a self-sterile gauze dressing secured in place with a self-adherent roller bandage.adherent roller bandage.

2. Place the wrapped part in a plastic bag, in 2. Place the wrapped part in a plastic bag, in accordance with local protocol.accordance with local protocol.

3. Place the wrapped and bagged part in a cooler or 3. Place the wrapped and bagged part in a cooler or any other available container so that it is on top of a any other available container so that it is on top of a cold pack or a sealed bag of ice (do not use dry ice). cold pack or a sealed bag of ice (do not use dry ice). The part should be kept as cool as possible, without The part should be kept as cool as possible, without freezing. Do not cover the part with ice or immerse it freezing. Do not cover the part with ice or immerse it in any kind of liquid.in any kind of liquid.

4. When EMTs arrive, give them the amputated part 4. When EMTs arrive, give them the amputated part so it can be transported with the victim.so it can be transported with the victim.

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Clamping InjuriesClamping Injuries

1. Remove the clamping object as quickly as 1. Remove the clamping object as quickly as possible. If you cannot remove the clamping possible. If you cannot remove the clamping object, apply a lubricant, such as green soap, object, apply a lubricant, such as green soap, and slowly but firmly wiggle the body part until and slowly but firmly wiggle the body part until it is loose.it is loose.

2. If possible, elevate the affected extremity while 2. If possible, elevate the affected extremity while you remove the clamping object.you remove the clamping object.

3. If you are unable to loosen the body part or 3. If you are unable to loosen the body part or remove the clamping object, activate the EMS remove the clamping object, activate the EMS system.system.

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PROGRESS CHECKPROGRESS CHECK

1. To treat a chest injury, cover the wound with an occlusive 1. To treat a chest injury, cover the wound with an occlusive dressing and tape it on ____________ sides. dressing and tape it on ____________ sides. (two/three/all)(two/three/all)

2. Cover protruding abdominal contents with a dressing, 2. Cover protruding abdominal contents with a dressing, then ____________ material. then ____________ material. (occlusive/porous/adherent)(occlusive/porous/adherent)

3. The goal in treating a wound with an impaled object is to 3. The goal in treating a wound with an impaled object is to prevent ____________ as much as possible. prevent ____________ as much as possible. (bleeding/pain/motion)(bleeding/pain/motion)

4. If you find an amputated part, wrap it in gauze, then4. If you find an amputated part, wrap it in gauze, thenkeep it ____________. keep it ____________. (moist and cool/dry and cool/dry and (moist and cool/dry and cool/dry and

room temperature)room temperature)5. In cases of a clamping injury, activate the EMS system 5. In cases of a clamping injury, activate the EMS system

if_______. if_______. (the wound bleeds/you cannot remove the (the wound bleeds/you cannot remove the clamping object/ there is severe pain)clamping object/ there is severe pain)