CHAPTER 7

SOFT TISSUE INJURIES

• Closed Injuries
– Soft tissues beneath the skin are damaged, but the
skin is not broken.
• Types of closed injuries:
– Contusion
– The epidermis remains intact: in the dermis, however,
cells are damaged and blood vessels are torn.
– Characterized by: local pain and swelling. If small
vessels beneath the skin have been broken, the area
will turn black and blue as blood and fluid leak into the
damaged tissue.
• Hematoma
– A collection of blood beneath the skin.
– If large vessels have been torn beneath a bruised area,
a hematoma develops.
– Characterized by: lump with bluish discoloration
• Crush injuries
– Underlying layers of skin sustain severe damage; the
internal layers of skin can actually rupture.
– The force of a sudden blunt or trauma can cause a
blunt injury. Although the injury site maybe painful,
swollen or deformed . there Is usually little or no
external bleeding.
•  
• First Aid Care
– If you suspect internal bleeding or the victim shows
the s/sx of shock, treat for shock.
– Apply ice or cold compress to help relieve pain and
reduce swelling. Never apply ice directly to the skin
,and do not apply ice for more than 20 mins. At a time.
If the bruise is large, apply pressure to control internal
bleeding, cover it with gauze pad and wrap with elastic
bandage.
– Splint painful, swollen, or deformed extremities to
help control pain and swelling and prevent further
injury
•  
• Open Injuries
– The skin is broken and the victim is susceptible to
external bleeding and wound contamination.
• Types of open injuries:
– Abrasion
• superficial wound caused by rubbing, scraping or shearing
part of the skin layer
• All abrasions regardless of size, are extremely painful
because of the nerve endings involved.
• Abrasions can pose a threat if large areas of skin are
involved.
• The most serious threat from abrasions is that of
contamination and infection.
• Laceration
– Is a break in the skin of varying depth.
– Can either be linear or irregular.
– Linear lacerations (incisions) – are characterized by
sharp even cuts with smooth edges
• Intentional
– Irregular lacerations (stellate) –
• Tear caused by a sharp uneven instrument.
• Unintentional or accidental
• Avulsion
– Is the tearing loose of a flap of skin which may either
remain hanging or be torn off altogether.
– The seriousness of an avulsion depends on how
disrupted circulation is to the flap.
• Penetrating and puncture wounds
– Is caused by the penetration of a sharp object through
the skin and underlying structures. The opening in the
skin may appear very small.
• Gunshot wounds – may cause both entrance and
exit wounds.
– The entrance wound is usually much smaller than the
exit wound.
• Knife and stab wounds – are dangerous and
ofthen fatal.
– Because knife wounds are easy to see, first aiders too
frequently concentrate only on the superficial skin
wound and fail to consider the damage to underlying
organs.
• Remember! – the superficial skin wound is almost never
fatal. The fatalities all relate to the injured organs that lie
beneath the skin wound.
• Amputations
– The ripping, tearing force of industrial and automobile
accidents can be great enough to tear away limbs from
the body.
• Bites
– Nine out of ten animal bites are inflicted by dogs;
– Complications can include
• Cellulitis
• Tetanus
• Hepatitis
– Bites are a combination of a penetrating injury and a
crush injury
– The most difficult bite to manage is a human bite
because of the high infection rate associated with it.
• First aid care
– Always take measures to avoid contact with body
substances when caring for a victim of a soft – tissue
injury, because there is a high chance of contact with
the victim’s blood or body fluids.
– If possible, use protective equipment.
– After caring for the victim, wash your hands
thoroughly.
• Before you begin:
– Maintain an airway
– Provide artificial ventilation possible
• Control bleeding with direct pressure.
• Prevent further contamination by keeping the
wound as clean as possible, avoid touching the
wound with your hands if possible.
• Apply a dry, sterile dressing to the wound and
bandage it securely in place.
• In general, you should activate the EMS system if
any of the following are true:
– The wound has spurted blood, even if you have
controlled the bleeding.
– The wound is deeper than the outer layer of the skin
– There is uncontrolled bleeding
– There is embedded debris.
– The wound involves nerves, muscles or tendons.
– The wound involves the mouth, tongue, face, genitals,
or any area where a scar would be disfiguring
– The wound is a human or animal bite.
• Cleaning wounds and preventing infection
• For a shallow wound
– Wash the area around the wound with soap and water
– Irrigate the wound with tap water. Never scrub the
wound, you can damage the wounded tissues.
– Gently pat the wound dry with sterile gauze and apply
antibiotic ointment.
– Cover the wound with a sterile, nonstick dressing, and
bandage in place.
• Never apply hydrogen peroxide, isopropyl alcohol,
merthiolate, mercurochrome or iodine to a
wound because these can injure the tissues and
delay healing
• Left embedded in the skin, slivers almost always
cause infection, so it is important to remove them.
• If a sliver is deeply embedded and you cannot see
one end of it, take the victim to the nearest hospital.
• If you can see the end of the sliver, use tweezers to
remove it. Grasp the sliver firmly and pull at the
same angle at which the sliver penetrated the skin.
• If you can see the end of the sliver but cant grasp it
with tweezers, use a sterilized needle to gently bring
it to the surface; then remove it with tweezers.
• Once you have removed the sliver, clean the area
with soap and water, apply antibiotic ointment
and apply and adhesive strip to discourage
infection.
• Removing a Fishhook 
– You can safely remove a fishhook if the point but not
the barb has penetrated the skin. To remove the hook:
• Apply ice to the skin temporarily to numb it, then back the
fishhook out.
• Wash the wound with soap and water, apply antibiotic
ointment and apply and adhesive strip.
• If the barb has penetrated the skin:
– Gently tape the fishhook to the skin
• So it wont move – movement causes pain and increases injury.
– Wait for a physician to remove the hook.
• Chest injuries
• In the case of penetrating chest injuries
– Activate the EMS system
– Put an occlusive (airtight) dressing over the open wound
– Tape it on three sides.
• You can use household plastic wrap or Vaseline gauze.
– One corner should be left untapped enough too flutter
as the victim breathes.
• If the organs protrude though an open abdominal
wound, activate the EMS system; then;
• Do not touch abdominal organs or try to replace
them in the abdomen.
• Cover protruding abdominal organs with a clean
dressing.
– Never use absorbent cotton or any material that clings
when wet.
• Cover the moist dressing with an occlusive
material.
• Gently wrap the dressing in place with a bandage.
• Impaled objects
– Never remove an impaled object unless it penetrates the
cheek or interferes with chest compressions. To treat:
– Remove the victims clothing if necessary to expose the wound.
– Manually secure the impaled object to prevent any motion.
– Control bleeding with direct pressure but do not exert any
pressure on the impaled object.
– Stabilize the impaled object with bulky dressings and bandage
in place.
– Calm and reassure the victim as you monitor for shock.
– Keep the victim at rest
– Do not attempt to cut off the impaled object unless
transportation is not possible with it in place.
– If the object must be cut off, stabilize it securely before cutting.
– Activate the EMS system immediately.
• To remove an object impaled in the cheek:
– Feel inside the victims mouth to determine whether the
object has penetrated completely.
– Remove the object by pulling it back out of the wait it
entered.
– Control bleeding on the cheek and dress the wound.
– If the object penetrated completely pack the inside of the
cheek with sterile gauze to control bleeding
– Activate the EMS system.
• If you encounter too much resistance in trying to
remove the object from the cheek, maintain the
airway and activate the EMS system immediately.
Stabilize the penetrating object while waiting for
emergency personnel.
• Amputations
– If possible rinse the amputated part with clean water.
– Wrap the part in a dry sterile gauze dressing secured in
place with a self adherent roller bandage.
– Place the wrapped part in a plastic bag, in accordance
with local protocol
– place the wrapped and bagged part in a cooler or any
available container.
– When EMT’s arrive give them the amputated part so it
can be transported with the victim.
• An important consideration in amputation is to
preserve as much as possible of the original
length of the limb.
• Clamping injuries
• Remove the clamping object as quickly as
possible.
– If you cannot remove the clamping object apply a
lubricant and slowly but firmly wiggle the body part
until it is loose.
– If possible , elevate the affected extremity while you
remove the clamping object.
– If you are unable to loosen the body part or remove
the clamping object, Activate the EMS system.
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