Soft Tissue Injuries

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Topic: Soft Tissue Injuries

Level of Instruction: 3

Time Required: 3 Hours

Materials:

• Various size sterile dressings
• Various size bandage materials
• Multi-trauma pads
• Triangular bandages/cravats
• Occlusive dressings
• Blankets
• 3" tape
• Board splints

References:

• Brady Company Fireground Operations, Second Edition, Chapters 2, 8, and 11
• Brady Emergency Care (9th ed.)

Motivation: Soft tissue injuries are among the most common injuries encountered in the field. An understanding of the underlying anatomy and physiology, quick recognition and rapid, efficient treatment are important to the successful recovery from these injuries.

Objective (SPO): The student will be able to list, from memory and without assistance, the principles of wound management and demonstrate the appropriate treatment of soft tissue injuries and shock.

Overview: Soft Tissue Injuries

• Principles of Bandages and Dressings
• Treatment of Shock
• External Bleeding Control
• Soft Tissue Injuries of the Head and Neck
• Penetrating Chest Wounds
• Treatment of Impaled Objects
• Treatment of Eviscerations
• Treatment of Amputations
• Treatment of Avulsions

SPO 1-1
The student will be able to list, from memory and without assistance, the principles of wound management and demonstrate the appropriate treatment of soft tissue injuries and shock.

EO 1-1
Describe/demonstrate the principles of bandage and dressing use.

EO 1-2
Describe/demonstrate the treatment of shock (hypoperfusion).

EO 1-3
Describe/demonstrate the principles of external bleeding control.

EO 1-4
Describe/demonstrate the treatment of soft tissue injuries of the head and neck.

EO 1-5
Describe/demonstrate the treatment of penetrating chest wounds.

EO 1-6
Describe/demonstrate the treatment of impaled objects.

EO 1-7
Describe/demonstrate the treatment of eviscerations.

EO 1-8
Describe/demonstrate the treatment of amputations.

EO 1-9
Describe/demonstrate the treatment of avulsions.

Principles of Bandaging and Dressing (1-1)

• Dressing
• Preferably sterile
• Used to cover wounds to...
• Control bleeding
• Prevent additional contamination
• Generally individually wrapped material of various sizes
• 2" x 2", 4" x 4", 5" x 9"
• Occlusive
• used when an airtight seal is needed
• Bandages
• Any material used to hold dressings in place
• Need not be sterile
• Variety of types
• self-adherent, form fitting roller bandage
• triangular
• tape
• any material that can be used to apply pressure to a wound
• Dressing Open Wounds
• Take body substance isolation precautions
• Expose the wound
• Use sterile or very clean material
• Cover the entire wound
• Control bleeding
• Do not remove dressings once applied.
• Bandaging Open Wounds
• Do not bandage too tightly
• Do not bandage too loosely
• Do not leave loose ends
• Do not cover the tips of fingers and toes
• Cover all edges of the dressing
• Special problems when bandaging extremities
• pressure point if you bandage a small area
• cover large area
• apply small to large (distal to proximal)
• do not bend a joint after it is bandaged
• may restrict circulation

Treatment of Shock (Hypoperfusion) (1-2)

• Types of Shock
• Hypovolemic
• blood loss - hemorrhagic
• plasma loss
• Cardiogenic
• inadequate pumping of blood by the heart
• Neurogenic
• uncontrolled dilation of blood vessels
• Signs and Symptoms
• Altered mental status
• anxiety
• restlessness
• combativeness
• Pale, cool clammy skin
• Nausea and vomiting
• Pulse increases to compensate for blood loss
• late sign
• may become weak and thready
• Respirations increase to compensate
• late sign
• more rapid, labored, shallow or irregular
• Blood pressure drops
• late sign
• life threatening
• Thirst
• Dilated pupils
• Cyanosis at lips and nail beds
• Treatment
• Take body substance isolation precautions
• Maintain an open airway
• high concentration oxygen
• assist ventilations or administer CPR if indicated
• Control external bleeding
• Pneumatic anti-shock garments (PASG) as indicated
• Elevate legs 8" - 12" if no lower body or spinal injuries
• contraindicated with PASG
• Splint fractures
• Prevent loss of body heat
• Transport immediately
• Speak calmly and reassure the patient