This document summarizes treatment for various soft tissue injuries including open and closed wounds, amputations, impaled objects, neck wounds, chest injuries, and burns. It describes assessing the injuries, providing emergency care such as controlling bleeding and preventing infection, dressing wounds, and guidelines for transporting patients.

1. Chapter Soft Tissue Injuries Twenty-Two

2. Chapter Open vs. closed wounds Treatment of various types of open and closed wounds Care of specific injuries (amputations, impaled objects, neck wounds, chest injuries, burns) Principles of dressing and bandaging Twenty-Two CORE CONCEPTS

3. Soft Tissues

4. C LOSED WOUNDS

5. Closed Wound Internal injury with no open pathway from the outside to the injured site K EY TERM

6. Closed Wounds Contusion Hematoma Crush injury (Continued)

7. Closed Wound Contusion

8. Patient ASSESSMENT Closed Wounds Signs and Symptoms Assess for: Mechanism of injury Complaints of pain or tenderness Bruising or discoloration of the skin Swelling Deformity

9. Patient CARE Closed Wounds Emergency Care Steps Take appropriate BSI precautions. Manage airway; apply oxygen. If shock is suspected, treat it. (Continued)

10. Patient CARE Closed Wounds Emergency Care Steps Splint painful, swollen, or deformed extremities. Transport.

11. O PEN WOUNDS

12. Open Wound An injury in which the skin is interrupted (broken), exposing the tissue underneath K EY TERM

13. Abrasions Laceration (Smooth Edges)

14. Laceration (Jagged Edges) Avulsion

15. Puncture Open Wound: Amputation

16. Entrance and Exit Wounds

17. Crush injuries can cause open and closed wounds.

18. Patient ASSESSMENT Open Wounds Signs and Symptoms Assess for: Bleeding severity Amputations or avulsions Open wounds to chest or neck that may require an occlusive dressing Open wounds to abdomen that may have caused an evisceration of abdominal organs

19. Patient CARE Open Wounds Emergency Care Steps BSI precautions: Gloves Eye protection Gown Hand washing (Continued)

20. Patient CARE Open Wounds Emergency Care Steps Expose the wound. Clean the wound surface. Control bleeding. Treat for shock. (Continued)

21. Patient CARE Open Wounds Emergency Care Steps Prevent further contamination. Bandage dressing in place, after bleeding is controlled. Keep patient lying still. Reassure the patient.

22. Chest wounds may cause damage to lungs.

23. Patient ASSESSMENT Chest Wounds Signs and Symptoms Wound or trauma to the chest Sucking sound Gasping for air (possible open wounds)

24. Patient CARE Chest Wounds Emergency Care Steps Apply occlusive dressings to open wounds. Place in position of comfort (if no spine injury suspected) .

25. Flutter Valve Inspiration

26. Flutter Valve Exhalation

27. Patient CARE Closed Chest Wound Emergency Care Steps Monitor airway; administer oxygen. Suspect damage to underlying organs. Suspect and treat for shock.

28. Patient CARE Impaled Object Emergency Care Steps Do not remove object unless: Through the cheek. Interferes with chest compression. Interferes with transport. (Continued)

29. Patient CARE Impaled Object Emergency Care Steps Manually stabilize object. Expose area. Control bleeding. Stabilize with bulky dressing. Bandage.

30. Impaled Object Cheek

31. Manually stabilize object in place. Use bulky dressings and bandage to stabilize.

32. Impaled Object in the Eye

33. Patient CARE Closed Abdominal Wound Emergency Care Steps Monitor airway; give oxygen. Be alert for vomiting. Flexing patient’s knees may reduce pain. Treat for shock. Transport.

34. Patient CARE Emergency Care Steps Do not touch exposed organs. Do not try to replace organs. Cover exposed organs/wound with dressing moistened with sterile saline. Abdominal Evisceration

35. Abdominal Evisceration Expose the wound.

36. Cover with sterile dressing. Follow local protocols.

37. Tell new EMT-Bs that the old textbooks describe using aluminum foil as the airtight dressing for eviscerations. Today, plastic wrap is preferred as an occlusive dressing, because the sharp edges of the aluminum foil may cause further damage to abdominal organs. P RECEPTOR P EARL

38. Patient CARE Amputations Emergency Care Steps Wrap the amputated part in sterile dressing. Wrap part in plastic. Keep cool. Transport part with patient if possible. (Continued)

39. Patient CARE Amputations Emergency Care Steps Monitor airway; administer oxygen. Control bleeding. Do not complete partial amputations. Treat for shock.

40. Patient CARE Open Neck Wound Emergency Care Steps May cause air embolism. Cover with occlusive dressing. Do not compress both carotids at same time.

41. Cover wound with gloved hand. Place occlusive dressing over wound.

42. Place dressing over occlusive dressing. Bandage. Do not compress both carotids or restrict breathing.

43. B URNS

44. Patient ASSESSMENT Burn Depth: Superficial Signs and Symptoms Reddened skin Pain at burn site Involves only epidermis

45. Patient ASSESSMENT Burn Depth: Partial-Thickness Signs and Symptoms Intense pain White to red skin Blisters Involves epidermis and dermis

46. Patient ASSESSMENT Burn Depth: Full-Thickness Signs and Symptoms Dry, leathery skin Loss of sensation All dermal layers/tissue may be involved (white, dark brown, or charred) (little pain)

47. Superficial Full- Thickness Partial- Thickness Classifying Burns by Depth

48. Skin Reddened Blisters Charring Classifying Burns by Depth

49. Patient ASSESSMENT Burn Severity Signs and Symptoms Body Surface Area A burn equal to the size of the patient’s hand is equal to 1% BSA.

50. Rule of Nines Adult

51. Rule of Nines Child and Infant

52. Tell new EMT-Bs that an alternative way to determine the BSA estimate is the “Rule of Palm,” which uses the patient’s palm surface area as a unit of measurement. The patient’s palm is considered equal to approximately 1% of the BSA. Using this method, you can mentally estimate a burn area on any age patient. For example, if the burn area is equal to “7 palm surface areas,” the burn would be estimated at 7% BSA. P RECEPTOR P EARL

53. Patient ASSESSMENT Burn Severity Signs and Symptoms Burns to these areas are Face, upper airway Hands and feet Genitalia considered serious: (Continued)

54. Patient ASSESSMENT Burn Severity Signs and Symptoms Preexisting medical conditions Age of patient Conditions That May Affect Severity: Less than 5 Greater than 55 (Continued)

55. Patient ASSESSMENT Burn Severity Signs and Symptoms Full-thickness burns involving face, hands, feet, or genitalia Burns complicated by respiratory injury (Continued) Full-thickness burns greater than 10% BSA

56. Patient ASSESSMENT Burn Severity Signs and Symptoms Partial-thickness burns greater Critical Burns than 30% BSA Burns complicated by painful, swollen, or deformed extremity (Continued)

57. Patient ASSESSMENT Burn Severity Signs and Symptoms Moderate burns in young or Critical Burns elderly patients Burns encircling any body part (arm, chest, etc.) (Continued)

58. Patient ASSESSMENT Burn Severity Signs and Symptoms Full-thickness burns 2–10% BSA Superficial burns greater than Moderate Burns 50% BSA (Continued)

59. Patient ASSESSMENT Burn Severity Signs and Symptoms Full-thickness burns less than Minor Burns 2% BSA Partial-thickness burns less than 15% BSA (Continued)

60. Patient ASSESSMENT Breathing Adequacy Signs and Symptoms Greater surface area in relation Infants and Children to total size Greater fluid and heat loss Higher risk for shock May be a result of abuse

61. Infants and Children Burn Severity Critical Any full-thickness burns Partial-thickness >20% BSA or involving hands, feet, face, genitalia Moderate Partial-thickness, 10 – 20% BSA Minor Partial-thickness, <10% BSA

62. Patient CARE Burns Emergency Care Steps Use BSI, protective gear. Stop the burning process with water or saline. Remove smoldering clothing and jewelry. (Continued)

63. Patient CARE Burns Emergency Care Steps Monitor the airway for closure. Prevent further contamination (from chemicals) . Cover burn area with dry, sterile dressing. (Continued)

64. Patient CARE Burns Emergency Care Steps Do not use ointments/lotions. Do not break blisters. Transport. Follow local transport protocols.

65. Chemical Burns Protect yourself from exposure. Wear appropriate protective gear. Activate hazmat team if necessary.

66. Patient CARE Chemical Burns Emergency Care Steps Brush dry powders off skin before flushing. Flush with large amounts of water. Do not contaminate uninjured areas while flushing. Continue flushing en route to hospital.

67. Electrical Burns Do not touch a patient who is in contact with electrical source. Contact trained personnel for rescue.

68. Electrical burns may have entry and exit wounds.

69. Special Areas of Concern Burns to the eyes Do not attempt to open burned eyelids. Assure burn is thermal, not chemical. Apply dry, sterile dressing to both eyes to prevent simultaneous movement. Flush chemical burns with water for at least 20 minutes while en route to hospital. Flush from medial to lateral side of eye (to avoid injury to other eye) . (Continued)

70. Special Areas of Concern Burns of the hands and toes Remove all jewelry. Separate all digits with dry, sterile dressings to prevent digits from adhering to each other.

71. Patient CARE Electrical Burns Emergency Care Steps Administer oxygen. Watch for respiratory, cardiac arrest. Internal injuries are often more severe than external ones. Treat soft tissue injuries. Transport patient as soon as possible.

72. Purposes Stop bleeding. Protect wound from further Prevent contamination and damage. infection. Dressing and Bandaging

73. Sterile, directly covering wound 4 x 4 gauze Universal or combination Occlusive Dressings

74. Hold dressings in place Roller gauze Triangular bandage Tape, air splints Bandages

75. Dressings and Bandages

76. Dressing/Bandage: Forehead Dressing/Bandage: Elbow

77. Dressing/Bandage: Hand Dressing/Bandage: Shoulder

78. 1. What is the difference between an open wound and a closed wound? Amputations Impaled objects Neck wounds Chest injuries Burns 2. What is the treatment for: R EVIEW QUESTIONS