CHAPTER 3: WOUND AND FRACTURE


SOFT-TISSUE INJURIES (WOUND)

SPS 321 – Sport Safety & Emergency Care

 INTRODUCTION
 Soft tissue are the layers of skin, fat & muscles that protect
underlying structures & organs.
 Soft-tissue injury is often an obvious and dramatic one, it is seldom
the most serious type of injury.
 Unless it compromises the airway or causes massive hemorrhage.
 An injury to the skin and underlying musculature is commonly
referred to as a wound.
 Wound is an injury, cause by trauma.
 Disrupts the normal continuity of the tissue, organ or bone affected.

 Wounds may be generally classified as:

 Closed
 Open
 Single
 multiple
 Closed injuries

 In a closed injury, such as a bruise

 soft tissues beneath the skin are damaged, but the
skin is not broken.

 Type of closed injuries include:

 Contusions (bruises)
 Hematomas
 Crush injuries
 Closed injuries
 Contusion
 The epidermis (outer layer of the
skin) remains intact
 In the dermis (underlying layer of
skin), however, cell are damaged
and blood vessels are torn
 Contusions are characterized by
local pain and swelling
 If small blood vessels beneath
the skin have been broken, the
area will gradually turn black &
blue as blood & fluid leak into
the damaged tissue.
 Closed injuries
 Hematoma
 When large vessels have been
torn beneath a bruised area
 A collection of blood beneath skin
has develop
 Hematomas are characterized by
a lump with bluish discoloration
 Blood from a deep bruise can
actually separate tissue & pool in
a pocket
 The victim can lose 1 or more
liters of blood from a large
hematoma
Closed injuries
 Closed injuries
 Crush Injuries
 Force of a sudden blow or blunt trauma can cause a crush
injury
 Underlying layers of skin sustain severe damage; internal
layers of skin can actually rupture
 The injury site may be painful, swollen, or deformed, there
is usually little or no external bleeding
 The victim of a crush injury can look fine at first, but
his/her condition may quickly deteriorate, resulting in
deep shock or death
 Always suspect hidden internal damage in victims with crush
injuries
Closed injuries
 Closed injuries
 First Aid Care
 Small bruises generally no treatment
 Large & crush injuries, however, can cause serious internal
injury & blood loss
 The treatment:
 If suspected internal bleeding or the victim shows the signs &
symptoms of shock, treat for shock
 Apply ice or cold compresses to help relieve pain & reduce
swelling
 Never apply ice directly to the skin, & do not apply ice for more than
20 minutes at a time
 Splint painful, swollen, or deformed extremities to help control
pain & swelling & prevent further injury
 If large bruised area present, assess carefully for fracture, especially if
any swelling or deformity is present
 Open Injuries
 Skin is broken & the victim is susceptible to external bleeding
& wound contamination
 The wound itself may be only part of victim’s injury
 An open wound may be only the surface evidence of a more
serious injury, such as a fracture.
 Open Injuries
 Classification of open wounds
 Open Injuries
 Abrasion
 A superficial wound caused
by rubbing, scraping, or
shearing
 Usually the epidermis & part
of the dermis is lost
 All abrasions, regardless of
size, are extremely painful
because of the nerve ending
involves
 Blood may leak from the
abrasion, but bleeding is
usually not severe
 The most serious threat from
abrasions is that of
contamination & infection
 Open Injuries
 Laceration
 A laceration is a break in the
skin of varying depth
 Lacerations can be either
linear (regular) or irregular, &
can occur either in isolation
or together with other types
of soft-tissue injury
 Lacerations can cause
significant bleeding
 Linear lacerations, also
known as incisions, are
characterized by sharp, even
cuts with smooth edges
 Open Injuries

 Avulsion
 The tearing loose of a slap
of skin
 Which either remain
hanging or be torn off
altogether
 Usually bleed profusely
 Most commonly avulsed
skin on fingers & toes,
hands, forearms, legs,
feet, ears, & nose
 Open Injuries

 Penetrating & Puncture

 Cause by the penetration of a
sharp object (such as a nail)
through skin & underlying
structures
 Opening in the skin may
appear very small, resulting
in little external bleeding, but
puncture wound may be
extremely deep
 Can cause internal organ
damage
 Superficial skin wound is
almost never fatal. The
fatalities all relate to the
injured organs that lie
beneath the skin wound.
 Open Injuries

 Amputations
 Tear away limbs from the
body; amputations can also
involve other body parts
 Blood vessels are elastic, they
tend to spasm & retract into
surrounding tissue in cases of
complete amputation
 Complete amputations may
cause relatively limited
bleeding
 However, lacerated arteries
continue to bleed profusely,
& blood loss can be massive
 Open Injuries
 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, body fluids, mucous membranes, or traumatic
wounds
 Use protective glove & dispose the gloves after used
 Wash hands thoroughly with soap & hot water
 Before begin to treat the injury itself, maintain an
airway & provide artificial ventilation if necessary
 Open Injuries
 First Aid Care
 Treat soft-tissue injuries as follows:
 Expose the wound so can see clearly; if necessary, cut the victim’s
clothing from around the wound.
 Control bleeding with direct pressure (bandage).
 Prevent further contamination by keeping wound as clean as
possible.
 Apply a dry, sterile dressing to the wound & bandage it securely
in place
 Open Injuries

 First Aid Care

 Activate EMS system if any of the following are true:
 The wound has spurted blood, even had control the bleeding.
 The wound is deeper than the outer layer of the skin.
 There is uncontrolled bleeding.
 There is extensive contamination.
 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.
 Open Injuries
 Cleaning Wounds & Preventing
Infection
 Wash the area around the wound
with soap & water.
 Irrigate the wound with clean tap
water with flow at moderate
pressure & be clean enough to drink.
Never scrub the wound.
 Gently pat the wound dry with
sterile gauze & apply antibiotic Clean the area around a shallow
ointment (Neosporin). wound using separate small
 Cover the wound with a sterile, stroke & by wiping away from
the edges
nonstick dressing, & bandage in
place.
 Open Injuries
 Cleaning Wounds & Preventing Infection
 Never apply hydrogen peroxide, isopropyl alcohol, Merthiolate,
or iodine to a wound – these can injure the tissues & delay
healing.

 Do Not close a wound with adhesive tape, Steri-strips, or

butterfly strips – these increase the risk of infection.
 Special Treatment Considerations

 The preceding first aid guidelines apply to most

soft-tissue injuries, but must be aware of special
considerations in the case of:
 Chest or abdominal injuries
 Impaled objects
 Amputations
 Clamping injuries
 Special Treatment Considerations
 Chest Injuries
 In case of penetrating chest injuries, activate the
EMS system, then put an occlusive (airtight) dressing
over the wound.
 Can use household plastic wrap or another occlusive
object (one that air will not pass through).
 1 corner should be left un-taped enough to flutter as
the victim breathes.
 Special Treatment Considerations
 Abdominal Injuries

 If organs protrude through 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, moist, sterile
dressing.
 Cont..
 Special Treatment Considerations

 Cover the moist dressing with an occlusive material,

such as plastic wrap, to retain moisture & warmth.
 Gently wrap the dressing in place with a bandage or
clean sheet.
 Special Treatment Considerations
 Impaled Objects
 Never remove an impaled object unless it penetrates
the cheek or interferes with chest compressions.
 To treat:
 Remove the victim’s clothing if necessary to expose wound.
 Manually secure the impaled object to prevent any motion.
Moving the impaled object even slightly can increase
bleeding & cause damage to underlying tissue.
 Cont..
 Special Treatment Considerations

 Control bleeding with direct pressure, but do not exert

any pressure on the impaled object.
 Stabilize the impaled object with bulky dressing &
bandage in place.
 Calm & reassure the victim as you monitor for shock.
 Keep the victim at rest.
 Do not attempt to cut off, break off, or shorten an
impaled object unless transportation is not possible with
it in place.
 REMEMBER – any motion of the impaled object is
transmitted to the victim & can cause additional
tissue damage and shock.
 Special Treatment Considerations
 Amputation
 Generally, you should not waste time searching for
amputated parts or neglect victim care.
 If you can find the amputated parts quickly proceed as
follows:
 Rinse the amputated part with clean water, but do not scrub.
Wrap the part in a dry sterile gauze.
 Place the wrapped part in a plastic bag.
 Cont..
 Special Treatment Considerations
 Place in a cooler or bag or container so that it is
on top of a cold pack.
 When EMTs 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.
 Special Treatment Considerations

 Clamping Injuries

 Most clamping injuries involve the hand – more

specifically a finger.
 To treat a clamping injury:
 Remove the clamping object as quickly as possible.
 Elevate, the affected extremity while you remove the
clamping object.
 Cont..
 Special Treatment Considerations

 If you are unable to loosen the body part or remove

the clamping object, activate the EMS system.
 When EMS arrive, give them the amputated part so
it can be transported with the victim.
 SUMMARY

 Close wound are those in which the tissue beneath

the skin is damaged, but the skin is not broken –
bruises & hematomas.
 Open wounds are those in which the skin is broken
– abrasions, incisions, lacerations, punctures,
avulsions, bites, & amputations
 SUMMARY

 The most serious threat from an abrasion is

infection; blood loss is usually minimal.
 Lacerations with smooth edges heal better than
those with ragged edges.
 The biggest threat from an avulsion is lack of
circulation to the flap; make sure the flap is not
bent back.
 SUMMARY

 If you can find an amputated part, your

proper care of it can dramatically improve
the odds of the surgeon’s successfully
reattaching it.
 Even if a limb is severely mangled, you
should never complete an amputation;
nerves & blood vessels in even small strands
of tissue may enable the surgeon to reattach
the limb completely.
 KEY TERMS
 MAKE SURE TO UNDERSTAND THE FOLLOWING KEY
TERMS:
 Wound
 Contusion
 Epidermis
 Dermis
 Hematoma
 Abrasion
 Laceration
 Avulsion
 Occlusive