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• Soft tissue injuries

  Anything other than cartilage or bones
• Soft tissue injuries

  • Range in severity from scrape or cut to life-threatening injuries
  • Don't be distracted by open wounds we can see - e.g liver, brain, etc
• Soft tissue

  Skin, muscles, tendon, fascia, nerves, fat, blood vessels
• Elderly and very young


  • Have skin that is more easily compromised (especially in eyelids, lips, ears)
• Layers of skin

  • Epidermis
  • Dermis
  • Subcutaneous layer
  • Fascia (tough)
  • Muscle
• Skin functions

  • Barrier against infection
  • Sensation
  • Temperature regulation
  • Fluid regulation
• Types of soft-tissue injuries

  • Closed injuries
  • Open injuries
  • Blast injuries
  • Burns
• Closed injuries

  • Typically results from blunt trauma
  • Usually no break in skin
• Signs and symptoms of closed injuries

  • Pain and tenderness
  • Deformity
  • Swelling
  • Ecchymosis
• Types of closed injuries

  • Contusion (bruise, no break in skin; minor blood vessels compromised; not a lot of swelling)
  • Hematoma (blood collected within damaged tissue or in a body cavity)
• Crush syndrome

  1. Decreased circulation to anaerobic metabolism

  2. Generates lactic acid

  3. Increased cellular wall permeability

  4. Cellular death

  5. Increased blood toxicity distal to crushing force
• Crush injury

  • Alert and conscious patient can rapidly deteriorate
  • Cardiac arrhythmias/arrest
  • Renal failure
  • Respiratory distress
  • Liver disease
• Assessment of crush injury

  • Larger area of body entrapped for prolonged time (>4 hours)
  • Patient may appear stable
  • Distal pulses may be difficult to assess
  • Numbness may mask pain
• Patient management for crush injury

  1. ALS - physician at scene if possible

  2. ABCs - oxygenate

  3. Assess for crush injury, not entrapment duration

  4. Be prepared for deterioration after patient is freed

  5. BVM, AED

  6. Rapid transport
• Compartment syndrome


  • Results from the swelling that occurs whenever tissues are injured
  • Look for weakened circulation
  • More pain than would result from visible injury
• Severe closed injuries can also damage internal organs
• Open injuries

  Protective layer of skin is damaged
• Types of open injuries

  • Abrasions (not typically life threatening, but very painful; usually scrapes away upper layer of epidermis)
  • Lacerations (linear)
  • Avulsions (tearing away of a piece of skin)
  • Penetrations (stabbings or shootings often result in multiple penetrating injuries)
• Treatment for open injuries

  1. Abdominal dressings w/o saline so bleeding stops

  2. Bulky dressing to keep things in place
• Care for blast injuries

  1. BSI

  2. xABCs

  3. Control hemorrhaging first

  4. Treat for shock

  5. Apply cold splint/immobilize
• Impaled objects

  Only remove object when:

  Object penetrates the cheek with airway compromise

  Object is in the chest and interferes with CPR

  Object prevents the transport of patient - can anything be done so object doesn't have to be removed
• Open neck injuries

  Can be life threatening

  Air embolism - air gets in circulation
• Treatment for open neck injuries

  Occlusive dressing - things that are not semipermeable; covered with sterile dressing; bandage into place

  Apply pressure - do not apply pressure to both carotid arteries at the same time
• Burns

  Occur when the body receives more radiant energy than it can absorb

  Sources include heat, toxic chemicals, and electricity
• Complications of burns

  • Infection

  Hypothermia

  Hypovolemia

  Shock
• Factors affecting burn severity

  • Depth of burn

  Extent of burn

  Critical areas involved (face, upper airway, hands, feet, genitalia)

  Preexisting medical conditions

  Patient age (<5, >55)
• Burn depth

  • Superficial or first degree burns (epidermis is burned)

  Partial-thickness or second degree burns (epidermis and some portion of the dermis; blisters are hallmark)

  Full thickness or third degree burns (extend through all skin layers)
• Thermal burns

  Caused by heat; most commonly caused by scalds or open flames
• Inhalation burns

  Can occur when burning takes place in enclosed spaces without ventilation

  Paper airway damage associated with the inhalation of superheated gases

  Lower airways damage associated with the inhalation of chemicals and particulate matter
• Emergency medical care for burns

  Stop burning process

  Remove any clothing, jewelry, etc

  ABCs - humidified air, ALS needed?

  Consider transport to a burn center

  Aeromedical transport?

  For burns <10% BSA (body surface area): Moistened sterile dressing

  For burns >10% BSA: Dry sterile dressing (want to prevent hypothermia)
• Abdominal and genitourinary injuries

  Mechanism of injury is important

  Significant trauma to the abdomen can occur from blunt trauma, penetrating trauma, or both

  Injuries to the abdomen that go unrecognized are not repaired in surgery and are a leading cause of traumatic death
• Abdominal quadrants

  • RUQ - liver, gallbladder, duodenum, pancreas

  LUQ - stomach and spleen

  LLQ: descending colon, left transverse colon

  RLQ: larger and small intestine, appendix
• Hollow organs

  Stomach, intestines, ureters, bladder

  When ruptured or lacerated, contents spill into peritoneal cavity

  Can cause intense inflammation and infection such as peritonitis
• Abdominal injuries

  • Closed abdominal injuries

  Open abdominal injuries
• Open abdominal injuries

  Foreign objects enters abdomen and opens peritoneal cavity to the outside

  Damage depends on velocity of object - low velocity (knives, other edged weapons), medium velocity (smaller caliber handguns and shotguns), high velocity (rifles and handguns)
• Hollow organ injuries

  Often have delayed signs and symptoms

  Spill contents into abdomen

  Infection develops, which can take hours or days

  Stomach and intestines can leak highly toxic and acidic liquids into peritoneal cavity
• Solid organ injuries


  Can bleed significantly and cause rapid blood loss

  Can be hard to identify from physical exam

  Liver is the largest organ in abdomen and is vascular, injuries can lead to hypoperfusion

  Spleen and pancreas are vascular and prone to heavy bleeding
• Assessment of abdominal injuries

  • Difficult - rely on mechanism of injury

  Causes of injury may be apparent but resulting tissue damage may not be

  Patient may be overwhelmed with more painful injuries

  Some injuries develop and worsen over time
• Physical examination of abdomen


  Visually inspect for bleeding

  Expose injuries for visual assessment

  Position of comfort

  Examine entire abdomen

  DCAP-BTLS

  Assess for rigidity, distention

  Inspect and palpate kidney area for tenderness, bruising, swelling, or other trauma signs
• Management of closed abdominal injuries

  Monitor and evaluate for progression into shock

  Administer oxygen/assist ventilations if necessary

  Consider ALS