It is important to be able to identify and care for patients with soft-tissue injuries. The functions, disease, assessment, and management of this type of injury require complete knowledge of the soft-tissue anatomy and the procedures used to treat damage to these tissues.
Skin is considered an organ. It is, in fact, the largest organ of the body. One can only imagine the potential impact from trauma and/or injury to this organ. The EMT must know details about the skin’s makeup, function, types of skin and soft tissue injuries, and how to identify and manage these injuries.
Terms/Concepts to Know: epidermis, dermis, mucous membranes, the three types of soft tissue injury, contusion, ecchymosis, hematoma, crushing injury, crush syndrome, compartment syndrome, contamination abrasion, laceration, incision, avulsion, fascia, amputation, penetrating wound, impaled objects
These injuries are two of the three types of soft tissue injuries. A competent EMS (Emergency Medical Services) worker is well-versed in the identification of this type of injury and knows the importance of assessment and appropriate management. Knowing how to handle these emergencies will aid in the avoidance of common complications related to shock, infections, and bleeding.
The skin has several functions. The main functions include temperature regulation, nerve pathway, and shielding to maintain fluids inside the body and keep bacteria out. Understanding these functions will help during your treatment of skin injuries.
The patient assessment of open and closed injuries includes scene size up/MOI, primary assessment, patient history, secondary assessment and reassessment. Critical points to consider involve the difference in presentation of the closed versus open injury. Open wounds are more obvious and can be difficult to triage as even a simple and small exposed surface area is at risk for bleeding and contamination. Paying attention to a closed wound with high acuity symptoms is critical for preventing hypovolemic shock and other critical complications.
Medical care of open and closed injures during an emergency requires immediate assessment and triage. Deciding what injuries require immediate attention is key and should be the priority of emergency care. Critical open wounds include abdominal, impaled objects, neck injuries, closed fractures, and bites. Examples of closed wounds include compound-fractured bones.
Terms/Concepts to Know: RICES, evisceration, rabid, key treatment skills for abdominal, impaled, neck and bites
Burns occur when there is exposure to heat, radiation, toxins, chemical substances, and/or electricity. Injuries of this type not only include burns, but also burn-related exposure injuries. Burns are classified according to the degree of severity.
The disease potential of a burn is multifaceted. Depending on the type and severity of the burn, there can be increased capillary permeability, which creates plasma leakage in and around tissue. This increases the risk of edema, impact to blood volume, and cardiac output concerns.
The impact from burns breaches the protective barrier between external exposures and the skin. Complications from this breach may include: pain, infection, dehydration, neurovascular compromise, compartment syndrome, body temperature irregularity, shock, and even airway issues.
The degree of severity includes five factors that help to guide assessment and emergency treatment regimens. Another consideration about the degree of severity relates to the trauma level of the hospital to which the patient will be transported.
The burn patient assessment requires not only an indication of degree of severity, but also making note of the patient’s age, as additional considerations exist if they fit into a special population category. The EMT will perform scene size up/MOI, primary assessment, history, secondary assessment, and reassessment.
Nine key steps must be followed when treating an emergency burn patient. You should memorize and use them because they are important for decreasing the risk of further injury. Managing the care of burns depends on the classification and degree of the burn. The use of high flow oxygen, cool water, and dry sterile bandages or clean sheets are standard treatment regimes. Dressings and bandages are used to prevent these things: further trauma to the open area, bleeding, and contamination.
Terms/Concepts to Know: types of burns: thermal (contact, scald, steam, flame, flash), chemical, inhalation, electrical, taser, and radiation; excited delirium; occlusive dressing; the first two factors of importance in determining burn severity; three questions that are important for burn severity rating; skin layer involvement with first, second and third degree burns; classification of burns for adults, children, and infants; rule of nines; key factors to identify during respiratory assessment of a burn patient
This chapter overviews the identification, management, and emergency care for patients with face and neck injuries, including injury to the eyes, ears, nose, neck/throat, mouth, and dental areas. These parts of the body have special concerns that are related to potential for airway obstruction, bleeding, and disfiguring scars.
Understanding the anatomy and physiology of the face and neck area is key to identifying potential life-threatening injuries there. Since this area includes the airway, it is critical to understand the connections between the ear, nose, and throat. Additionally, knowledge of the structure of the facial and skull bones will help you understand the impacts to these areas when bleeding, bruising, or a penetrating wound is present.
The eyes serve as one of the five senses. The eye is approximately 1 inch in diameter and is surrounded by bones, muscles, and nerves. Considering how small the eyes are, it is amazing that they play such a major role in how human beings obtain information.
Terms/Concepts to Know: orbital socket and bones, extraocular muscles, lens, optic nerve, retina, cornea, iris, pupil, sclera, conjunctiva, globe, vitreous and aqueous humor, major components of the eye, symptoms of retinal detachment, anisocoria
Injuries to the face and neck area may often seem benign, especially if there are no open wounds or penetrating injuries. Understanding how injuries occur and present in these areas will help to identify potential concerns and promote prompt identification and treatment.
Due to the abundance of veins in the facial area, soft tissue injuries here commonly cause bleeding. Skin that has been broken by penetration or abrasion may emit copious amounts of blood. Injury where the skin is intact may present in the formation of a hematoma, or bruise.
Dental injuries can range from a broken/cracked tooth to lip, gum, tongue, frenulum, or cheek laceration. In some instances, foreign objects can cause injury. An example is that caused by broken braces or other sharp objects.
Terms/Concepts to Know: avulsion, hematoma
The patient assessment of facial and neck injuries includes scene size up/MOI, primary assessment, patient history, secondary assessment, and reassessment. Special attention should be given to the airway, depending on the location of bleeding and anatomical location of face/neck injury.
Terms/Concepts to Know: major facial bones
Emergency care of soft tissue injury to the face and neck area requires the use of respiratory and neurological assessment and precautions. Soft tissue in the face/neck area has high risk of bleeding. There are also many bones located in this area. A careful view of the entire area, including the removal of clothing, eye glasses, and hats, is critical to ensure there is no sign of compound fractures, bleeding, or airway obstruction. Take care to use appropriate first aid techniques to address wounds, impaled objects, and fractures.
Eye injuries can be as minor as an irritated contact lens to the catastrophic penetration of a sharp foreign object. High-risk injuries may potentially cause blindness or loss of the eye. The important thing to remember with emergency eye problems or injuries is that time is important for positive patient outcomes. Basic care can include flushing the eye with saline, guarding/covering the eye, and stabilizing the impaled object until medical/surgical care can be provided.
Nose injuries may present with varied symptoms. A basic and common symptom of a nose injury is bleeding. Other symptoms of nose injuries may be bruising around the eyes, difficulty breathing through the nose, blunt or penetrating injuries, and even swelling of, or around, the nose.
Ear injuries may present with chief complaints related to the inner, middle, or outer areas. Understanding the anatomy and physiology of the ear is critical to observe for signs and symptoms that can impact hearing loss or high acuity injuries. Ear injuries can be stabilized in an emergency situation and almost always require a physician to examine and/or treat.
Fractures can be very serious. The facial bone structure is multifaceted, as it supports and involves the nose, eyes, ears, teeth, cheeks, jaw, dental, and even part of the skull. Fractures of facial bones can present various emergency conditions including bleeding and difficulty breathing. Emergency care should include preparation to handle these delicate injury types.
Emergency care for injury to dentition and surrounding areas require knowledge of first-aid treatment for pain, bleeding, and broken, loose, or dislodged teeth. Be aware of these potential injuries to provide time-sensitive response. The mucous membrane, gums, and bones of the mouth are all at risk for injury. Use first aid techniques, as appropriate, and be sure to recover chipped or broken teeth, if possible. Handle these teeth or parts on the crown side, only.
Several bones make up the cheeks. Injury to them may present with pain caused by swelling, muscle, and/or nerve involvement. Some injuries may cause indentation or misalignment of the cheek bones. In some cases, these injuries will prevent the patient from being able to open the mouth or jaw. Prehospital care would include stabilization of the injury and addressing bleeding, impalement, or fracture.
Injury of the neck can occur at a superficial, venous, or arterial level. There may also be impacts to the upper airway or bones. Injures to this area can affect function and be life threatening. If injury occurs in any of the seven vertebrae present in the neck area, precaution must be taken to stabilize it and prevent further injury. It is important to know the MOI related to these types of injuries for insight into providing safe care and treatment.
Injury to the larynx may present with symptoms of hematoma, bleeding, edema, and subcutaneous emphysema. These injury types can be caused by a crushing, blunt, or penetrating trauma. Injury to the larynx can put a patient at risk for respiratory and airway difficulties. Emergency care includes managing wounds and bleeding, while watching for any signs of a compromised airway.
Terms/Concepts to Know: blow out fracture, tragus, turbinates, subcutaneous emphysema, sternocleidomastoid muscles, temporomandibular joint, mastoid process, air embolism