Soft Tissue Injuries And Nursing Care

The Skin

– The Largest Organ in the Body

 

Functions of the Skin

  • Protects the body from the environment and bacteria, viruses and other harmful organisms
  • Regulates body temperature
  • Contains nerves that sense heat, cold, touch, pressure and pain

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Closed Injuries

Soft-tissue injuries sometimes appear worse than they actually are.

– A soft-tissue injury before cleaning.

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– A soft-tissue injury after cleaning.

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Contusion:

– A type of closed soft-tissue injury in which cells are damaged in the skin and blood vessels torn in the dermis; also called a bruise.

 

Contusion produced by an ankle sprain.

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Hematoma:

– A closed soft-tissue injury produced by an accumulation of blood under the skin.

– Similar to a contusion, but with more blood and tissue damage.

 

Crush injury:

– An open or closed soft-tissue injury resulting from blunt force trauma.

– A closed crush injury produced when a van wheel rolled over the patient

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Open Injuries

 

Abrasion:

– An open soft-tissue injury resulting from a scraping force.

Abrasions produce damage to the epidermis.

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Laceration:

– A break in the skin of varying depth caused by a sharp object.

– Lacerations can be linear (regular) or stellate (irregular).

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A severe open injury.

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Avulsion:

– A flap of skin that is torn or pulled loose.

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Puncture wound:

– An open soft-tissue injury caused by an object being pushed into the skin.

– Sometimes referred to as a penetration wound.

 

Puncture wound and lacerations caused by a dog bite.

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Amputation:

– The separation of an appendage from the body; such as a finger or an arm.

– Usually a result of great shearing forces.

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Open crush injuries can result in  soft-tissue trauma and damage to the underlying organs.

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Emergency Medical Care for Soft-Tissue Injuries

– Ensure patent airway

  • Provide ventilation with oxygen as necessary
  • – Treat for shock, if signs and symptoms
    are present
  • High-flow oxygen
  • Direct pressure for bleeding control
  • Shock position
  • Rapid transport

– Expose the wound

– Place sterile dressing over wound and bandage in place

– Assess patient for possible spinal injury and immobilize appropriately

– If stable and airway patent, splint any painful, swollen or deformed extremity

 

In penetrating injuries, always check for an exit wound.

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Dressings are used to stop bleeding and cover the wound; while the bandage is used to secure the dressing in place.

 

Occlusive dressing:

– Made of nonporous material to prevent the entry of any air, and usually containing an ointment that seals the dressing.

– Plastic wrap or aluminum foil can be used as a seal.

– With open neck or chest wounds, use an occlusive dressing to prevent air from entering the circulation.

 

Dressings come in assorted styles and shapes.

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Bandages include tape, triangular bandages, gauze and an air splint.

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Dressing & Bandaging

– Follow BSI precautions

– Expose the injured area

– Place sterile dressing over
entire injury

– Maintain pressure to control bleeding

  • If bleeding not controlled, ensure pressure is being placed on the correct site

– Use bandage to secure dressing
in place

  • Assess distal skin color and circulation

– If dressing becomes saturated with diffuse bleeding, add additional dressings

  • Do not remove bottom dressing in contact with wound

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