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BASIC SOFT TISSUE TRAUMA
Superficial skin injuries are some of the most commonly encountered injuries. While rarely dangerous on their own, they are commonly present in patients with more severe underlying conditions. The ones to know are:
- punctures, and
ABRASIONS: superficial wounds where the outermost layer of skin is scraped or rubbed off.
- "Road Rash" from a fall is a common abrasion.
- These injuries can be extremely painful as they involve the layer of the skin that contains the nerves.
- These injuries rarely bleed excessively once they have been dressed or had pressure applied to them for a short time.
LACERATIONS: a cut in the skin caused by impact with a sharp object. (A micro-assessment of lacerations shows that all are, in fact, tears--when a pressure exerted against the skin creates a force beyond which the skin's normal elasticity can tolerate.)
- The edges are usually rough or jagged unless the object was extremely sharp.
- Depending on the severity of the laceration, bleeding may be minimal or severe depending on the depth of the cut and involvement of deeper and larger blood vessels.
PUNCTURES: different than lacerations because the force is directed towards the body, as opposed to across the body in a laceration. (Like lacerations, technically punctures are tears.)
- Puncture wounds leave a wound in the shape of the offending object.
- All punctures must be assessed for the presence of an exit wound which is created when the penetrating object traverses the body completely and leaves a second wound with a tract connecting them.
- Removing the clothing and assessing all skin surfaces is vital and a key step in assessing these patients.
- Impaled Objects: These are penetrating objects that are stuck through the skin. As per other chapters, penetrating objects should not be removed. Applying a bulky dressing and stabilizing the object for transport is key.
BITES: Bites from insects or animals are another type of open soft trauma injury.
- Human bites are considered an emergency as they can become seriously infected.
- Transport is appropriate for a serious human bite.
- Animal bites are of varying concern.
- Bites from insects and some reptiles can be poisonous.
- Bites from large animals can obviously be severely traumatic, and smaller mammals may be hosts for various diseases, such as rabies.
Eye injuries are a unique category of soft tissue injury. Even simple things such as grit, metal dust, or chemicals that are harmless to skin can cause severe injury to the eye.
- Redness, tears, pain, and blurring of vision are key signs of eye injuries.
Treatment of abrasions, lacerations, punctures, and bites is focused around the use of dressings--sterile pieces of cloth that absorb blood and help compress the wound and control bleeding. They come in many shapes and sizes. Bandages go over dressings and hold them in place.
For eye injuries, pre-hospital procedures for dealing with foreign bodies or abrasions to the eye are
- to lay the patient flat and tilt their head to the affected side, so that whatever is in it does not get into the unaffected eye.
- Hold the patient's eyelid open with one hand, using the orbital bones for gentle leverage. Never press onto the eye itself.
- Flush the affected eye for at least 15 minutes with water or normal saline.
(For alkali burns--more damaging to the eyes than acids--even more flushing is necessary.)
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