Soft Tissue Injuries and

Burns for EMT-Basic

Paul Vogt
UT Southwestern
Dallas, Texas
 Structure and Function
of Skin
 Most durable and
largest organ
 Three Layers
 Epidermis, dermis, and
subcutaneous layers
 Roles
 Protection from the
environment
 Bacteria, viruses, and
other micro-organisms
 Body temperature
regulation
 Receptor organ
 Heat, cold, touch
pressure, and pain
 Eliminates water and
salts
 BSI and Soft Tissue
Injuries
 Open soft tissue
injuries
 Body fluids
 Exposure risk
 Protect your self
 Closed Soft Tissue
Injuries
 A wound that is
beneath unbroken
skin
 Skin is intact
 Types
 Contusions
 Hematomas
 Crush Injury
 Closed Soft Tissue
Injuries
 Contusions
 Damage in the
dermis layer
 Swelling pain
 Ecchymosis
 Closed Soft Tissue
Injuries
 Hematoma
 Similar to contusion
– Larger vessel,
larger amount of
tissue affected
 Goose egg
 Fist can be equal
10% of blood loss
 Closed Soft Tissue
Injuries
 Crush Injuries
 Blunt force trauma
 Soft tissue damage
and internal
bleeding
 Organ rupture
possible
Open Soft Tissue Injuries
 Continuity of  Types
skin is broken  Abrasion
 External  Laceration
bleeding  Penetrations/Punctu
 Contamination re
 Amputations

 Crush injuries
Open Soft Tissue Injuries
 Abrasions
 Scrapping, rubbing
or shearing of the
epidermis
 Painful – Nerve
ending exposed
 Blood – Oozing in
nature
 Contamination and
infection
Open Soft Tissue Injuries
 Laceration
 Break in skin of
varying depth
 Arteries can be
involved
Open Soft Tissue Injuries
 Avulsion
 Loose flap of skin
 Partial or complete
 Significant bleeding
can occur
 Scarring can be
extensive
Open Soft Tissue Injuries
 Amputations
 Disruption of the
continuity of the
extremity or other
body part
 Extensive bleeding
possible (partial vs.
complete)
Open Soft Tissue Injuries
 Penetrations/Punct
ures
 Object being
pushed into the
body
 Wound can be deep
 Severity depends
on location, depth,
force of object
Open Soft Tissue Injuries
 Blunt trauma or
crushing forces
 Suspect internal
injuries
 Concern of when
the object is
removed
 Profuse bleeding
 General Management of
Open and Closed Soft
Tissue Injuries
 Closed
 BSI precautions
 Ensure adequate airway and breathing
 Supply oxygen?
 Treat for shock
 Keep them warm, feet elevated?
 Splint painful, swollen, deformed
extremities
 Additional soft tissue injury, if a fracture is
involved
 General Management of
Open and Closed Soft
Tissue Injuries
 Open  Prevent further
 BSI precautions contamination
 Ensure an adequate  Dress and bandage
airway and the wound
breathing  CMS checks – pre
 Provide oxygen? and post
 Expose he wound  Keep the patient
 Control bleeding calm and quiet
through direct  Treat for shock
pressure with
elevation (when
 Transport
possible)
 Pressure point,
tourniquet (last
 General Management of
Open and Closed Soft
Tissue Injuries
 Amputations
 Take care of the patient first
 Search for missing body part
 Do not delay transport while searching for body part
if not immediately available
 Part found
 Wrap in dry or slightly moistened sterile dressing
 Do not immerse in water or saline
 Place part in a plastic bag
 Keep the body part cool
 Ice, ice pack – do not allow the part to freeze
 Transport the patient and part (if found)
 General Management of
Open and Closed Soft
Tissue Injuries
 Chest Injuries
 Occlusive dressings
 Abdominal injuries
 Do not touch or replace abdominal
organs
 Cover the exposed organs
 Sterile dressings large enough to cover all
tissue
 Occlusive dressing

 Flex the patient’s knees and hips, if not

contraindicated
 General Management of
Open and Closed Soft
Tissue Injuries
 Impaled objects
 Should never be removed
 EXCEPT:
 In the cheek or airway and creating an obstruction
 Manually secure the object
 Expose the wound

 Control bleeding

 Use bulking dressings to stabilize the

object
 General Management of
Open and Closed Soft
Tissue Injuries
Care
 Neck Injuries 
 Place a gloved hand
 Major vessels, over the wound to
control bleeding
airway  Apply an occlusive
structures, spinal dressing (tape on all
sides)
cord  Cover the occlusive
 Air embolism an dressing with a regular
dressing
issue to be  Apply only enough
considered pressure to stop
bleeding
 Blood Flow –  When bleeding is
Arterial or controlled, apply a
pressure dressing
Venous  Consider spinal
 Burns
 Burn Classifications
 Superficial/1st
degree
 Epidermis
 Partial Thickness/2nd
degree
 Epidermis and
dermis
 Full Thickness/ 3rd
degree
 Epidermis, dermis,
fat and muscle
 Burns
 Superficial (1st)
 Flash type burns,
liquid, or sun
 S/S – Red skin, pain
at site, tenderness,
no blisters
 Days to heal
 Burns
 Partial Thickness
(2nd)
 Contact with fire,
hot liquids or
objects, chemical
substances, severe
sun burn
 S/S – Blisters,
Intense pain, White
or red skin, moist
and mottled skin
 Damaged blood
vessels leak plasma
 Burns
 Full Thickness (3rd)
 Hot liquids or solids,
flame, chemicals,
and electricity
 Lathery
appearance,
charring (dark
brown or white),
skin is hard to the
touch, no pain, pain
in periphery
 Eschar
 Confined space?
Rule of Nines
 Rule of Palm
 Palm
approximation
 1%
Critical, Moderate, Minor
burns
 Respiratory tract
involvement
 Other major trauma
 Full or partial
thickness burn that
involves:
 Faces, eyes, ears,
hands, feet, or genitalia
 Any full thickness >
10% BSA
 Any partial thickness
>20% BSA
 Burn injuries with a
suspected fractures
extremity
 Any burn that
encircles a body part
 Specialized burns –
Electrical, chemical,
inhalation
 Extreme of ages
Critical, Moderate, Minor
burns
 Full thickness burns with 2-10% BSA
 Excluding the face, hands, feet,
genitalia, or respiratory tract
 Partial thickness burns with 15-20%
BSA
 Critical, Moderate,
Minor burns
 Full thickness involving less than 2%
BSA
 Partial thickness less than 15% BSA
 Superficial burns less than 50% BSA
 General Burn Care
(Thermal)
 Remove the  Remove jewelry,
patient from the belts, shoes…
source of the burn
and stop the  Cover the burned
burning process area with dry
 Do not enter an
sterile dressings
unsafe
environment  Keep the patient
 Establish and warm and seek
maintain an other injuries
effective airway  Transport to an
 Oxygen, BVM…
appropriate facility
 Classify the
severity of the burn
 Inhalation Burns
 Considered a Critical
Burn
 Sources and S/S
 Burns of the face,
mouth, throat or history
of an enclosed space
entrapment, and/or
smoke, toxic gas
inhalation are all
possible causes
 Result = Possible
laryngeal edema
 Airway obstruction – Be
prepared to
aggressively manage
 Inhalation Burns
 Management –
 Ensure good oxygenation and
ventilation
 Rapid transportation

 Other burn care

 May have a difficult airway to manage

 Electrical Burns
 Sources and Other
Relevant Points
 Electrical current or
lightning
 Can injure soft tissue or
the whole body
 Electricity seeks to be
grounded, will take the
path of least resistance
to exit
 Exit and Entrance –
Burns in between
 Heart – Electrical
current can be
disturbed
 Electrical Burns
 Management - Critical
Burn
 Ensure your safety first
 Ensure an adequate
airway and good
ventilation
 Oxygen or BVM

 Cardiac arrest? – AED &

CPR
 Assess more muscle
tenderness
 Assess Exit and
Entrance wounds –
Provide appropriate
 Chemical Burns
 Immediate care
required
 Skin contact =
Continued burning
 Dry chemicals
should be brushed
off, then flushed for
at least 15 minutes
 Protect yourself
from exposure
 Remove patient’s
clothing
 Chemical Burns
 Management
 Protect yourself first
 HazMat
 Brush off dry
chemicals – then
flush with copious
amounts of water
(ensure water will
not make matters
worse)
 Flush for at least 20
minutes
 Allow fluid to run
away from wound
The End