SOFT TISSUE INJURIES

The Skin and the Soft Tissue:

A. Three Major Functions of the Skin:
1. To protect the human body in the environment. (protection)
2. To regulate the temperature of the body. (thermoregulation)
3. To transmit information from the environment to the brain. (sensation)
Protective Functions of the Skin:
Note that over 70% of the body is composed of water.
1. The water contains a delicate balance of chemical substances.
2. The skin is watertight and serves to keep this balanced internal solution intact.
3. The skin protects the body from the invasion of infectious organisms.
B. Two Parts of the Skin:
1. Superficial Epidermis
2. Deeper Dermis
C. Subcutaneous Tissue it is the soft tissue below the dermis; it is composed largely of fat, which
serves as an insulator for the body and as a reservoir for storing energy.
Soft Tissue Injuries and Their Care:

WOUND it is a break in the continuity of a tissue of the body, either internal or external.
A. Common Causes:
1. External physical forces.
2. Mishandling of sharp objects, tools, machinery, weapon & equipment.
3. Explosion.
B. Classifications of Soft Tissue Injuries:
1.

CLOSED SOFT TISSUE INJURY it is a wound without break or damage in the skin
or mucous membrane; a closed wound.
a. Causes:
1. Contact with blunt objects, resulting in contusions (bruises).
2. Application of external forces such as motor vehicle accidents and falls.
b.

Other Injuries Which May Be Involved:

1. Damage beneath the epidermis, depending on varying depth.
2. Damaged cells and small blood vessels that are usually torn, depending on the
extent of force.
3. Varying amounts of edema fluid and blood that leak into the damaged area.
4. Possible fracture.

c.

Signs and Symptoms:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Pain and tenderness

Swelling
Discoloration (ecchymosis black/blue color)
Hematoma (pool of blood within damaged tissue)
Uncontrolled restlessness
Thirst
Symptoms of shock
Vomiting or coughed up blood (usually in head injury)
Passage of blood in the urine or feces
Signs of blood along mouth, nose, and/or ear canal

d. First Aid for Closed Soft Tissue Injuries: (R - I - C - E - S)

R Rest
I Ice application
C Compression
E Elevation
S Splinting
3.

OPEN SOFT TISSUE INJURY it is a break in the skin or mucous membrane such
that the protective skin layer is damaged; an open wound.
a. Kinds of Open Wounds (P - A - I - L - A)

Kinds

Causes

Characteristics

Danger

Puncture

Penetrating pointed
instruments such as
nails, ice picks,
daggers, etc.

Deep & narrow;

serious or slight
bleeding; dirty

Internal
hemorrhage,
infection and
shock

Abrasion

Scrapping or rubbing
Shallow; wide;
Against rough surfaces oozing of blood;
dirty

Infection

Incision

Sharp instruments
like knives, scissors,
bolos, etc.

Clean cut; deep;

severe bleeding;
wound is clean

Infection and
shock

Laceration

Blunt instruments
such as shrapnel,
rocks, etc.

Torn with irregular

edges; serious
bleeding

Hemorrhage,
infection and
shock

Avulsion

Explosion; animal

Tissue forcefully

Infection,

bites; mishandling of
tools & equipment

separated from
the body

hemorrhage
and shock

b. Kinds of Bleeding:
1. CAPILLARY BLEEDING the most common type of bleeding; capillary oozing;
can be ordinarily controlled by Band-Aid or sterile pad; expected in all minor cuts,
scratches and abrasions.
2. VENOUS BLEEDING characterized by an even flow of blood. Blood is dark red
with a bluish hue. Blood loss is slower but can eventually lead to shock.
3. ARTERIAL BLEEDING characterized by the irregular spurting of blood. Blood
is bright red. Blood loss is rapid and quickly leads to shock.
c.

First Aid for Open Soft Tissue Injuries:

1. Wounds with severe bleeding (4 Cs)
C Control bleeding!
- mainly, direct pressure on the wound will constrict the blood
vessels manually, helping to stem blood flow. Apply direct pressure,
except on eye injuries, wounds with embedded objects, and head
injuries.
- elevation; keeping the wound above the level of the heart will decrease
the pressure at the point of injury, and will reduce the bleeding. This
mainly applies to limbs and the head, as it is impractical (and in some
cases damaging) to attempt to move the torso around to achieve this.
- pressure point bleeding control
(pressure bandage)
C Cover wound with dressing and bandage!
C Care for shock!
C Consult physician!
NOTE: DO NOT USE TOURNIQUETS! These should never be used to control
serious bleeding except by fully trained medical professionals, and only by them
as an absolute last resort. The scenario in which use of tourniquet is most likely
is when a limb has been partially or wholly severed, when it has very little chance
of survival anyway.
2. Minor wounds with non-severe bleeding, (home care)
Clean wound with soap and water.
Apply mild antiseptics (H2 O2 ; povidone iodine).
Cover wound with dressing and bandage.

General Guidelines in Giving Emergency Care:

1. All wounds must be thoroughly inspected and covered with a dry, sterile compression
dressing to control bleeding and prevent further contamination.
2. Once bleeding is controlled by compression, the limb should be splinted to further control
bleeding, stabilize the injured part, minimize the victims pain, and facilitate the patients
transport to the hospital.

3. As with closed soft tissue injuries, the injured part should be elevated to just above the level
of the victims heart to minimize severity.
4. Amputated body parts should be saved, wrapped in a dry sterile gauze, placed in a plastic
bag, kept cool, and transported with the victim to the hospital.
5. Do not touch the wound with bare hands. Always wear gloves or anything that can cover the
hands.
6. Do not induce further bleeding to clean the wound.
7. Do not use absorbent cotton as a dressing.
Dressing and Bandaging:
DRESSING it is any material held over a wound to stop it from bleeding and to protect it from
infection. Some types of dressings are:

Sterile dressings these dressings are made up from a sterile gauze pad that is covered with a
layer of cotton wool and then a bandage.
Adhesive dressings also known as plasters, these come in variety of shapes and sizes (some
are specifically designed to fit a finger or particular body part.)
Non-adhesive dressings these non-fluffy dressings can be applied directly onto a wound and
will not stick.
Occlusive dressings these dressings are generally made with a waxy coating so as to provide a
total seal, and as a result do not have the absorbent property of gauze pads. They are typically
used to treat open, sucking chest wounds to alleviate or prevent tension pneumothorax.
Makeshift dressings when sterile dressing is not available, use the cleanest, non-fluffy material
available.

BANDAGES hold dressings in place. Effective bandaging has several roles: It controls bleeding,
ensures that the dressing stays firmly in place, and it immobilizes and supports the injured limb. The
three basic types of bandages are:

Roller bandages, for securing dressings and supporting limbs.

Triangular bandages, for making slings or securing large dressings.
Tubular bandages, for supporting injured limbs and holding dressings on digits.

Dressing and Bandaging Guidelines:

1. Skin is not sterile. If a dressing slips over the victims skin while you are trying to position it,
discard it and use a fresh one. Place the dressing over the wound; do not slide it into place.
2. Use a dressing large enough to extend at least 1 inch beyond the edges of the wound.
3. Avoid touching the dressing where it will come into contact with the wound; hold it at the
sides so that it stays sterile and the risk of infection is less.
4. If body tissues or organs are exposed, cover the wound with a dressing that will stick. Then
secure the dressing with a bandage or adhesive tape.
5. Never take off a dressing, even if a wound continues to bleed through it. Instead, apply more
dressing material on top of the first until bleeding is controlled.
6. If the bandage is over a joint, splint and make a bulky dressing so that the joint remains
immobilized. If there is no movement of a wound over a joint, there should be improved
healing and educed scarring.
7. A bandage should fit snugly but should not cut off circulation or cause the victim discomfort. If
the area beyond the wound changes color, or begins to tingle or feel cold, or if the wound
starts to swell, the bandage is too tight and should be loosened.
8. Bandaging technique depends upon:
Size and location of the wound.
Your first aid skills.
Materials at hand.
9. Bandages must:

be C careful
be A accurate
be N neat
E end with a square knot
be S speedy and snug

Use of Triangular Bandages:

A. Open Phase

Top of head
Face; back of head
Chest; back
Hand; foot
Arm sling
Underarm sling

B. Cravat Phase

Forehead; eye
Ear; cheek; jaw
Shoulder; hip
Arm; leg
Elbow; knee (straight, bent)
Palm pressure bandage
Palm bandage of open hand
Sprained ankle bandage (shoe-on; shoe-off)

First Aid for Specific Body Injuries:

A. EYE INJURIES
1. Foreign Body in the Eye
A foreign body in the eye may not be visible. Sometimes a scratch on the surface of the eye
gives the sensation of something in the eye when, in fact, nothing is there.
Wash your hands thoroughly.
Examine the affected eye in good light to help locate the foreign body. Have the victim
look all around as you examine the eye.
If you cannot find the foreign body, look inside the victims lower eyelid. Have the victim
look up as you gently pull down his/her lower lid. If you can see the object on the inner
surface of the eyelid, try to flush it out with water or to lift it off with a clean cloth (not a
tissue or cotton swab!). If you are unable to remove the object using these methods, get
medical help.
If you cannot locate the foreign body, or if you removed it but the victim still has
discomfort, cover both his/her eyes with eye patches or dry, protective dressing (to
discourage eye movement) and get medical help. Having the eyes bandaged can be
frightening, so remember to calm and reassure the victim.
If, after having something removed from the eye, the victim develops any unusual signs
and symptoms involving the eye, get medical help.
2. Object Stuck in the Eye
Any penetrating injury of the eye requires immediate medical attention even if the object in the
eye is small.
Leave the stuck object in place. Do not touch it and do not let anything press on it!
Wash your hands thoroughly.
How you bandage the eye depends upon the size of the object embedded in it.
If the object is large, place a paper cup or cone over the injured eye and tape or bandage
it in place. Cover the uninjured eye with an eye patch or a sterile dressing.
If the object is small, cover both eyes with eye patches or sterile dressing.
Calm and reassure the victim, since having the eyes bandaged can be frightening.
Keep the victim calm until you have medical help.
3. Chemical Exposure

Flush the eyes with lots of fresh water for at least 15-30 minutes, or until you have medical
help. You may have to force the victims eye open.
If both eyes are affected, or if other parts of the victims body are affected, have the victim
take a shower.
Take out contact lenses after the eyes have been thoroughly rinsed.
Cover both eyes with eye patches or sterile dressing until you have medical help. Even if
only one eye is affected, covering both eyes will help discourage eye movement.
How to Flush the Eye with Water:
The safest way to deal with a foreign object or substance in the eye is to flush the eye
liberally with sterile saline solution. If there is none, use tap water. If the victim is wearing
contact lenses, do not remove them before flushing the eye.
1. Tilt the victims head so that the affected eye is down. Be careful not to touch or
contaminate the unaffected eye.
2. With one hand, pour a steady stream of water from the inside corner of the eye (next
to the nose) to the outside corner.
3. With your other hand, hold the victims eyelid open to make sure the eye is properly
flushed. Keep flushing the eye for 15-30 minutes or until you have medical help.

4. If both eyes are affected, have the victim open his/her eyes under water in a bowl of
fresh water. If you are washing chemicals from the victims eye, use a stream of fresh
water. If possible, put the victim under a shower.
5. Remove contact lenses after flushing.
4. Burns

Immediately flush the eyes with cool water to reduce swelling and relieve pain. If flushing
makes the pain worse, stop.
A light, cool compress may be helpful. But do not apply pressure and do not use a fluffy
(cotton) bandage!
If the white of the eye or if the area around the eye swells, or if the victim experiences any
visual problem, get medical help.

B. FACIAL INJURIES

Check the victims ABCs. Begin AR, CPR, or control bleeding, if necessary.
If the victims ABCs are present but the victim is unconscious, give first aid for head injury.
Try to determine whether or not spinal injury may have occurred.
If you are in doubt, and if the victim is unconscious, assume that spinal injury has occurred.
If spinal injury is not suspected, place the victim in recovery position to allow fluids to drain.
If the victim is conscious, an alternative is to have him/her sit down and lean forward.
With a finger sweep, clear the victims airway of any fluid or debris.
If there is severe bleeding in the mouth, and you have a suction bulb, suction out the blood.
If the airway is still obstructed, give first aid for choking.
Continue to monitor the victims airway; keep it clear.
Monitor the victim for signs of serious head injury. If the victim has severe facial injuries and is
not talking or claims not to be in much pain, suspect that judgment has been impaired by
serious facial injury.
Control severe facial or mouth bleeding by applying direct pressure. If you suspect broken
facial bones, apply pressure gently.
Administer first aid for wounds as needed.
If the victim may have broken his/her jaw, do not put anything in his/her mouth. Apply cold
compress to help relieve the pain and stop the bleeding.
Care for any dental injuries.
Seek medical and dental care as needed.

Wounds to the face can be disfiguring and often are treated differently from wounds elsewhere in
the body. Special attention is given to the cause of the wound and the portion of the face where
the wound occurred.
C. DENTAL INJURIES

Save any teeth that have been knocked out for possible re-implantation.
Apply cold compress for pain.
Apply direct pressure to control bleeding.
Seek immediate dental attention.

D. EAR INJURIES
1. Injury to the Outer Ear

If there is bleeding from cuts on the outer ear, apply direct pressure. Give first aid for
wounds.
If any tissue has been amputated, collect it and seek immediate medical assistance. Do
not assume that severed tissue cannot be reattached!

Watch the injured ear for drainage either bloody or clear fluid from the ear canal.
Cover the entire ear with a sterile dressing that conforms to the contour of the ear and
tape it loosely in place.
Apply cold compress on the dressing to help reduce pain and swelling.
Get medical help.

2. Drainage from Inside the Ear

Cover the outside of the ear with a sterile dressing that conforms to the contour of the ear
and tape it loosely in place.
To promote drainage, have the victim lie down on his/her side with the affected ear down.
Do not move the victim if you suspect neck or back injury!
Get medical help.

3. Foreign Body Stuck in the Ear

Calm and reassure the victim, who may be very disturbed.

Look inside the ear.
If you can clearly see the foreign body at the entrance of the ear canal and the victim
is cooperative, turn the victims head so that the affected ear points down and gently
remove the object with tweezers. Then get medical help to make sure that the entire
object has been removed.
If you think a small object may be lodged within the ear but you cannot see it, do not
reach inside the ear canal with tweezers. Get medical help.
If an insect is in the ear, do not let the victim poke a finger into his/her hear, since this
may make the insect bite or sting.
- First, turn the victims head so that the affected ear is up and wait to see if the
insect crawls out. If this does not work, if medical help is not nearby, and if the
victim is in intense pain, place a few drops of room temperature oil (mineral oil,
baby oil, cooking oil, or olive oil) in the ear canal to drown the insect. Then get
medical help. Use oil if you are certain that the foreign body is an insect since oil
can cause other kinds of objects to swell.

4. Ruptured Eardrum
If you suspect the victim may have ruptured eardrum (there is severe pain), place sterile
cotton gently on the outer ear canal to keep the inside of the ear clean. Get medical help.
E. NOSE INJURIES
1. Nosebleeds

Have the victim sit down and lean forward to help keep blood from going down the back of
his/her throat.
Check to see if there is an object in the victims nose and remove it if necessary.
If you can see clots in the nostril, have the victim blow them out. Then pinch the soft part
of the victims nose firmly for a full 15 minutes without releasing. Have the victim breathe
through his/her mouth. Place a cold compress on the bridge of the nose.
If the victims nose is still bleeding after a second attempt, get medical help.

2. Object Lodged in the Nose

Determine which nostril is affected. But do not have the victim breathe in sharply, since
this may force the object further up the nose.
Gently press the other nostril with one finger.
Have the victim blow his/her nose.

If the object is still lodged, give some pepper to sniff and encourage the victim to sneeze.
If the object is still lodged, get medical help.

3. Broken Nose

Have the victim sit down and lean forward to help keep blood from going down the back of
the throat.
Have the victim apply cold compress to the nose until you get medical help. (You can
apply the compress yourself but the victim will better know how much pressure to apply.)

F. HEAD INJURIES

Check the victims ABCs. Begin AR, CPR, or control bleeding, if necessary.
If the victims ABCs are present but the victim is unconscious, care for the victim as if
there is a spinal injury.
If the victim is conscious, keep him/her calm. Encourage the victim to lie still and not
to attempt to get up.

Give first aid for any obvious injuries. If you suspect the skull may be fractured, do not apply
pressure to the bleeding site and do not remove any debris from the wound. Cover the wound
with sterile dressing and get immediate medical help.
If the victim starts having seizures, protect the head by placing cushions around it. Remove
any harmful objects from the area and give first aid for convulsions.
Vomiting is common with head injuries. Take steps to protect the victims airway.
Apply ice to areas of swelling.
Get medical help.

G. CHEST INJURIES

Check the victims ABCs. Begin AR, CPR, or control bleeding, if necessary.
If there are no open wounds but the victims chest moves in an uneven way as he/she
breathes, suspect broken ribs. Firmly support the injured chest.
If there are open wounds in the neck or chest, they must be closed immediately, especially if
air bubbles appear in the wound. Bandage the wound at once.
A sucking chest wound allows air to enter the victims chest cavity as he/she breathes. This
can cause a collapsed lung. Bandage the wound with plastic wrap, a plastic bag or gauze
pads covered with petroleum jelly. Sealing it prevents air from entering the chest through the
wound.

H. GENITAL INJURIES

I.

Calm and reassure the victim. As you give first aid, maintain privacy for the victim and shield
the injured area.
Use direct pressure to control external bleeding. Place a sterile dressing over any open
wounds. If there is severe bleeding from the vagina, pack the area with sterile gauze or clean
washcloths.
Apply cold compress to reduce swelling.
If the testicles have been injured, support them with a sling made from folded towels laid
across the victims thighs.
If an object is embedded in a body opening or wound, leave it alone.
Get medical help.

OTHER SPECIFIC INJURIES

1. Infection

Immobilize the entire infected area.

Elevate the affected body part.
Apply heat to the area with hot water bottles.
Refer to a physician.

2. Animal and Human Bites

If you have an animal or human bite, you generally need medical attention because of
possible infection. If the victim was bitten by an animal, you will need to contact authorities so
they can find out whether or not the animal has rabies. Rabies is a rare but potentially fatal
disease transmitted by the saliva of a rabid animal.
Calm and reassure the victim. Put on gloves or wash your hands.
Check for bleeding.
If the bite is not bleeding seriously, wash it well (for at least 5 minutes) with
mild soap and running water, then apply a bandage.
If the bite is actively bleeding, control bleeding. Do not attempt to clean a
wound that is actively bleeding.
Get medical help, especially if signs and symptoms of infection develop.
NOTE: Everyone should be up to date on tetanus immunization.
3. Amputation

Check the victims ABCs. Begin AR, CPR, or control bleeding, if necessary.
Calm and reassure the victim since amputation is painful and extremely frightening.
Control bleeding as discussed under first aid for severe bleeding wound.
Save and keep with the patient any severed body part.
Care for shock.
Stay with the victim until you have medical help.

How to Save an Amputated Part:

1. After you give first aid to the victim, try to find and save any severed body parts. It is
important to bring an amputated part to the hospital; it may be used to repair the wound.
2. Gently raise any obvious debris off the part.
3. If ice is available, wrap the part in a moistened dressing (a clean towel, washed cloth or
gauze will do). Place the wrapped part in a plastic bag or sealed container then place it on
a bag of ice and water. Cooling the part will keep it viable for about 18 hours. Do not use
dry ice! Do not place the part directly on the ice!
4. If ice is not available, place the part directly in a plastic bag or sealed container without
wrapping it in a dressing. The part will remain viable for about 4-6 hours.
5. Label the container holding the part with the victims name and the time of the accident.
6. Keep the part with the victim. Do not take it to the hospital separately!

BURN it is an injury involving the skin, muscles, bones, nerves, and blood vessels. It results from
heat, chemicals, or radiation. It may vary in depth, size, and severity, and it may cause cell damage in the
affected area.
Types of Burns and Corresponding First Aid:
1. Thermal Burns caused by heat; the most common type of burn.
a. Signs and Symptoms:
st
Red skin (1 degree)
st
Swelling (1 degree)

nd

Blistering (2 degree)
rd
Peeling of skin (3 degree)
rd
White or charred skin (3 degree)
nd
Pain (2 degree is the most painful)
Shock (watch for pale and clammy skin; weakness; bluish lips and fingernails;
decreasing alertness)
For airway burns: Charred mouth; burnt lips; singed nose hairs or eyebrows;
burns on the head, face, and neck; difficulty breathing; coughing.

b. Seriousness of Thermal Burns:

Factors to determine the seriousness:
st
nd
rd
Depth (1 , 2 , or 3 degree)
Amount of surface area (Rule of Nine*)
Involvement of critical areas (hands, feet, face, genitalia)
The patients age (very young low pain tolerance, underdeveloped
functions; very old deteriorating functions)
The patients general health (note if there are other injuries or illnesses
present)
* Rule of Nine it is a useful means of estimating the percentage of total body
surface that has been burned.
Head: 9%
Chest: 9%
Abdominal area: 9%
Upper back: 9%
Lower back: 9%
Left and right upper extremities: 9% each
Left and right lower extremities: 9% each (front); 9% each (back)
Genital area: 1%
Critical burns are the most serious; they include:
All burns complicated by fractures
Any degree of respiratory injury
rd
3 degree burns that involve >10% of the body surface area
nd
2 degree burns that involve >25% of the body surface area
Any otherwise moderate burn in an elderly or critically ill patient
rd
nd
For children, any 3 degree burn and any 2 degree burn of >20% of the
body surface area
Moderate burns:
rd
3 degree burns that involve 2-10% of the body surface area (excluding
the hands, feet, or genitalia)
nd
2 degree burns that involve 15-25% of the body surface area
st
1 degree burns that involve 50% or more of the body surface area
nd
For children, 2 degree burn of 10-20% of the body surface area
Minor burns:
rd
3 degree burns that involve <2% of the body surface area
nd
2 degree burns that involve <15% of the body surface area
nd
For children, 2 degree burn of <10% of the body surface area
c.

First Aid:
Stop the burning process and prevent further injury.
Cover the burned area with a dry, sterile, non-adhesive dressing to decrease
heat loss and decrease the risk of infection.
Support the victims vital functions.

 Seek medical help.

If the fingers or toes have been burned, separate them with a dry, sterile, nonadhesive dressing.
For airway burns:
Maintain open airway. Do not place a pillow under the victims head.
Conscious victim: Place him/her in a position easiest for him/her to
breathe.
Unconscious victim (and you do not suspect spinal injury): Place him/her
in the recovery position.
d. Some Reminders:
If the victims clothing is still on fire, wrap him/her in a blanket or use a dry
chemical fire extinguisher.
Remove any smoldering clothing.
If skin and clothing are still hot, immerse them in cool water or cover them with
wet dressing to relieve pain.
Do not immerse the burnt area for more than 10 minutes. Never use ointment,
lotion, or antiseptic of any kind. Do not disturb blisters or dead skin.
Care for shock.
2. Chemical Burns occur from any toxic substance that comes in contact with the body.
a. Causes:
Strong acid
Strong alkali
Strong chemical fumes
b. First Aid:
Basically the same as first aid for thermal burns.
Do not try to find something to neutralize the chemical, but flood the area with
water immediately. Do not direct a forceful stream of water from a hose to the
affected area, since that pressure may add mechanical energy to the burned
skin.
Brush off powdered chemicals first (do not blow them off) before flushing the
injured area with water.
Continue flooding the burned area for 10 minutes after the burning pain has
stopped.
3. Electrical Burns may occur as a result of contact with high or low voltage electricity.
a. Causes:
Faulty electrical equipment
Careless use of appliances
b. First Aid:
Administer RB or CPCR, if needed.
Place a dry, sterile dressing on the affected area.
Apply a splint if there is a suspected fracture.
c.

Dangers Associated with Electrical Burns:

Amount of deep tissue injury may be very great.
The burn may be accompanied by cardiac arrest from the electrical shock with
further complicates the victims injury.

d. Some Reminders:
All electrical burns are potentially severe injuries and may likely require further
treatment.

 Never move a downed wire unless you are absolutely certain that it is not live or
you have had special training and have the necessary equipment to handle live
electrical wire.
High voltage can cause:
Destruction of muscle and skin.
Amputation may become necessary.
An electric shock can cause:
Disruption of the normal electrical rhythm of the heart.
Fracture or dislocation.
Compression fracture of the vertebrae.
Posterior dislocation.