Soft Tissue Injuries, Bleeding, and

Burns

Lecturer : dr. Ratin Adira, Sp.B

 Learning Objective

Know how to handle mild to moderate soft tissue

injuries
Know the signs and symptoms of shock
Be able to identify methods of assessment and outline
measures to stabilize, treat, and transfer patients with
burn injuries.
Be able to list criteria for the transfer of patients with
burns
After the clinical skills station course
Perform initial treatment to control external bleeding
Identify shock condition and perform initial steps on a
simulation case patient
Demonstrate the initial assessment and treatment of
patients with burn injuries
 SOFT TISSUE INJURIES

Soft Tissue???
Skins Anatomy
 SOFT TISSUE INJURIES

Wound: injury to the soft tissue

Closed wound
Skin surface???
Open wound
Close Wound
Bruise

Develops when the body is bumped or hit

The force of the blow damages the soft tissue layers
beneath the skin causes internal bleeding
Blood and other fluids seep into the surrounding
tissues causing the area to swell and change color
Injury of larger blood vessels and deeper layers of
muscle tissue heavy bleeding beneath the skin
and damage to internal organs Shock
Do not assume that all closed
wounds are minor injuries
 Signals of internal bleeding

Tender, swollen, bruised or hard areas of the body,

such as the abdomen
Rapid, weak pulse
Skin that feels cool or moist or looks pale or bluish
Vomiting blood or coughing up blood
Excessive thirst
An injured extremity that is blue or extremely pale
Altered mental state, such as the person becoming
confused, faint, drowsy or unconscious
 What To Do??

Applying cold
Fill a plastic bag with ice and water or wrap ice in a
wet cloth and apply it to the injured area for 20
minutes.
Place a thin barrier between the ice and bare skin.
Elevating
Elevating the injured part may help to reduce
swelling
Do not elevate the injured part if it causes more pain
 Open Wound

The skin surface is break

4 Types of open wound
Abrasion
Laceration
Avulsion
Puncture
 Abrasion

The most common type

Caused by something rubbing
roughly against the skin
Abrasions do not bleed much
bleeding comes from capillaries
Dirt and germs frequently have
been rubbed into this type of
wound important to clean and
irrigate with soap and water
Painful because scraping of the
outer skin layers exposes sensitive
nerve endings.
 Laceration
Laceration is a cut in the skin, which
commonly is caused by a sharp
object, but also can occur when a
blunt force splits the skin.
Deep lacerations may cut layers of
fat and muscle, damaging nerves
and blood vessels.
Bleeding may be heavy or there may
be none at all.
Lacerations are not always painful
because damaged nerves cannot
send pain signals to the brain.
Infection can easily occur.
 Avulsion

Avulsion is a portion of the skin

and/or soft tissue are partially
or completely torn away.
This type of injury often
damages deeper tissues, causing
significant bleeding.
 Puncture

Puncture occur when a

pointed object pierces the
skin.
Do not bleed much unless a
blood vessel has been
injured.
An object that goes into the
soft tissues beneath the skin
can carry germs deep into
the body infection
 What to do?

Control bleeding and prevent infection direct

pressure, dressings and bandages
Use Tourniquet
as a last resort in cases of delayed care
direct pressure does not stop the bleeding
you are not able to apply direct pressure
What to do???
 Initial Assessment of TRAUMA/INJURY patient

A: Airway Management + C-Spine Protection

B: Breathing + Ventilation
C: Circulation + Hemorrhage Control
D: Disability
E: Exposure/Environment (completely undress the patient
and prevent hypothermia)
 Shock

Classic signs and symptoms of shock are tachycardia,

hypotension, tachypnea, mental status changes,
diaphoresis, and pallor.
 Shock

The goal of fluid resuscitation is to re-establish tissue

perfusion.
Fluid resuscitation begins with a 2 L (adult) or 20 mL/kg
(child) IV bolus of isotonic crystalloid (Ringer's lactate).
For persistent hypotension, this is repeated once in an adult
and twice in a child before red blood cells (RBCs) are
administered.
Adequate urine output is 0.5 mL/kg per hour in an
adult, 1 mL/kg per hour in a child, and 2 mL/kg per
hour in an infant <1 year of age.
 Burn Injury

Burns are a special kind of soft tissue injury.

Classified as thermal, electrical, or chemical burns
Burns are classified by their depth.
superficial (1st degree),
partial thickness (2nd degree): Superficial, Deep
full thickness (3rd degree).
 Superficial Burns (1st degree),

Involve only epidermis.

Cause skin to become
red and dry
Painful and the area
may swell.
Heal within a week
without permanent
scarring.
Ex: sunburn
 Partial Thickness burns (2nd degree)

Involve epidermis +
partial dermis
Cause skin to become
red; usually painful; have
blisters that may open
and weep clear fluid,
making the skin appear
wet; may appear mottled;
and often swells.
Usually heal in 3 to 4
weeks and may scar.
 Full Thickness burns (3rd degree)

Destroy all layers of skin

(epidermis, dermis) and
some or all of the
underlying structures
The skin may be brown or
black (charred), with the
tissue underneath
sometimes appearing
white
Painless
Healing may require
medical assistance;
scarring is likely
Estimating total body surface area burned

Rule of nine
 The Lund and Browder chart

a more precise estimate of burn TBSA

based on the individuals age.
 When To Call For Help

Trouble breathing.
Burns covering more than one body part or a large surface
area (2nd degree burns >20%; >10% in <10 or >50 years
old).
3rd degree burns > 5% in any age group.
Suspected burns to the airway inhalation injury
Burns to the head, neck, hands, feet or genitals.
A burn caused by chemicals, explosions or electricity.
Burn injury in patients with pre-existing medical disorders
Any burn patient with concomitant trauma (for example
fractures)
 What To Do Until Help Arrives

Heat burns :
Check the scene for safety.
Stop the burning by removing the person from the source
of the burn.
Check for life-threatening conditions.
As soon as possible, cool the burn with large amounts of
cold running water, at least until pain is relieved. Beware of
hypothermia
Cover the burn loosely with a sterile dressing.
Take steps to minimize shock. Keep the person from getting
chilled or overheated.
Comfort and reassure the person.
Heat burns :
Do not apply ice or ice water to any burn. Ice and ice water
can cause the body to lose heat rapidly and further
damages body tissues.
Do not touch a burn with anything except a clean covering.
Do not remove pieces of clothing that stick to the burned
area.
Do not try to clean a severe burn.
Do not break blisters.
Do not use any kind of ointment on a severe burn
 Chemical burns

The chemical will continue to burn as long as it is on the skin

remove the chemical from the skin as quickly as possible.
Dry chemicals brush off using gloved hands or a towel and
remove any contaminated clothing before flushing with tap
water.
Flush the burn with large amounts of cool running water (20
minutes or until EMS personnel take over).
If an eye is burned by a chemical flush the affected eye with
water.
If possible, have the person remove contaminated clothes to
prevent further contamination.
Be aware that chemicals can be inhaled, potentially damaging
the airway or lungs.
 Electrical burns

Never go near the person until you are sure he or she is not still
in contact with the power source
Turn off the power at its source and care for any life-threatening
conditions.
Call the local emergency number.
Care for shock and thermal burns.
Look for entry and exit wounds and give the appropriate care.
Be aware that electrocution can cause cardiac and respiratory
emergencies.
Any person who has suffered an electrical shock needs to be
evaluated by a medical professional to determine the extent of
injury.
 Management Burn Injury
IV Access resuscitation: Parkland Formula

Escharotomy (if necessary)

Topical wound agent
Surgery
 Reference
1. Advanced trauma life support student course manual
8th edition. American College of Surgeon Committee
on Trauma, 2008.
2. First aid/ CPR/AED participants manual 4th edition. The
American National Red Cross, 2011.
3. Barraclough N. First aid made easy edition 7.1.
Qualsafe Limited, 2008.
4. Schwartz Principles of Surgery. 9th edition. 2010
5. Trauma. 6th Edition. 2008
6. Grabb & Smiths Plastic Surgery. 6th dition. 2007
Thank You