Caring for Soft Tissue Injuries and Bleeding, Slides of Medicine

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Emergency Medical

Responder

Chapter 18

Caring for Soft Tissue Injuries and Bleeding

The Circulatory System: A Quick Review

Heart: The central pump.

Blood Functions: Carries O2/CO2, nutrients, and waste; helps

with regulation and defense against disease.

Blood Vessels:

Perfusion: The adequate supply of well-oxygenated blood to

organs. Shock is hypoperfusion.

Arteries: Carry blood away from the heart.

Veins: Carry blood back to the heart.

Capillaries: Microscopic vessels where O2/CO2 exchange

happens.

Identifying Types of External Bleeding

Arterial Bleeding

Spurting, pulsating, bright red blood. This is the most serious and difficult to control.

Venous Bleeding

A steady, flowing, dark red blood. It can be severe but is typically easier to control than arterial bleeding.

Capillary Bleeding

Slow, oozing, bright red blood. High risk of infection, but often clots easily on its own.

Common Types of Dressings

Sterile Dressings

Individually wrapped and free of germs. Gauze pads are the most common. Use these whenever possible.

Occlusive Dressings

An airtight dressing (e.g., petroleum jelly gauze, plastic wrap). Used for sucking chest wounds and eviscerations.

Hemostatic Dressings

Contain a substance that actively promotes clotting. Used in severe, life-threatening bleeding that is not controlled by direct pressure.

Common Types of Bandages

• Roller Gauze: The most common. Comes in various widths,

conforms easily, and is self-adherent.

• Triangular Bandage (Cravat): A large, triangular piece of

cloth. Can be used as a sling, a swathe, or folded into a

cravat to secure splints.

• Self-Adherent Bandage: Elastic, "stretchy" wrap that sticks

to itself. Use caution: very easy to apply too tightly and cut

off circulation.

• Improvised: Clean handkerchiefs, towels, or strips of cloth.

Rules of Bandaging: Application Technique

Wrap Distal to Proximal: Start at the point farthest from the heart and wrap towards the heart.

This prevents trapping blood in the limb.

Cover the Dressing: The bandage should completely cover the dressing, extending 1-2 inches

beyond its edges.

Check Tension: Bandage snugly, but not too tightly. It should be tight enough to apply pressure, but

not so tight it cuts off circulation.

Leave Fingers/Toes Exposed: Whenever possible, leave the digits exposed to make it easy to

re-check CSM.

Re-Check CSM: After the bandage is secure, immediately check Circulation, Sensation, and Motor

function again!

Special Bandage: Sling & Swathe

Used to immobilize an injury to the shoulder, clavicle, or arm.

• Sling: A triangular bandage used to support the weight of the injured arm. The hand should be slightly higher than the elbow.
• Swathe: A second bandage (often a cravat) that is wrapped around the entire chest and arm, holding the arm securely against the body.
• Remember to place padding in the armpit for comfort.

Care for Suspected Internal Bleeding

1. BSI & Scene Safety: Ensure the scene is safe.
2. Activate EMS: Request ALS (Advanced Life Support) immediately.
3. Manage Airway/Breathing: Provide high-flow oxygen per protocol.
4. Treat for Shock: Have the patient lie supine (flat on their back).
5. Keep Warm: Cover the patient with a blanket to prevent heat loss.
6. Rapid Transport: This is a life-threatening emergency that requires surgery.

Soft Tissue Injuries

● Soft tissues

○ Skin, muscles, nerves, blood vessels, fatty tissues, and cells

Types of Open Soft Tissue Injuries

Abrasion: A scrape or "road rash." The top layer of skin is removed. Painful, but bleeding is minimal.

High risk of infection.

Laceration: A cut, either smooth (incised) or jagged. Can bleed heavily depending on depth and

location. May be produced from the impact of a blunt object.

Puncture: A deep, narrow wound (e.g., from a nail). Little external bleeding but high risk of deep

infection. Always check for an exit wound. Stabilize impaled object by using bulky dressings

Do not remove the object

Avulsion: A tearing loose of a flap of skin, which may remain attached. Bleeds heavily.

Open wound: Skin has been damaged/Obvious bleeding