First Aid Chapter 7

Soft Tissues

layers of skin and the fat and muscle beneath the skin's outer layer


An injury to the soft tissue

Closed Wound

The skin's surface is not broken. Tissue damage and any bleeding occur below the surface

Open Wound

The skin's surface is broken, and blood may come through the tear in the skin

Simplest closed wound



The force of the blow to the body damages the soft tissue layers beneath the skin. This causes internal bleeding. Blood and other fluids seep into surrounding tissue and causes the area to swell and change color.

What to look for (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/coughing up blood, excessive thirst, an injured extremity that is blue or extremely pale, altered mental state

When to call 911 (Internal bleeding)

a person complains of severe pain or cannot move a body part without pain, you think the force that caused the injury was great enough to cause serious damage, an injured extremity is blue or extremely pale, the person's abdomen is tender and distended, the person is vomiting blood/coughing up blood, person shows signals of shock or becomes confused, drowsy, or unconscious

Caring for a closed wound

apply an ice pack (decreases bleeding beneath the skin, helps control pain and swelling), apply it to the injured area for 20 minutes, remove the ice and wait for 20 minutes before reapplying. Elevate the injured part may help to reduce swelling, but only do it if it doesn't cause more pain. Help the person rest comfortably and make sure they don't get chilled or overheated.

Four types of Open wounds

abrasions, lacerations, avulsions, and punctures


Most common type of open wound. Usually caused by something rubbing roughly against the skin. Don't usually bleed much. Any bleeding that does occur comes from capillaries (tiny blood vessels). Dirt and germs often get rubbed into these wounds so it is important to clean with soap and water. Usually painful because scaling of the outer skin layers exposes sensitive nerve endings.


A cut in the skin. May not always be painful because damaged nerves cannot send pain signals to the brain.


A serious soft tissue injury. It happens when a portion of the skin, and sometimes other soft tissue, is partially or completely torn away. Causes significant bleeding. With amputations sometimes bleeding is easier to control because the tissues close around the vessels at the injury site.


Usually occur when pointed object such as a nail, pierces the skin. Do not bleed much unless a blood vessel has been injured. Object remains in the wound it is called an embedded object

When to call 911 (open wounds)

For any major open or closed wound

General care for open wounds

Includes controlling bleeding, preventing infection and using dressings and bandages

Preventing infection

For minor wounds after controlling bleeding, wash the area with soap and water and if possible irrigate with large amounts of fresh running water to remove debris and germs. You should not wash more serious wounds it is more important to control bleeding.

Early signs of infection

Area around the wound becomes swollen and red, throb with pain, discharge pus, serious infection may lead to fever. Red streaks may develop that progress from the wound toward the heart. If you see any signals of infection keep the area clean, soak it in clean warm water and apply an antibiotic ointment. Change coverings over the wound daily.

Determine if the person needs stitches

Will need to stitch a wound if the edges of skin do not fall together, the laceration involves the face or when any wound is over 1/2 inch long.

Major injuries often requiring stitches

bleeding from an artery or uncontrolled bleeding, wounds that show muscle or bone involve joints gape widely or involve hands or feet, wounds from large or deeply embedded objects, wounds from human or animal bites, wounds that if left unstitched could leave conspicuous scars such as those on the face


Are pads placed directly on the wound to absorb blood and other fluids and to prevent infection. Most dressings are porous allowing air to circulate to the wound to promote healing.

Occlusive dressing

A bandage or dressing that closes a wound or damaged area of the body and prevents it from being exposed to the air or water. By preventing exposure to the air, occlusive dressings help to prevent infection. They help to keep in place medications that been applied to the affected area. They also help to keep in heat, body fluids, and moisture. Improvised occlusive dressing is plastic wrap secured with medical tape. This can be used for certain chest and abdominal injuries.


Any material that is used to wrap or cover any part of the body. Bandages are used to hold dressings in place, to apply pressure, to control bleeding, to protect a wound from dirt and infection, and to provide support to an injured limb or body part.

Pressure bandage

Any bandage applied snugly to create pressure on a wound

Adhesive compresses

Consist of a small pad of nonstick gauze on a strip of adhesive tape that is applied directly to minor wounds

Bandage compresses

thick gauze dressings attached to a bandage that is tied in place. Specially designed to help control severe bleeding and usually come in sterile packages

Roller bandages

Made of gauze. A narrow bandage would be used to wrap a hand or wrist. It can be tied or taped in place.

When applying a roller bandage

Check for feeling, warmth, and color of the area below the injury site before and after applying the bandage, elevate the injured body part only if you do not suspect that a bone has been broken or if it causes more pain, secure the bandage in place with a turn of the bandage, tie or tape the bandage in place, do not cover fingers or toes. If fingers or toes become cold or begin to turn pale, blue, or ashen, the bandage is too tight and should be loosened. Apply additional dressings and another bandage if blood soaks through the first bandage.

Elastic roller bandages

sometimes called elastic wraps are designed to keep continuous pressure on a body part

Care for minor open wounds

use a barrier between your hand and the wound (disposable gloves and sterile dressing), apply direct pressure for a few minutes to control any bleeding, wash the wound thoroughly with soap and water (if possible irrigate an abrasion for about 5 minutes with clean warm running tap water), apply an antibiotic ointment to a minor wound, cover the wound with a sterile dressing and a bandage or with an adhesive bandage to keep the wound moist and prevent drying

Care for major open wounds

put on disposable gloves, control bleeding by covering the wound with a dressing and firmly pressing against the wound with a gloved hand until the bleeding stops, care for shock, have the person rest comfortably, wash your hands immediately after.


A tight band placed around an arm or leg to constrict blood vessels in order to stop blood flow to a wound. Should only be used a s a last resort.

Hemostatic Agents

Substances that speed clot formation by absorbing the excess moisture caused by the bleeding. Some types present a risk of further injury or tissue damage, the routine use of hemostatic agents in first aid settings is not recommended.


a special kind of soft tissue injury. Can damage the top layer of skin or the skin and the layers of fat, muscle, and bone beneath. Classified by their depth.

Three classifications of burns

superficial (first degree), partial thickness (second degree), full thickness (third degree). Also classified by their source heat (thermal), chemical, electrical and radiation

What to look for (superficial burns)

Involve only the top layers of skin, cause skin to become red and dry (usually painful and area may swell), usually heal within a week without permanent scarring

What to look for (partial thickness burns)

involves the top layers of skin, 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.

What to look for (full thickness burns)

May destroy all layers of skin and some or all of the underlying structures, the skin may be brown or black with the tissue underneath sometimes appearing white, and can either be extremely painful or relatively painless (if the burn destroys nerve endings), healing may require medical assistance, scarring is likely.

When to call 911 (burns)

Trouble breathing, burns covering more that one body part or a large surface area, suspected burns to the airway, burns to the head, neck, hands, feet, or genitals, full thickness burns and is younger than 5 years or older than 60 years, a burn caused by chemicals, explosions, or electricity.

What to do until help arrives (Heat Thermal Burns)

Check the scene for safety, stop the burning by removing the person from the source of the burn, check for life threatening conditions, cool the burn with large amounts of cold running water, at least until pain is relieved, cover the burn loosely with a sterile dressing, take steps to minimize shock, comfort and reassure the person, do not apply ice or ice water to any burn, 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.

What to do until help arrives (Chemical burns)

If the burn was caused by dry chemicals brush off the chemicals using gloved hands and remove any contemned clothing before flushing with tap water, flush the burn with large amounts of cool running water. Continue flushing the burn for at least 20 minutes. If an eyes ir burned flush the affected eye with water until EMS comes. Tilt the head so that the affected eye is lower than the unaffected eye as you flush. Have the person remove contaminated clothes.

What to do until help arrives (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 911, be aware that electrocution can cause cardiac and respiratory emergencies (CPR./AED), care for shock and thermal burns, look for entry and exit wounds, remember that anyone suffering from electric shock requires advanced medical care.

What to do until help arrives (radiation burns)

care for sun burns as you would for any thermal burns

Crush injuries

Caused by strong pressure against a body part. It may result in serious damage to underlying tissue, causing bruising, bleeding, lacerations, fractures, shock and internal injuries. Care for specific injuries found and assume that internal injuries are present.

Severed body parts

Call 911, try to find the part and wrap it in gauze, put the wrapped part in a plastic bag and seal the bag, keep the part cold and bag cool by placing it in a larger bag or container of an ice and water slurry.

Embedded Objects

If an object is embedded do not remove it. Place several dressings around it to keep it from moving.

Nose Injuries

Person sit with the head slightly forward while pinching the nose together for about 10 minutes

Mouth injuries

Make sure the person is able to breathe. Place the person in a seated position leaning slightly forward.

What to look for (Chest injuries)

trouble breathing, severe pain at the site of injury, flushed pale ashen or bluish skin, obvious deformity, coughing up blood, bruising at the sight, a sucking noise or distinct sound when the person breathes. Call 911 for any open or closed chest wound.

Caring for a sucking chest wound

Cover the wound with a large occlusive dressing. A piece of plastic wrap folded several times and makes an effective occlusive dressing. Tape the dressing in place except for one side.

What to look for abdominal Injury

severe pain, bruising, external bleeding, nausea, vomiting, weakness, thirst, pain/tenderness in the abdomen, organs protruding from the abdomen, rigid abdominal muscles, signals of shock