Soft Tissue (Sherpath Notes)

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Soft Tissue Injuries

Soft tissue injuries, including sprains, strains, dislocations, and subluxations, usually result from trauma.

TYPES: They can be OPEN OR CLOSED

Crush Injuries are common ways to cause compartment syndrome - This type of injury most often happens when part of the body is squeezed between two heavy objects.

Ischemia (inadequate blood supply to an organ or part of the body) can occur within 4 to 8 hours after the onset of compartment syndrome. Any one of the six Ps characterizes compartment syndrome.

There are two basic causes of compartment syndrome:

Decreased compartment size resulting from restrictive dressings, splints, casts, excessive traction, or premature closure of fascia

Increased compartment contents related to bleeding, inflammation, edema, or intravenous infiltration

Dark urine is a sign of myoglobinemia from compartment syndrome resulting from release of myoglobin from damaged muscle cells. The nurse should increase fluid intake to promote kidney flushing and prevent acute kidney injury.

Elevate the extremity to lower venous pressure and slow arterial perfusion.

Do not elevate the extremity above the heart level if compartment syndrome is suspected.

Do not apply cold compresses because of the risk for vasoconstriction and increased risk for compartment syndrome.

1.) Pain - Out of proportion to the injury, not managed by opioid analgesics, and on passive stretch of muscle traveling through the compartment

2.) Pressure - Increasing pressure in the compartment

3.) Paresthesia - Numbness and tingling

4.) Paralysis - Loss of function

5.) Pallor - Coolness and loss of normal color of the extremity due to decreased oxygen to tissues.

6.) Pulselessness - Diminished or absent peripheral pulses

Nursing Care: If excessive edema is present or anticipated after a fraction or surgery (open reduction internal fixation), a splint or half-cast is often used to help reduce the risk for compartment syndrome. The nurse must perform circulation, motion, and sensation (CMS) checks every 2 hours minimally to assess blood flow to the affected extremity. Typically, a standard cast is applied days to weeks later after edema has resolved.

SPRAINS & STRAINS are the most common soft tissue injuries.

Both are classified as 1st, 2nd or 3rd degree.

SPRAINS

1st Degree: Minimal swelling & Tenderness

2nd Degree: Additional swelling

3rd Degree: Complete tearing of the ligament with moderate-to-severe swelling; extremely painful with gap in the muscle

STRAINS

First-degree: mild or slightly pulled muscle

Second degree: moderate or moderately torn muscle

Third-degree: severely torn or ruptured muscle

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Clinical Manifestations

Pain

Edema

Decreased Mobility & Function

Contusion (A Bruise)

Health care providers will order a STAT X-Ray as a priority to rule out a fracture and identify the cause of a patient's pain.

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Soft Tissue Types

Avulsion is a serious soft-tissue injury. It happens when a portion of the skin, and sometimes other soft tissue, is partially or completely torn away.

Amputation - Can partial or complete severance.

Crush (Closed Type) - Occurs when a great amount of force is applied to the body over time.

Puncture - Impaled object creates a small opening site, risk for infection is high.

Abrasion - Top layers of skin are scraped off. Raw, tender area left behind.

Laceration - Penetrates into the dermis, has jagged edges compared to an incision with clean edges.

Elevate extremity

Conduct a baseline neuromuscular assessment.

Apply compression bandage, except in dislocation

Apply ice packs

Immobilize affected extremity in the position found

Anticipate X-rays of injured extremity

Give analgesic drugs as prescribed

Administer tetanus and diphtheria prophylaxis if necessary

Administer antibiotic prophylaxis for large tissue defects or mangled extremity injury

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Nursing Interventions. Implement R.I.C.E.