SOFT-TISSUE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 162

CHAPTER 12
SOFT-TISSUE INJURIES
James A. Wilkerson, M.D.
Principal Contributor
Lacerations, abrasions, bruises, and blisters are the most common injuries occurring in the
wilderness. They are called “soft-tissue” injuries to distinguish them from injuries to bones
and ligaments.
The treatment of soft-tissue injuries has four objectives:
Control of bleeding
Control of infection
Promotion of healing
Preservation of function in the injured part
CONTROLLING BLEEDING
Directpressureistheonlyeffectivemeansforcontrollingbleedingfromasoft-tissuewound.
The damaged blood vessels must be collapsed to obstruct blood flow and permit clots to
form. Pressure must be applied directly over the wound. Pressure points are not worth con-
sidering. Tourniquets can be dangerous and are needed or justifiable only for severe injur-
ies such as amputations, open-limb fractures complicated by arterial injuries, or gunshot
wounds that have penetrated a major artery. When such injuries are the result of falls, in-
jured individuals may bleed to death before anyone can get to them. (Falls severe enough to
produce amputations would often produce fatal injuries to other parts of the body.)
If a tourniquet is to be applied, it must be recognized that the tissues beyond the tourni-
quet are totally deprived of blood and may die, necessitating amputation. Pressure from the
tourniquet can also damage nerves.
Thetourniquetshouldbemadefromfabric,suchasatriangularbandagefoldedtomakea
bandonetotwoincheswide.Thebandshouldbeplacedaroundthelimbtwotothreeinches
abovetheinjuryandtiedinanoverhandorsquareknot.Astick,rod,orsimilarobjectshould
be placed on top of the knot and held in place with another square knot. The stick should
be rotated like a windlass until the bleeding stops. One end of the stick can be tied or taped
to hold it in place. The tourniquet should not be released until the injured individual is in a
situation where bleeding can be controlled by an experienced medical professional.
Bleeding frommostskinwoundsisfromveinsandcapillaries. Thepressureinthese ves-
sels is so low that simply holding a dressing on the wound for five minutes allows the blood
to clot and plug the vessels. Deeper lacerations may cut larger veins that bleed more pro-
fusely, such as the veins visible beneath the skin of the arms and legs, but bleeding from