An alternate method is to use a 12- to 16-gaugeintercatheter. Locate the cricothyroid membrane asdescribed above and insert the needle into the trachea.Immediately upon penetration of the cricothyroidmembrane, thread the plastic catheter into the tracheaand remove the needle. Then connect the catheter to anoxygen line for translaryngeal oxygen jet insufflation.Do not attempt a cricothyroidotomy except as alast resort when other methods of opening theairway have been unsuccessful.SOFT TISSUE INJURIESLEARNING OBJECTIVE: Recognize thedifferent types of wounds, and determinemanagement and treatment procedures foropen and internal soft-tissue injuries.The most common injuries seen by the Corpsmanin a first aid setting are soft tissue injuries with theaccompanying hemorrhage, shock, and danger ofinfection. Any injury that causes a break in the skin,underlying soft tissue structures, or body membranesis known as a wound. This section will discuss theclassification of wounds, the general and specifictreatment of soft tissue injuries, the use of dressingsand bandages in treating wounds, and the specialproblems that arise because of the location of wounds.CLASSIFICATION OF WOUNDSWounds may be classified according to theirgeneral condition, size, location, the manner in whichthe skin or tissue is broken, and the agent that causedthe wound. It is usually necessary for you to considerthese factors to determine what first aid treatment isappropriate for the wound.General Condition of the WoundIf the wound is fresh, first aid treatment consistsmainly of stopping the flow of blood, treating forshock, and reducing the risk of infection. If the woundis already infected, first aid consists of keeping thevictim quiet, elevating the injured part, and applying awarm wet dressing. If the wound contains foreignobjects, first aid treatment may consist of removing theobjects if they are not deeply embedded. DO NOTremove objects embedded in the eyes or the skull, anddo not remove impaled objects. Stabilize impaledobjects with a bulky dressing before transporting thevictim.Size of the WoundIn general, since large wounds are more seriousthan small ones, they usually involve more severebleeding, more damage to the underlying organs ortissues, and a greater degree of shock. However, smallwounds are sometimes more dangerous than large onessince they may become infected more readily due toneglect. The depth of the wound is also importantbecause it may lead to a complete perforation of anorgan or the body, with the additional complication ofentrance and exit wounds.Location of the WoundSince a wound may involve serious damage to thedeeper structures, as well as to the skin and the tissueimmediately below it, the location of the wound isimportant. For example, a knife wound to the chestmay puncture a lung and cause interference withbreathing. The same type of wound in the abdomenmay result in a dangerous infection in the abdominalcavity, or it might puncture the intestines, liver,kidneys, or other vital organs. A knife wound to thehead may cause brain damage, but the same wound in aless vital spot (such as an arm or leg) might be lessimportant.Types of WoundsWhen you consider the manner in which the skin ortissue is broken, there are six general kinds of wounds:abrasions, incisions, lacerations, punctures, avulsions,and amputations. Many wounds, of course, arecombinations of two or more of these basic types.ABRASIONS.—Abrasions are made when theskin is rubbed or scraped off. Rope burns, floor burns,and skinned knees or elbows are common examples ofabrasions. This kind of wound can become infectedquite easily because dirt and germs are usuallyembedded in the tissues.INCISIONS.—Incisions, commonly called cuts,are wounds made by sharp cutting instruments such asknives, razors, and broken glass. Incisions tend tobleed freely because the blood vessels are cut cleanlyand without ragged edges. There is little damage to thesurrounding tissues. Of all classes of wounds,incisions are the least likely to become infected, since4-29
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