An alternate method is to use a 12- to 16-gauge intercatheter. Locate the cricothyroid membrane as described above and insert the needle into the trachea. Immediately upon penetration of the cricothyroid membrane, thread the plastic catheter into the trachea and remove the needle. Then connect the catheter to an oxygen line for translaryngeal oxygen jet insufflation. Do not attempt a cricothyroidotomy except as a last resort when other methods of opening the airway have been unsuccessful. SOFT TISSUE INJURIES LEARNING OBJECTIVE: Recognize the different types of wounds, and determine management and treatment procedures for open and internal soft-tissue injuries. The most common injuries seen by the Corpsman in a first aid setting are soft tissue injuries with the accompanying hemorrhage, shock, and danger of infection. Any injury that causes a break in the skin, underlying soft tissue structures, or body membranes is known as a wound. This section will discuss the classification of wounds, the general and specific treatment of soft tissue injuries, the use of dressings and bandages in treating wounds, and the special problems that arise because of the location of wounds. CLASSIFICATION OF WOUNDS Wounds may be classified according to their general condition, size, location, the manner in which the skin or tissue is broken, and the agent that caused the wound. It is usually necessary for you to consider these factors to determine what first aid treatment is appropriate for the wound. General Condition of the Wound If the wound is fresh, first aid treatment consists mainly of stopping the flow of blood, treating for shock, and reducing the risk of infection. If the wound is already infected, first aid consists of keeping the victim quiet, elevating the injured part, and applying a warm wet dressing. If the wound contains foreign objects, first aid treatment may consist of removing the objects if they are not deeply embedded. DO NOT remove objects embedded in the eyes or the skull, and do not remove impaled objects. Stabilize impaled objects with a bulky dressing before transporting the victim. Size of the Wound In general, since large wounds are more serious than small ones, they usually involve more severe bleeding, more damage to the underlying organs or tissues, and a greater degree of shock. However, small wounds are sometimes more dangerous than large ones since they may become infected more readily due to neglect. The depth of the wound is also important because it may lead to a complete perforation of an organ or the body, with the additional complication of entrance and exit wounds. Location of the Wound Since a wound may involve serious damage to the deeper structures, as well as to the skin and the tissue immediately below it, the location of the wound is important. For example, a knife wound to the chest may puncture a lung and cause interference with breathing. The same type of wound in the abdomen may result in a dangerous infection in the abdominal cavity, or it might puncture the intestines, liver, kidneys, or other vital organs. A knife wound to the head may cause brain damage, but the same wound in a less vital spot (such as an arm or leg) might be less important. Types of Wounds When you consider the manner in which the skin or tissue is broken, there are six general kinds of wounds: abrasions, incisions, lacerations, punctures, avulsions, and amputations. Many wounds, of course, are combinations of two or more of these basic types. ABRASIONS.—Abrasions are made when the skin is rubbed or scraped off. Rope burns, floor burns, and skinned knees or elbows are common examples of abrasions. This kind of wound can become infected quite easily because dirt and germs are usually embedded in the tissues. INCISIONS.—Incisions, commonly called cuts, are wounds made by sharp cutting instruments such as knives, razors, and broken glass. Incisions tend to bleed freely because the blood vessels are cut cleanly and without ragged edges. There is little damage to the surrounding tissues. Of all classes of wounds, incisions are the least likely to become infected, since 4-29