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
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