MANAGEMENT  OF  SOFT  TISSUE INJURY Internal soft tissue injuries may result from deep  wounds,  blunt  trauma,  blast  exposure, crushing  accidents,  bone  fracture,  poison,  or sickness. They may range in seriousness from a simple contusion to life-threatening hemorrhage and  shock. Visible  indications  of  internal  soft  tissue  in- jury  include  the  following: 1. 2. 3. 4. 5. 6. 7. 8. Hematemesis - vomiting bright red blood. Hemoptysis  -    coughing   up   bright   red blood. Melena  -  excretion  of  tarry  black  stools. Hematochezia   -   excretion  of  bright  red blood  from  the  rectum. Hematuria  -  pass  blood  in  the  urine. Nonmenstrual  vaginal  bleeding. Epistaxis - nosebleed. Pooling of the blood near the skin surface. More  often  than  not,  however,  there  will  be no visible signs of injury, and the corpsman will have  to  infer  the  probability  of  internal  soft  tissue injury  from  other  symptoms  that  include: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Pale,  moist,  clammy  skin. Subnormal  temperature. Rapid,  feeble  pulse. Falling  blood  pressure. Dilated,  slowly  reacting  pupils  with  im- paired  vision. Tinnitus. Syncope. Dehydration  and  thirst. Yawning  and  air  hunger. Anxiety,  with  a  feeling  of  impending doom. There is little that a corpsman can do to cor- rect  internal  soft  tissue  injuries  since  they  are almost  always  surgical  problems.  The  hospital corpsman’s  goal  must  be  to  obtain  the  greatest benefit from the victim’s remaining blood supply. The  following  should  be  done: 1. 2. 3. Treat  for  shock. Keep the victim warm and at rest. Replace  lost  fluids  with  a  suitable  blood volume  expander  (refer  to  the  “Intra- venous  Therapy”  section  of  the  Nursing Procedures  Manual);  DO NOT give the vic- tim  anything  to  drink  until  the  extent  of the  injury  is  known  for  certain. 4. 5. 6. 7. Give  oxygen,  if  available. Splint injured extremities. Apply  cold  compresses  to  identifiable  in- jured areas. Transport the victim to a medical treatment facility  as  soon  as  possible. Dressings  and  Bandages A dressing is a pad or bolster of folded linen that is placed in direct contact with the wound. It should be large enough to cover the entire area of the wound and to extend at least 1 inch in every direction beyond the edges. If the dressing is not large enough, the edges of the wound are almost certain  to  become  contaminated. In   most   situations,   a   corpsman   will   have sterile,  prepackaged  dressings  available.  However, emergencies will sometimes arise when they will be impossible to obtain, or the supplies will run out.  In  such  a  situation,  use  the  cleanest  cloth available.  A  freshly  laundered  handkerchief, towel, or shirt may be used. Unfold these material carefully so that you do not touch the part that goes next to the skin. Always be ready to impro- vise, but never put materials directly in contact Figure 4-23.—Roller bandages. 4-26