Chapter 26 - Soft Tissue Injuries

Which of the following statements regarding crush syndrome is correct?

Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours.

Closed soft-tissue injuries include

Contusion (bruise) Hematoma Crushing injury Crush syndrome Compartment syndrome

Which type of soft-tissue injury is LEAST likely to result in infection?

Contusions on the left lateral chest Contusions are closed injuries and are less likely to become infected.

Crush syndrome

Crush syndrome is significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods. This can lead to renal failure or death.

The severity of a thermal injury directly correlates with temperature, concentration, and what other factor?

Duration of exposure The severity of a thermal injury directly correlates with temperature, concentration, and duration.

You are responding to a fight at a restaurant and find a man, conscious and alert. His face is mottled with blisters and abrasions, and he has blood on his shirt. He tells you he was trying to stop the fight when he was hit in the face with scalding hot coffee and fell backwards over a chair. According to the rule of nines, what percentage of the patient's skin surface is burned?

The burns are on his face, which, according to the rule of nines, constitutes 9% of an adult's body area.

Which of the following is true about electrical burns?

They are always more severe than the external signs indicate A major danger associated with electrical burns is the amount of deep tissue damage done. Electrical burns are always more severe than the external sign

Crushing injury

occurs when significant force is applied to the body. continued compression of the soft tissues cuts off circulation, producing further tissue destruction.

Hematoma

occurs whenever a *large blood vessel is damaged* and bleeds rapidly.

As you approach a young male who was involved in an industrial accident, you note that his eyes are closed and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with minimal bleeding, and a closed deformity to his right leg. You should:

open his airway and assess his breathing status.

The hallmark sign of compartment syndrome is:

pain out of proportion to the injury.

Characteristics of closed injuries

• A history of blunt trauma • Pain at the site of injury • Swelling beneath the skin • Discoloration

You are treating an 8-year-old who fell while riding his bike on a gravel road. The wound on his arm is seeping blood, is about 7 inches long, and there is a lot of dirt and gravel in it. How should you treat this injury?

Apply sterile dressing. In general, you should not remove material from an open wound, no matter how dirty the wound is. By applying a sterile dressing, you are reducing the risk of further contamination. This keeps foreign material, such as hair, clothing, and dirt, out of the wound and decreases the risk of infection.

Which of the following is the final stage of wound healing?

Collagen production In the last stage of wound healing, collagen provides stability to damaged tissue and joins wound borders, closing the open tissue.

You are assessing a 28-year-old with a rigid cast extending the length of his left leg. The patient is complaining of pain on passive movement and he is showing signs of impaired circulation. What do you suspect?

Compartment syndrome Compartment syndrome commonly develops in the extremities and may occur in conjunction with open or closed injuries or when swelling occurs under restrictive immobilization devices such as a cast.

Compartment syndrome

Compartment syndrome commonly develops in the extremities and may occur in conjunction with open or closed injuries or when swelling occurs under restrictive immobilization devices such as a cast.

You are assessing a patient who has been in a high-impact T-bone collision. She is bleeding from the abdomen and you can see part of her large intestine outside her body. What is this injury called?

Evisceration

When using the rule of nines, which of the following do you need to include in your calculations?

Full and partial thickness burns Calculating burn area includes partial- and full-thickness burns. You should document superficial burns but do not include them in the body surface estimation.

Functions of the skin

Keeps *pathogens* out Keeps *fluids* in Helps body regulate *temperature* Nerves in the skin report to the brain on the environment and sensations.

Occlusive dressings

Occlusive dressings are used to cover sucking chest wounds, abdominal eviscerations, penetrating back wounds, and neck injuries.

Which of the following is a sign of compartment syndrome?

Pain upon passive movement of the injury site

What is your first responsibility when treating a burn patient?

Stopping the burning

A 39-year-old male was struck in the head by a baseball during a game. He is confused, has a large hematoma in the center of his forehead, and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should:

administer high-flow oxygen.

During your assessment of a 22-year-old male who was assaulted, you note widespread contusions and abrasions to his face, chest, and abdomen. His pulse is rapid and weak, and his skin is cool and clammy. You should:

administer oxygen and prepare for rapid transport.

Crush syndrome

an area of the body is trapped for *longer than 4 hours* and arterial blood flow is compromised

Contusion

an injury that causes bleeding beneath the skin but does not break the skin. The buildup of blood produces *ecchymosis,* a blue or black discoloration.

A 30-year-old male experienced a crushing injury when his arm was trapped between the back of a truck and a loading dock. Upon your arrival, the man's arm has been freed. Your assessment reveals that his arm is obviously deformed and swollen and is cold and pale. Further assessment reveals an absent radial pulse. You should be MOST concerned that this patient has:

compartment syndrome.