Chapter 30 - Soft Tissue Injuries

Which of the following is the outermost layer of the​ skin?

Epidermis

Which of the following best describes an​ avulsion?

Flap of skin that is partially or completely torn away from the underlying tissue

You are dispatched to an industrial plant for a burn. You arrive and find a​ 60-year-old male who came in contact with a broken steam line and appears to have partial thickness burns on both hands and arms. He is lying on the ground and coworkers are gently spraying him with water from a nearby hose. What should you​ do?

Care for the burn and do a complete patient​ assessment, including cervical spine precautions.

A burn extending into the subcutaneous fat would be classified as which type of​ burn?

Full thickness

Bleeding from​ soft-tissue injuries should initially be controlled with which one of the following​ techniques?

Direct pressure

Which of the following best describes a partial thickness​ burn?

The skin is red and moist with blister formation.

When using the rule of palm to estimate the approximate body surface area​ burned, the​ patient's palm equals about what percentage of the​ body's surface area​ (BSA)?

1 percent

A​ 36-year-old man has accidentally shot a nail into his thigh while using a nail gun. Under which of the following circumstances should the EMT remove the nail from the injury​ site?

1) Bleeding from the wound is minimal. 2) The​ patient's distal​ pulse, motor​ function, and sensation are intact. 3) The nail is less than 2 inches in length. NONE of the above

You are assessing a​ 30-year-old male patient that had his arm caught in a piece of machinery. By the time you​ arrive, he has been freed. The patient tells you that he does not understand why you were​ called, but as you inspect the injured limb you notice a small puncture wound. You should have a high index of suspicion of which of the following​ injuries?

1) Chemical Burn​ 2) puncture 3) HIGH PRESSURE INJECTION 4) crush injury

Which of the following is of concern with a puncture​ wound?

1) Hidden internal bleeding with minimal external bleeding Your answer is not correct. 2) Strong possibility of contamination 3) An object that remains impaled in the body ALL of the above

Which of the following injuries requires the use of an occlusive​ dressing?

1) Open wound to the chest 2) Open wound to the neck 3) Open wound to the abdomen from which a loop of intestine is protruding All of the above

Which of the following is a consideration in determining a​ burn's severity?

1) Other illnesses or injuries the patient may have 2) The type of agent that caused the burn 3) Body surface area​ (BSA) involved in the burn ALL off the above

Which of the following is appropriate in caring for a patient with closed​ soft-tissue injuries and a significant mechanism of injury​ (MOI)?

1) Splint any​ swollen, deformed extremities. 2) Treat for shock if you think there are internal injuries even if the​ patient's vital signs are normal. 3) Anticipate vomiting. ALL of the above

Which of the following is not considered soft​ tissue?

1) The skin 2)Cartilage This is the correct MUSCLES 3) Membranes

Which of the following is true concerning​ lacerations?

1) They may be caused by blunt trauma. 2) They may indicate deeper underlying tissue damage. 3) They may be caused by penetrating trauma. ALL answers are correct.

According to the rule of nines for infants and young​ children, the​ patient's head and neck account for what percentage of the total body surface​ area?

18 percent

Your patient is a​ 40-year-old man who was burned when he spilled gasoline on his pants as he was standing near the pilot light of his hot water heater. He has partial thickness burns from his feet to just above his​ knees, and circumferentially around both legs. Using the rule of​ nines, which of the following most accurately represents the extent of body surface area​ burned?

18 percent

Which of the following is not a type of​ avulsion?

A finger is cut off with a​ butcher's saw.

While assessing a patient with partial thickness burns to his chest and​ neck, what should be your highest priority​ (even if there are no symptoms​ presently)?

Airway

Your patient is a​ 25-year-old man who picked up an iron skillet with a very hot handle. He has a reddened area with blisters across the palm of his hand. Which of the following must be avoided in the prehospital management of this​ wound?

Application of antibiotic ointment

Your patient is a​ 35-year-old female who spilled a cup of hot coffee on herself. She has an area about twice the size of the palm of her hand on her right thigh that is red and​ painful, but without blisters. When caring for this injury in the prehospital​ setting, which of the following is​ appropriate?

Apply a dry sterile dressing.

A​ 37-year-old male was hit by a trolley and his foot was almost severed. It is only connected by some skin and crushed bone. What should you​ do?

Apply a pressure dressing to control​ bleeding, stabilize the foot by​ splinting, apply​ oxygen, and transport as a priority patient.

In caring for a​ 27-year-old male who has a large laceration on his anterior​ forearm, you have noticed that your pressure dressing has become saturated with blood. Which of the following should you do​ next?

Apply additional dressing material over the top of the original dressing and bandage it in place.

Your patient is a​ 14-year-old male who crashed his​ bicycle, landing prone and sliding along a gravel trail. He has deep abrasions to his​ hands, arms,​ chest, and knees. The patient has small pieces of​ gravel, twigs, and dirt embedded in the abrasions. Which of the following is the best way to manage this situation after taking cervical spine​ immobilization?

Assess for additional​ injuries, flush away large pieces of debris with a sterile​ dressing, place dressings on the​ abrasions, bandage them in​ place, and transport.

Your patient is a​ 40-year-old male who has been exposed to a dry chemical powder and is complaining of severe pain on both of his​ hands, the site of the contact. He is working in an illegal chemical manufacturing plant and there is no decontamination shower on site. Which of the following would be the best way to manage this​ situation?

Brush away as much of the powder as possible and then have the patient hold his hands under running water from a faucet or regular garden hose.

You assess a​ 35-year-old female patient with a chemical burn to her right forearm and hand. As you assess the​ burn, you notice a white powder on the burn. What should be your next​ step?

Brush the powder off the​ patient's arm and​ hand, and then flush with copious amounts of water.

Which of the following is not an open tissue​ injury?

Contusion

Which of the following statements is false regarding an electrical​ injury?

Injury is usually limited to the area around the source and ground burns.

Which of the following statements is not true concerning the proper transport of an avulsed​ ear?

It should be in a dry sterile dressing.

Your patient is a​ 32-year-old man with a fish hook that has perforated his hand between the thumb and index finger. Which of the following is the best way to manage the situation in the prehospital​ setting?

Leave the hook in place and try not to disturb it.

While assessing a​ 78-year-old male patient who escaped an apartment fire with partial thickness burns to both​ arms, the EMT must be aware of which of the​ following?

Medical conditions may be aggravated by the burn.

Burns pose a greater risk to infants and children for which of the following​ reasons?

Pediatric patients have a greater risk of shock from the burn.

Your patient is a​ 55-year-old male who was found in the parking lot behind a tavern. He states that he was assaulted and robbed by three individuals. He is complaining of being​ "hit in the face and kicked and punched in my ribs and​ stomach." Your examination reveals contusions and swelling around both​ eyes, bleeding from the​ nose, a laceration of his upper​ lip, and multiple contusions of the​ chest, abdomen, and flanks. Which of the following should cause the greatest concern regarding the prehospital care of this​ patient?

Potential internal injuries

Which type of wound has a small opening into the​ skin, but may be quite​ deep, and is often caused by instruments such as​ nails, ice​ picks, or​ pencils?

Puncture

Which of the following is not a major function of the​ skin?

Regulates the pH balance of the body

You are dispatched to an auto repair shop for an​ "accident." You arrive and are told by the owner that one of the workers apparently got his hand in the way while using a​ high-pressure grease gun and injected the grease into his hand. You find the patient seated in a chair with a coworker applying ice to the injured hand. Your examination reveals a minor round laceration in the hand. The patient is complaining of pain in the area but wants to let the wound take care of itself and go back to work. What should you​ do?

Remove the ice from the​ wound, then elevate and splint the limb. Transport the patient high priority.

Which of the following is a description of the rule of nines for an​ adult?

The rule of nines assigns 9 percent to the head and​ neck, each upper​ extremity, the​ chest, the​ abdomen, the upper​ back, the lower back and​ buttocks, the front of each lower​ extremity, and the back of each lower​ extremity, then 1 percent to the genital region.

Which of the following is recommended when caring for an amputated​ part?

Seal the part in a plastic bag and keep it cool.

You are dispatched to the local elementary school for an injured student. Upon​ arrival, you find that two​ 7-year-olds got into a fight and one of them jabbed a pencil in the​ other's cheek. The pencil is still sticking out of the​ child's cheek. When you examine the​ patient, you cannot see the end of the pencil that went through the​ cheek, as it appears to be stuck in the palate. There is not significant​ bleeding, and the child is not having any difficulty breathing. The child is very upset and wants you to pull the pencil out. What should you​ do?

Stabilize the​ object, but do not try to remove it.

Which of the following is a desirable characteristic of dressings used in the prehospital management of most open​ wounds?

Sterile

Which of the following layers of the skin is the most important in insulating the body against heat​ loss?

Subcutaneous layer

You are dispatched to the local high school for a​ "person struck with a​ baseball." You arrive on the scene and find a​ 16-year-old male sitting on the bench. Apparently he was the pitcher and was struck in the abdominal area by a line drive ball that was hit very hard. He states that nothing is hurting except he has some mild pain in the area where he was struck. He is upset that the ambulance was called and wants to go back into the game and continue pitching. Your exam reveals nothing remarkable except mild pain when you palpate the injured area. Vital signs are normal. What is the next​ step?

Take appropriate Standard​ Precautions, apply​ high-concentration oxygen by nonrebreather​ mask, and transport the patient​ ASAP, carefully monitoring the patient during transport.

Which of the following is of concern in a patient who received burns to his hand when he grabbed a live electrical​ wire?

The extent of tissue damage may be much greater than it appears on the surface.

You are examining a​ 48-year-old patient who has been burned. You decide to use the rule of palm to measure the extent of the burn. What does this​ mean?

The palm of the​ patient's hand equals about​ 1% of the​ body's surface area.

Which of the following is not true concerning​ lacerations?

They may involve degloving injuries to the skin or tissue.

Which of the following is required in the management of all open​ soft-tissue injuries?

Use of Standard Precautions by the EMT

You are dispatched to a local industrial plant for an​ "electrical injury." You arrive​ on-scene and find a​ 46-year-old male lying supine in front of an electrical panel. You are told he was attempting to make a repair and somehow received an electrical shock and was thrown to the ground. The scene is safe and the electricity is off. Your initial exam reveals a conscious​ person, breathing adequately. Vital signs are normal and there are no obvious signs of burns. Coworkers state that he was unconscious until your arrival. What is the next​ step?

While on the​ scene, rapidly do a complete​ assessment, provide​ oxygen, provide care for potential spine​ injuries, and transport as soon as possible after the exam.

You are treating the amputation of three fingers on a​ 40-year-old male. The fingers were torn off while he was cleaning his snow blower. You have stopped the bleeding. What should you do with the amputated​ fingers?

Wrap them in a sterile​ dressing, put them in a plastic​ bag, and keep them cool.

You are caring for a​ 23-year-old female who fell off of a bicycle and sustained a severe laceration on the inside of her upper thigh. Her slacks are​ torn, and you can see most of the wound. What is the next​ step?

You need to expose the wound​ completely, control​ bleeding, clean the surface by simply removing large pieces of foreign matter if​ any, and dress and bandage the wound.

A wound in which the epidermis is scraped away with minimal​ bleeding, such as commonly occurs when a child falls on his knees on a​ sidewalk, is called​ a(n):

abrasion

When managing an electrical​ burn, the EMT​ should:

check for a source and ground burn injury.

An injury in which the epidermis remains​ intact, but blood vessels and cells in the dermis are​ injured, is called​ a(n):

contusion.

An injury caused by heavy pressure to the​ tissues, such as when an extremity is trapped under a fallen​ tree, that results in damage to underlying​ structures, bleeding, and inflammation is called​ a(n):

crush injury.

The meatus​ is:

the external opening of the urethra.

You are treating a​ 5-year-old for extensive burns. You know that burns pose a greater risk to infants and children. The reason for this​ is:

their body surface area is greater in relation to their total body size.

For which of the following patients should the EMT carefully continue to monitor the​ patient's ventilatory status throughout treatment and transport due to the greatest risk of respiratory​ failure?

​16-year-old male whose shirt caught on​ fire, resulting in circumferential burns of his chest

Which of the following patients has the greatest likelihood of being cared for in a burn​ center?

​30-year-old woman who has full thickness burns on her hand and arm as a result of spilling hot cooking oil on herself