Chapter 25- Soft-Tissue Injuries
Which of the following is NOT a function of the skin?
Destruction of sebum
After ensuring you and your partner's safety, the next step in caring for a patient with any burn is to:
move the patient to a place of safety.
The mouth, nose, and other body orifices are lined with ___________________, which secrete a watery substance and provide a protective barrier against harmful agents.
mucus membranes
The skin sends messages to the brain to regulate various functions via:
sensory nerves
Which layer of the skin contains cells that are replaced with new cells that are formed in the germinal layer?
Epidermis
Which of the following statements regarding electrical burns is correct?
Internal injury caused by an electrical burn is usually more severe than the external burns indicate.
Appropriate management for a patient with a serious closed injury and signs of shock includes all of the following, EXCEPT:
15" to 20" elevation of the lower extremities
Which of the following physiologic responses occurs initially following a burn injury?
Vasoconstriction and decreased blood flow to the burned area
Which of the following weapons would MOST likely result in the largest surface area of tissue damage?
12-gauge shotgun
When administering IV crystalloid boluses to a patient with an electrical injury, you should give enough fluid to maintain a urine output of:
1 mL/kg per hour.
How much IV fluid (per bolus) should you administer to a 65-kg patient with extensive burns and severe shock?
1,300 mL
A 4-year-old boy pulled a pot of boiling water from the stovetop. He has superficial and partial-thickness burns to his head, left anterior trunk, and entire left arm. On the basis of the "rule of nines," what percentage of this child's body surface area (BSA) has been burned?
30%
A 60-year-old male has sustained partial- and full-thickness burns to his anterior chest, head, and both anterior arms. On the basis of the "Rule of Nines," what percentage of his body surface area (BSA) has been burned?
36%
Why does the skin become flushed or red when a person is exposed to a hot environment?
Blood vessels dilate and heat radiates to the skin surface.
Which of the following statements regarding the dermal layer of the skin is correct?
Blood vessels in the dermis do not penetrate into the epidermis
Which of the following factors has the MOST significant impact on determining the severity of a burn?
Depth and extent of the burn
In which of the following circumstances should you remove an impaled object?
Metal shard in the cheek and inadequate respiratory effort
Which of the following would be classified as a moderate burn in an infant or child?
Partial-thickness burns covering 15% of the BSA
A 22-year-old male has sustained full-thickness burns to approximately 55% of his BSA. You are appropriately managing his airway and are administering 100% oxygen. You note that the patient's heart rate is 140 beats/min and thready and his blood pressure is 78/58 mm Hg. You should:
administer 20 mL/kg crystalloid boluses to maintain perfusion
You are assessing a 4-year-old male who was electrocuted when he stuck a pin into an electrical socket. He is conscious and alert and complains of pain to his left hand, where you find a small entrance wound. When treating this child, you should:
anticipate extensive internal injuries.
A utility worker was trimming branches away from a high power line when he accidentally cut the power line. He is unresponsive, apneic, and pulseless. You should begin CPR and then:
apply the AED as soon as possible
A young male tripped on a garden hose, fell, and struck his head on a concrete sidewalk. He is unresponsive and has a large hematoma to his forehead. His respirations are slow and shallow. You should:
assist his ventilations with 100% oxygen.
An elderly male was removed from his burning house by firefighters. He has extensive full-thickness burns; is semiconscious; and has shallow, stridorous respirations. The firefighters have already stopped the burning process. After ensuring an open airway, you should:
assist his ventilations with a bag-mask device and 100% oxygen
When caring for a patient with multiple abrasions, you should:
be alert for underlying injuries
When assessing a conscious patient who experienced an electrical injury, you note irregularity in his pulse. This is MOST indicative of:
cardiac dysrhythmia
Melanin granules, which are contained within the deeper cells in the germinal layer, are responsible for:
color of skin
Heat that is generated by an electrical injury can cause coagulation and vascular occlusion, resulting in:
compartment syndrome
During your assessment of a patient with blunt chest trauma, you note the presence of ecchymosis to the area of impact. This finding is MOST characteristic of a/an:
contusion
All of the following are characteristic of a closed soft tissue injury, EXCEPT:
deformity of a short bone
Upon arriving at the scene of a motor-vehicle crash involving a telephone pole, you note that the driver appears unconscious and is bleeding heavily from the mouth. There is a power line across the hood and roof of the car. You should:
ensure that the power line is not electrically active.
When assessing a patient with multiple gunshot wounds, you should:
identify the number and location of all wounds
In contrast to upper-airway injury following a burn, lower-airway injury is usually the result of:
inhalation of chemicals and particulate matter
When managing an adult patient with an inhalation injury, inspiratory stridor, and an altered mental status, you should:
prepare for early definitive airway management
During an explosion, a metal worker sustained a large laceration to the left side of his neck by flying debris. He is conscious, but restless; the wound is moderately bleeding. Appropriate care for this patient's injury includes:
preventing air from entering the wound and applying a pressure dressing.
You are dispatched to the scene of a shooting. Upon arrival, you are directed by law enforcement to the patient, a 44-year-old male, who is unconscious. He is lying in an impressive pool of blood and you can hear gurgling from his mouth when he breathes. After your partner assumes C-spine control and opens the patient's airway, you should:
suction the patient's oropharynx
A thermal burn involving the epidermis that is characterized by redness and pain is classified as a:
superficial burn
A thermal burn involving the epidermis that is characterized by redness and pain is classified as a:
superficial burn.
Death immediately following a burn is MOST commonly the result of:
toxic chemical inhalation.
Radiation is released into the atmosphere when:
unstable atoms emit excess energy in an attempt to stabilize.
High-voltage burn injuries occur MOST frequently in:
utility workers.
A 40-year-old patient has sustained circumferential burns to the chest. The MOST serious complication associated with this type of burn injury is:
ventilatory insufficiency
All of the following signs are indicative of upper airway burns due to an inhalation injury, EXCEPT:
wheezing or rhonchi.
You are dispatched to an industrial plant for a worker who was exposed to an unknown chemical. Upon arrival, you find the patient sitting outside of the plant. He has a white, dry powder covering his right arm. Care for this patient's exposure includes:
brushing the chemical from the patient's arm and then irrigating with water.
A 60-year-old male has sustained partial- and full-thickness burns to his anterior chest, head, and both anterior arms. On the basis of the "rule of nines," what percentage of his body surface area (BSA) has been burned?
36%
During a lengthy transport of a 120-lb 29-year-old female with partial- and full-thickness burns to 45% of her BSA, medical control orders you to begin IV fluid replacement based on the Parkland formula. What volume of IV crystalloid should you administer per hour?
620 mL
On the basis of the Parkland formula, how much crystalloid should you administer per hour to a 70-kg patient with severe burns to 50% of his BSA?
800-900 mL
Which of the following patients has experienced a critical burn?
A 65-year-old with 18% partial-thickness burns to both upper extremities
A 22-year-old male, who was trapped in a confined space during a structural fire, is conscious and alert and refuses EMS treatment and transport. He is breathing without difficulty, but has singed nasal hair and facial redness. Which of the following statements regarding this patient is correct?
The patient may die several hours later due to pulmonary complications
Which of the following statements regarding severe burns is correct?
Significant hypovolemia may not occur for several hours following the burn injury
Common prehospital treatment for patients with severe burns includes all of the following, EXCEPT:
Tetanus prophylaxis
Which of the following has the MOST impact on the severity of radiation injury or type of health effect?
The amount and duration of exposure
You and your partner are caring for a 30-year-old female who sustained extensive partial- and full-thickness burns when she was near a gas heater that exploded. Your primary assessment reveals that the patient is semiconscious with profoundly labored and stridorous respirations. Immediate management of this patient should include:
assisting her breathing with a bag-mask device and oxygen
A 28-year-old female was the unrestrained driver of a car that struck the rear end of another car while traveling at 35 mph. She is conscious and alert and complains of pain to the anterior chest. During your assessment, you note a large ecchymotic area over the superior aspect of the anterior chest. As your partner assumes manual stabilization of her head, you should:
apply 100% oxygen via a nonrebreathing mask.
A 28-year-old female was the unrestrained driver of a car that struck the rear end of another car while traveling at 35 mph. She is conscious and alert and complains of pain to the anterior chest. During your assessment, you note a large ecchymotic area over the superior aspect of the anterior chest. As your partner assumes manual stabilization of the patient's head, you should:
apply 100% oxygen via a nonrebreathing mask.
When a person is exposed to cold temperatures, blood vessels in the skin:
constrict and divert blood away from the skin.
Priority treatment for a patient with an open soft-tissue injury includes:
control of active bleeding.
A 34-year-old male was involved in a motor-vehicle crash. During the crash, his vehicle caught fire. Bystanders removed the patient from his vehicle prior to your arrival. The patient is conscious with adequate breathing. He has partial-thickness burns to his face and neck, and an open femur fracture with severe bleeding. Immediate management for this patient should include:
controlling the bleeding from his leg
A 59-year-old male has a partial amputation of his left arm, just proximal to the elbow. Bleeding has been controlled and you note that the arm is attached by only a few strands of tissue. You should:
cover the arm with a bulky dressing and carefully splint it.
When caring for an open wound that has small pieces of glass and other debris inside of it, you should:
cover the wound with a sterile dressing
When caring for an open wound that has small pieces of glass and other debris inside of it, you should:
cover the wound with a sterile dressing.
Appropriate management of a patient with an abdominal evisceration includes:
covering the exposed organs with a moist, sterile dressing and securing the dressing in place with a dry, sterile dressing
A 62-year-old female with a history of type 2 diabetes has sustained partial-thickness burns to 27% of her body surface area (BSA). This burn should be classified as a:
critical burn.
The layer of skin that lies below the germinal layer and contains nerves, sebaceous glands, and blood vessels is called the:
dermis
The layer of the skin that plays a key role in the cooling of the body is the:
dermis
Following an electrical burn, estimating the extent of the BSA involved is:
difficult because the degree and depth may be greater internally than externally.
Upon arriving at the scene of a motorcycle crash, you find the patient, a young male, lying supine approximately 10 feet from his bike. An emergency medical responder is manually stabilizing the patient's head. You note an obvious open injury to the patient's left lower leg with severe bleeding. Your MOST appropriate initial action should be to:
direct your partner to control the bleeding as you assess the patient's airway
What layer of the skin contains cells that are replaced with new cells that are formed in the germinal layer?
epidermis
Small muscles within the dermis that pull the hair into an erect position when you are cold or frightened are called the:
erector pili
Which of the following is the MOST significant acute complication associated with a laceration to the forearm?
external bleeding
A 20-year-old male was shot multiple times during a drive-by shooting. You arrive at the scene, which has been secured by law enforcement, and approach the patient. He is semiconscious and is bleeding heavily from the chest. You should:
follow proper standard precautions
Common signs and symptoms of radiation sickness include:
hair loss and skin burns
A 55-year-old male sustained partial-thickness burns to his face and neck when he opened the hot radiator cap on his car. He is conscious and alert, but complains of dyspnea and difficulty swallowing. His oxygen saturation is 96% on room air. You should be MOST concerned about the:
status of his airway
The three basic pathways by which radiation enters the body are:
inhalation, ingestion, and direct exposure.
A full-thickness burn is typically characterized by all of the following, EXCEPT:
intense pain.
The "rule of palms" for estimating the extent of the body surface area (BSA) burned is especially useful with:
irregularly-shaped burns.
An industrial-plant worker was splashed in the left eye with a strong acid chemical. The MOST appropriate initial care for this patient's injury is to:
irrigate the eye laterally, away from the unaffected eye
Which of the following is the MOST acute and serious complication associated with a break in the integrity of the skin?
loss of fluids
In addition to improving systemic perfusion following an electrical burn injury, you should administer IV crystalloid fluid boluses in order to:
maintain adequate urine output
Which of the following types of burns is characterized by intense pain and destruction of a portion of the dermis?
partial thickness
When managing a critically-burned patient, it is important to:
rapidly estimate the burn's severity and then cover with dry, sterile dressings.
When managing a critically burned patient, it is important to:
rapidly estimate the burns' severity and then cover them with dry, sterile dressings.
A burn occurs when the soft tissue of the skin:
receives more energy than it can absorb without injury
All patients with closed soft-tissue injuries should be assessed for:
serious hidden injuries
All patients with closed soft-tissue injuries should be assessed for:
serious hidden injuries.
You are dispatched to the scene of a shooting. Upon arrival, you are directed by law enforcement to the patient, a 44-year-old male, who is unconscious. He is lying in an impressive pool of blood and you can hear gurgling from his mouth when he breathes. After your partner assumes c-spine control and opens the patient's airway, you should:
suction the patient's oropharynx
Cardiac arrest following an electrical burn would MOST likely occur if:
the electricity flows from arm to arm.
In order for electricity to flow through the body and cause injury:
there must be a complete circuit between the electrical source and the ground
Compartment syndrome is caused by:
tissue compression and damage due to fluid trapped in a confined space
Compartment syndrome is caused by:
tissue compression and damage due to fluid trapped in a confined space.
