Chapter 26: Soft Tissue Injuries

True or False: A hematoma is an open injury that occurs whenever a large blood vessel is damaged and bleeds rapidly.

False. A hematoma does occur whenever a large blood vessel is damaged and bleeds rapidly, but it is a closed injury.

True or False: When possible, ALS providers should administer IV fluid within 3 minutes after the crushing object is lifted off the body.

False. When possible, ALS providers should administer IV fluid before the crushing object is lifted off the body.

Which of the following is true about electrical burns? (a) They are always more severe than the external signs indicate. (b) They always have an entrance wound but only occasionally have an exit wound. (c) The patient can go into cardiac arrest at any time within 24 hours of contact with electricity. (d) Seriousness of electrical burns depends on the type of current, amperage, and conductivity.

(a) They are always more severe than the external signs indicate.

The germinal layer of the epidermis contains pigment granules that are responsible for skin: (a) color. (b) texture. (c) moisture. (d) temperature.

(a) color.

A construction worker fell approximately 30 feet and landed in a pile of steel rods. Your assessment reveals that he is pulseless and apneic and has a 10-inch steel rod impaled in his left leg. You should: (a) control the bleeding, begin CPR, stabilize the steel rod, immobilize his spine, and transport immediately. (b) remove the steel rod, control the bleeding, apply an AED, begin CPR, and transport to a trauma center. (c) stabilize the steel rod, control the bleeding, begin CPR, and rapidly transport to a trauma center. (d) control the bleeding, carefully remove the steel rod, begin CPR, and transport as soon as possible.

(a) control the bleeding, begin CPR, stabilize the steel rod, immobilize his spine, and transport immediately.

Burns are classified according to: (a) depth and extent. (b) location and pain. (c) degree and location. (d) extent and location.

(a) depth and extent.

Functions of dressings and bandages include all of the following, EXCEPT: (a) immobilization of the injury. (b) prevention of contamination. (c) protection from further injury. (d) control of external hemorrhage.

(a) immobilization of the injury.

In addition to external bleeding, the MOST significant risk that an open soft-tissue injury exposes a patient to is: (a) infection. (b) hypothermia. (c) nerve damage. (d) vessel damage.

(a) infection.

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? (a) 4.5% (b) 9% (c) 12% (d) 18%

(b) 9%

Which of the following is the final stage of wound healing? (a) Cessation of blood loss (b) Collagen production (c) Formation of new capillaries (d) Inflammation

(b) Collagen production

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? (a) Ecchymosis (b) Compartment syndrome (c) Crush syndrome (d) Avulsion

(b) Compartment syndrome

The severity of a thermal injury directly correlates with temperature, concentration, and what other factor? (a) Source of thermal energy (b) Duration of exposure (c) Chemical reaction (d) Current

(b) Duration of exposure

When using the rule of nines, which of the following do you need to include in your calculations? (a) Only full-thickness burns (b) Full- and partial-thickness burns (c) Superficial, full-, and partial-thickness burns (d) Superficial and full-thickness burns

(b) Full- and partial-thickness burns

In order for electricity to flow through the body and cause damage: (a) an insulator must exist between the electrical source and the patient. (b) a complete circuit must exist between the electrical source and the ground. (c) the part of the body that is in contact with the electrical source must be dry. (d) the person must make direct physical contact with the source of electricity.

(b) a complete circuit must exist between the electrical source and the ground.

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: (a) perform a focused physical exam of his abdomen. (b) administer oxygen and prepare for rapid transport. (c) place him in a sitting position and give him oxygen. (d) conclude that he is experiencing intracranial bleeding.

(b) administer oxygen and prepare for rapid transport.

Common signs and symptoms of an airway burn include all of the following, EXCEPT: (a) hoarseness. (b) chest pressure. (c) singed nasal hair. (d) soot around the mouth.

(b) chest pressure.

A 30-year-old male experienced a crushing injury when his forearm 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: (a) internal hemorrhage. (b) compartment syndrome. (c) a severe closed fracture. (d) damage to the radial nerve.

(b) compartment syndrome.

A hematoma develops when: (a) small amounts of blood leak into the epidermis. (b) large blood vessels beneath the skin are damaged. (c) severe swelling compromises arterial circulation. (d) cells and small vessels in the dermis are damaged.

(b) large blood vessels beneath the skin are damaged.

A 5-year-old female pulled a pot of boiling water from the stove. She has superficial and partial-thickness burns to her head, face, and anterior trunk. What percentage of her body surface area has been burned? (a) 18% (b) 27% (c) 30% (d) 36%

(c) 30%

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? (a) Avulsion (b) Ecchymosis (c) Evisceration (d) Impalement

(c) Evisceration

What is your first responsibility when treating a burn patient? (a) Identifying life-threatening injuries (b) Administering high-flow oxygen (c) Stopping the burning (d) Preventing loss of body heat

(c) Stopping the burning

In contrast to animal bites, the bite of a human: (a) is usually less severe because the human mouth is cleaner. (b) typically results in a minor infection that is slow-spreading. (c) carries with it a wide variety of virulent bacteria and viruses. (d) is associated with a much higher incidence of rabies infection.

(c) carries with it a wide variety of virulent bacteria and viruses.

You are assessing a 30-year-old woman with multiple large bruises to her chest and abdomen that she experienced during an assault. She is conscious but restless, and her skin is cool and pale. You should be MOST concerned with: (a) performing a detailed secondary assessment to locate all of her injuries. (b) assessing the bruises that overlie major organs in the chest and abdomen. (c) the fact that her clinical signs could indicate that she is bleeding internally. (d) obtaining a complete set of vital signs to rule out the possibility of shock.

(c) the fact that her clinical signs could indicate that she is bleeding internally.

Functions of the skin include all of the following, EXCEPT: (a) maintenance of water balance. (b) regulation of body temperature. (c) the production of key antibodies. (d) sending information to the brain.

(c) the production of key antibodies.

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? (a) Flush the area with sterile saline. (b) Manually brush/pick the foreign material out. (c) Apply occlusive dressing. (d) Apply sterile dressing.

(d) Apply sterile dressing.

For which injury would you use an occlusive dressing directly on the wound? (a) Avulsion (b) Evisceration (c) Impaled object (d) Open neck injury

(d) Open neck injury

Which of the following is a sign of compartment syndrome? (a) Absence of pain at the injury site (b) Extreme redness to the injury site (c) A bounding pulse distal to the injury site (d) Pain upon passive movement of the injury site

(d) Pain upon passive movement of the injury site

Which of the following statements regarding severe burns is correct? (a) Severe burns involving the airway have a 100% mortality rate. (b) The majority of severe burns involve full-thickness burns only. (c) Patients with severe burns are especially prone to hyperthermia. (d) Severe burns are typically a combination of various degrees of burns.

(d) Severe burns are typically a combination of various degrees of burns.

When treating a partial-thickness burn, you should: (a) immerse the affected part in warm water. (b) rupture any blisters to prevent an infection. (c) cover the burn with a moist, sterile dressing. (d) avoid the use of creams, lotions, or antiseptics.

(d) avoid the use of creams, lotions, or antiseptics.

An abdominal evisceration: (a) is most commonly the result of blunt force trauma. (b) should be covered with bulky dry, sterile dressings. (c) often causes severe hypothermia because of heat loss. (d) occurs when organs protrude through an open wound.

(d) occurs when organs protrude through an open wound.

You and your partner arrive at the scene of a house fire where firefighters have rescued a 50-year-old male from his burning house. The patient has superficial and partial-thickness burns to his face and chest. His nasal hairs are singed and he is coughing up sooty sputum. You should be MOST concerned with: (a) treating him for hypothermia. (b) preventing the risk of infection. (c) estimating the extent of his burns. (d) the potential for airway swelling.

(d) the potential for airway swelling.

True or False: The goal of the inflammation phase of wound healing is the removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site.

True

True or False: You should never remove an avulsion skin flap, regardless of its size.

True

Which type of soft-tissue injury is LEAST likely to result in infection? (a) Contusions on the left lateral chest (b) Abdominal laceration (c) Burns to the face (d) Abrasions to the face

(a) Contusions on the left lateral chest

Which of the following statements regarding penetrating injuries is correct? (a) External bleeding may be minimal but internal injuries can be extensive. (b) The degree of internal injury can often be estimated by the external injury. (c) It is important to distinguish between entrance and exit wounds in the field. (d) The depth of a penetrating injury should be thoroughly assessed by the EMT.

(a) External bleeding may be minimal but internal injuries can be extensive.

RICES

mnemonic for closed injury treatment Rest Ice Compression Elevation Splinting