Chapter 26 - Soft Tissue Injuries

During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a: - shotgun. - handgun. - .22-caliber pistol. - .357 magnum.

During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a: *- shotgun.* - handgun. - .22-caliber pistol. - .357 magnum.

(T/F) 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*.

(T/F) 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.

For which injury would you use an occlusive dressing directly on the wound? - Avulsion - Evisceration - Impaled object - Open neck injury

For which injury would you use an occlusive dressing directly on the wound? - Avulsion - Evisceration - Impaled object *- Open neck injury* *If the veins of the neck are open to the environment, they may suck in air, leading to an air embolism. To control bleeding and prevent the possibility of air embolism, cover the wound with an occlusive dressing.*

What is DCAP-BTLS?

Deformities Contusion Abrasion Penetration/Puncture Burn Tenderness Laceration Swelling

In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is: - nerve fiber damage. - a spinal fracture. - an ischemic stroke. - an air embolism.

In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is: - nerve fiber damage. - a spinal fracture. - an ischemic stroke. *- an air embolism.*

The sebaceous glands produce sebum, a material that: - facilitates shedding of the epidermis. - waterproofs the skin and keeps it supple. - discharges sweat onto the skin's surface. - pulls the hair erect when you are cold.

The sebaceous glands produce sebum, a material that: - facilitates shedding of the epidermis. *- waterproofs the skin and keeps it supple.* - discharges sweat onto the skin's surface. - pulls the hair erect when you are cold.

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

The severity of a thermal injury directly correlates with temperature, concentration, and what other factor? - Source of thermal energy *- Duration of exposure* - Chemical reaction - Current

Which of the following patients is likely to have injuries with entrance and exit wounds? - A technician who has been exposed to gamma radiation - A do-it-yourselfer who touched a live wire while repairing a light fixture - A 19-year old who has been hit by high-caliber gunfire - A drug user who has been TASERed

Which of the following patients is likely to have injuries with entrance and exit wounds? - A technician who has been exposed to gamma radiation *- A do-it-yourselfer who touched a live wire while repairing a light fixture - A 19-year old who has been hit by high-caliber gunfire* - A drug user who has been TASERed

Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss? - Avulsion - Abrasion - Laceration - Incision

Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss? - Avulsion *- Abrasion* - Laceration - Incision

A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA. - 27% - 36% - 45% - 18%

A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA. - 27% - 36% - 45% *- 18%*

A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound? - Cover the exposed bowel and keep his legs in a straight position. - Irrigate it with sterile water and cover it with a dry dressing. - Carefully replace the exposed bowel into the abdomen and transport. - Cover it with moist, sterile gauze and secure with an occlusive dressing.

A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound? - Cover the exposed bowel and keep his legs in a straight position. - Irrigate it with sterile water and cover it with a dry dressing. - Carefully replace the exposed bowel into the abdomen and transport. *- Cover it with moist, sterile gauze and secure with an occlusive dressing.*

A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He 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: - palpate his radial pulses. - administer high-flow oxygen. - apply ice to the hematoma. - perform a neurologic exam.

A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He 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: - palpate his radial pulses. *- administer high-flow oxygen.* - apply ice to the hematoma. - perform a neurologic exam.

A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should: - replace the avulsed flap to its original position and cover it with a sterile dressing. - carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing. - carefully probe the wound to determine if the bleeding is venous or arterial. - thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.

A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should: *- replace the avulsed flap to its original position and cover it with a sterile dressing.* - carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing. - carefully probe the wound to determine if the bleeding is venous or arterial. - thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.

A burn that is characterized by redness and pain is classified as a: - full-thickness burn. - superficial burn. - second-degree burn. - partial-thickness burn.

A burn that is characterized by redness and pain is classified as a: - full-thickness burn. *- superficial burn.* - second-degree burn. - partial-thickness burn.

A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): - abrasion. - crush injury. - hematoma. - contusion

A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): - abrasion. - crush injury. - hematoma. *- contusion.*

What is excited delirium?

A serious behavioral condition in which a person exhibits agitated behavior combined with disorientation, hallucinations, or delusions; also called agitated delirium or exhaustive mania.

An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should: - advise the child that he will need rabies shots. - ask the child's father to try to locate the dog. - report the incident to the appropriate authorities. - administer oxygen via a nonrebreathing mask.

An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should: - advise the child that he will need rabies shots. - ask the child's father to try to locate the dog. *- report the incident to the appropriate authorities*. - administer oxygen via a nonrebreathing mask.

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: - apply high-flow oxygen and assess his injuries. - open his airway and assess his breathing status. - perform an immediate head-to-toe assessment. - assess his pulse for rate, regularity, and quality.

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: - apply high-flow oxygen and assess his injuries. *- open his airway and assess his breathing status.* - perform an immediate head-to-toe assessment. - assess his pulse for rate, regularity, and quality.

Burns to pediatric patients are generally considered more serious than burns to adults because: - pediatric patients have a proportionately larger volume of blood. - most burns in children are the result of child abuse. - pediatric patients are more prone to hyperthermia. - pediatric patients have more surface area relative to total body mass.

Burns to pediatric patients are generally considered more serious than burns to adults because: - pediatric patients have a proportionately larger volume of blood. - most burns in children are the result of child abuse. - pediatric patients are more prone to hyperthermia. *- pediatric patients have more surface area relative to total body mass.*

What is the Rule of Palm?

Compare the size of the burn area to the size of the patient's palm, which is roughly equal to 1% of the patient's total body surface area.

In which of the following patients should you remove an impaled object? - A pulseless and apneic patient with a knife impaled in the back - An apneic patient with a shard of glass impaled in the abdomen - A semiconscious patient with an ice pick impaled in the chest - A conscious and alert patient with a fishhook impaled in the eye

In which of the following patients should you remove an impaled object? *- A pulseless and apneic patient with a knife impaled in the back* - An apneic patient with a shard of glass impaled in the abdomen - A semiconscious patient with an ice pick impaled in the chest - A conscious and alert patient with a fishhook impaled in the eye

What is Crush Syndrome?

Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods. This can lead to renal failure and death.

What is Compartment Syndrome?

Swelling within a confined anatomic compartment that produces dangerous pressure, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power; frequently seen in fractures below the elbow or knee in children.

(T/F) 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.

(T/F) You should never remove an avulsion skin flap, regardless of its size.

True.

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

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

When caring for a patient whose arm is covered with a dry chemical, you should: - deactivate the chemical with a 5% vinegar solution. - brush away the chemical before flushing with water. - use forceful streams of water to remove the chemical. - quickly irrigate the arm with large amounts of water.

When caring for a patient whose arm is covered with a dry chemical, you should: - deactivate the chemical with a 5% vinegar solution. *- brush away the chemical before flushing with water.* - use forceful streams of water to remove the chemical. - quickly irrigate the arm with large amounts of water.

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

When using the rule of nines, which of the following do you need to include in your calculations? - Only full-thickness burns *- Full- and partial-thickness burns* - Superficial, full-, and partial-thickness burns - Superficial and full-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.*

Which of the following areas of the body has the thinnest skin? - Soles of the feet - Back - Scalp - Ears

Which of the following areas of the body has the thinnest skin? - Soles of the feet - Back - Scalp *- Ears*

Which of the following factors will help you to determine the severity of a burn? - Depth of the burn - Extent of the burn - Involvement of any critical body areas (face, upper airway, hands, feet, genitalia) - Preexisting medical conditions

Which of the following factors will help you to determine the severity of a burn? *- Depth of the burn - Extent of the burn - Involvement of any critical body areas (face, upper airway, hands, feet, genitalia) - Preexisting medical conditions*

Which of the following is a severe burn in a 65-year-old patient? - Full-thickness burn to 1% of the BSA - Second-degree burn covering 10% of the BSA - Partial-thickness burn to 20% of the BSA - Superficial burn to 30% of the BSA

Which of the following is a severe burn in a 65-year-old patient? - Full-thickness burn to 1% of the BSA - Second-degree burn covering 10% of the BSA *- Partial-thickness burn to 20% of the BSA* - Superficial burn to 30% of the BSA

Which of the following is the final stage of wound healing? - Cessation of blood loss - Collagen production - Formation of new capillaries - Inflammation

Which of the following is the final stage of wound healing? - Cessation of blood loss *- Collagen production* - Formation of new capillaries - Inflammation

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

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

Which of the following processes occurs during the inflammation phase of the healing process? - The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling. - White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow. - The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. - The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound.

Which of the following processes occurs during the inflammation phase of the healing process? *- The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling.* - White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow. - The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. - The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound.

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. - Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal. - With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity. - Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body.

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.* - Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal. - With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity. - Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body.

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

Which type of soft-tissue injury is LEAST likely to result in infection? *- Contusions on the left lateral chest* - Abdominal laceration - Burns to the face - Abrasions to the face

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? - Ecchymosis - Compartment syndrome - Crush syndrome - Avulsion

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? - Ecchymosis *- Compartment syndrome* - Crush syndrome - Avulsion *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? - Avulsion - Ecchymosis - Evisceration - Impalement

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? - Avulsion - Ecchymosis *- Evisceration* - Impalement

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? - 4.5% - 9% - 12% - 18%

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? - 4.5% *- 9%* - 12% - 18%

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? - Flush the area with sterile saline. - Manually brush/pick the foreign material out. - Apply occlusive dressing. - Apply sterile dressing.

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? - Flush the area with sterile saline. - Manually brush/pick the foreign material out. - Apply occlusive dressing. *- 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.*

You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should: - remove the bandage and dressing and apply another one. - carefully manipulate her arm until the symptoms subside. - remove the gauze bandage and replace it with an elastic one. - assess distal circulation and readjust the bandage as needed.

You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should: - remove the bandage and dressing and apply another one. - carefully manipulate her arm until the symptoms subside. - remove the gauze bandage and replace it with an elastic one. *- assess distal circulation and readjust the bandage as needed.*