chapter 30: emergency care
The layer of skin that is rich with blood vessels, nerves, and specialized structures is the:
dermis
In a contusion, what remains intact?
epidermis
The skin is the largest organ of the body. It is composed of three layers, including the:
epidermis
The skin is the largest organ of the body. It is composed of three layers, including the:
epidermis.
Abdominal bruising should be considered a sign of possible:
internal organ damage.
The structures within the dermis include:
sweat glands.
What is the primary risk for electrical injury patients?
Respiratory or cardiac arrest
Which layer of the skin provides shock absorption and insulation?
Subcutaneous
What is an example of classifying a burn by agent and source?
Thermal burn from excessively hot coffee
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
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.
You are performing a secondary assessment on your 19-year-old trauma patient with a severely bruised trunk and signs of damage to the ribs and sternum. He is coughing up frothy red blood and having difficulty breathing. What injury do these signs point to?
A punctured lung
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.
You are called to the scene of a patient who was burned by an electrical shock while installing a washing machine. On your arrival, the patient is lying beside the washing machine on which he was working. What is your first consideration for this patient?
Assume the source of electricity is still active.
In bandaging a hand wound, what important consideration is necessary?
Bandage the hand in the position of function.
Which of the following is a consideration in determining a burn's severity?
Body surface area (BSA) involved in the burn Other illnesses or injuries the patient may have The type of agent that caused the burn
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.
Your patient has sustained a chemical burn to her hands from dry lime. How is this treated in the field?
Brush off the powder before using water to flush.
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.
You are caring for a victim who was rescued from a burning building by the fire department. The patient is alert and oriented with superficial burns to the arms, chest, neck, and face. He complains that he cannot breathe well. What is this patient's most critical injury?
Burns to the face
How does the skin provide temperature regulation?
By altering the blood flow to the skin and by controlling perspiration
A patient who was injured by lightning is awake on your arrival but is not able to hear what you are saying. He can talk, and is frightened because he does not know what happened. The patient was in a picnic area at a park and was thrown several feet to the ground when the lightning struck near him. Which of the following steps has the highest priority in this patient's assessment and treatment?
Care for spine injuries, head injuries, and severe fractures.
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.
Which of the following is not considered soft tissue?
Cartilage
You are dispatched to the scene of a construction site where a 33-year-old male has been impaled with a piece of rebar to his right anterior chest near the clavicle. The rebar is too long to allow transport of the patient. The patient is alert and seated on the ground. How should you manage this injury?
Contact medical control and ensure someone stabilizes the object while it is gently cut to the desired length.
Which of the following is not an open tissue injury?
Contusion
You are caring for a 46-year-old female who accidentally sustained burns to her left hand up to the wrist from boiling water. You arrive moments after the incident. Of the following, which should you do first?
Cool the burned area to stop the burning process.
Bleeding from soft-tissue injuries should initially be controlled with which one of the following techniques?
Direct pressure
Which of the following is the outermost layer of the skin?
Epidermis
You arrive on scene to a residence where you find a 16-year-old female patient who was shocked while plugging in an appliance in the garage. Her father states that he heard the shock and saw her get "thrown to the ground." The patient is awake and alert, and still lying on the ground. Based on the patient's presentation, how should you manage this patient's injury?
Evaluate the patient for spine injuries and stabilize the spine.
Which of the following statements about puncture wounds is correct?
Even insignificant-looking puncture wounds can cause devastating injuries.
Which of the following best describes an avulsion?
Flap of skin that is partially or completely torn away from the underlying tissue
A burn extending into the subcutaneous fat would be classified as which type of burn?
Full thickness
You are caring for a 15-year-old female who has sustained a laceration to her lower arm. It is spurting bright red blood uncontrollably. What personal protective equipment would be most preferred in managing this wound?
Gloves and a face shield
Which of the following statements is false regarding an electrical injury?
Injury is usually limited to the area around the source and ground burns.
You are called to the scene of a metal fabrication plant, where you are presented with a 30-year-old male patient complaining of bilateral severe eye pain. Upon examination, you notice both eyes are red and irritated. Patient states that one of the dyes he was working with splashed into his eyes. How would you manage this patient's injury?
Irrigate both eyes with copious amounts of water for at least 20 minutes or until you arrive at the medical facility.
Which of the following statements is not true concerning the proper transport of an avulsed ear?
It should be in a dry sterile dressing.
You arrive on scene to an assault. Law enforcement has secured the scene. Your patient is a 23-year-old male with a blood-soaked shirt. The patient states that the assailant "slashed at him with a box opener." You expose the chest and note a jagged cut on his left anterior chest with steady, dark red hemorrhaging. Based on this assessment finding, the wound is most likely which of the following?
Laceration
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.
Crush injuries often can be identified by what?
Mechanism of injury
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.
In treating open wounds to the neck or abdomen, which type of dressing is preferred?
Occlusive dressing
Which of the following injuries requires the use of an occlusive dressing?
Open wound to the abdomen from which a loop of intestine is protruding Open wound to the neck Open wound to the chest
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 recommended when caring for an amputated part?
Seal the part in a plastic bag and keep it cool.
Which of the following is a function of the skin?
Sensation
Which of the following is appropriate in caring for a patient with closed soft-tissue injuries and a significant mechanism of injury (MOI)?
Splint any swollen, deformed extremities. Treat for shock if you think there are internal injuries even if the patient's vital signs are normal. Anticipate vomiting.
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 of concern with a puncture wound?
Strong possibility of contamination Hidden internal bleeding with minimal external bleeding An object that remains impaled in the body
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.
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? The nail is less than 2 inches in length. B. The patient's distal pulse, motor function, and sensation are intact. C. Bleeding from the wound is minimal. D. None of the above
The nail is less than 2 inches in length. The patient's distal pulse, motor function, and sensation are intact. Bleeding from the wound is minimal. None of the above
Which of the following best describes a partial thickness burn?
The skin is red and moist with blister formation.
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 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 true concerning lacerations?
They may indicate deeper underlying tissue damage. They may be caused by blunt trauma. They may be caused by penetrating trauma.
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
Which of the following is a guideline for the treatment of chemical burns?
Wash away the chemical with flowing water.
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.
When assessing a patient, consider the possibility of closed soft-tissue injuries whenever there is swelling, pain, or deformity, as well as:
a mechanism of blunt trauma.
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
All burns are to be treated as more serious if:
accompanied by other injuries or medical problems.
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
A burn injury should be considered to be:
an injury with the potential for many far-reaching effects.
Your patient suffered a severe electrical burn injury. In your emergency care, you should always:
assess for an entrance and an exit wound.
When a flap of tissue is traumatically removed, this condition is called a(n):
avulsion.
When crushed, the liver and spleen:
bleed profusely and cause shock.
Possible injury to the cervical spine or brain could be indicated by a(n):
bruise on the head or neck.
When managing an electrical burn, the EMT should:
check for a source and ground burn injury.
An internal injury with no open pathway from the outside is called:
closed
An internal injury with no open pathway from the outside is called:
closed.
For a young child with isolated genital injuries, you should:
consider the possibility of abuse, and treat the child with sensitivity.
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.
To control bleeding, start with:
direct pressure and elevation.
The sterile material that is placed directly on a wound is termed the:
dressing.
Generally, when providing emergency care of open wounds, the first thing you would do is:
expose the wound.
Your patient has a large bump on the forehead from being hit by a baseball. What type of injury is this?
hematoma
A swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel is a(n):
hematoma.
A wound under the skin that involves the collection of blood from injury to a large blood vessel is called a:
hematoma.
Damage to which of the following organs is least likely in the case of abdominal bruising?
lungs
Burns to the face are considered critical because:
of the potential for respiratory compromise or eye injury.
A puncture wound that is shallow or deep is a:
penetrating puncture wound.
Swelling or deformity at the site of a bruise indicates a:
possible underlying fracture.
The skin serves which of the following functions?
protection
Burns involving the airway often lead to:
respiratory compromise
Lacerations are cuts that are:
smooth or jagged.
Which of the following is a desirable characteristic of dressings used in the prehospital management of most open wounds?
sterile
The meatus is:
the external opening of the urethra.
Burns pose greater risks to infants and children than to adults because:
their body surface area is greater in relation to their total body size.
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.
In caring for an amputated part, it is important to:
wrap the part in sterile gauze and keep it cool.
In treating a puncture wound of the eye, if you bandage both eyes, it is because:
you want to avoid sympathetic eye movement.
Part of the assessment of a thermal burn is to calculate the percentage of the body surface area that has been burned. Your patient has burns to her anterior torso (chest and abdomen) and the anterior surface of her right arm. What is the estimated percentage of body surface burned?
22.5%
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
Your patient has burns to the entire right arm and the anterior chest. What is the estimated surface area involved?
18%
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
What is the resulting injury called when the burn penetrates all the way to the bottom layer of skin?
Full-thickness
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?
High-pressure injection
A bruise on the abdomen could indicate injury to which of the following?
Spleen, liver, or kidneys
White and dry to dark brown or black and charred skin is a sign of a:
full-thickness burn.
You are assessing a patient, and notice red discoloration with blisters on the legs. This type of burn would be classified as:
partial-thickness.
