EMT Chapter 26 - Soft Tissue Injuries
A construction worker fell approximately 30′ and landed in a pile of steel rods. Your assessment reveals that he is pulseless and apneic and has a 10″ steel rod impaled in his left leg. You should: A. control the bleeding, begin cardiopulmonary resuscitation (CPR), stabilize the steel rod, immobilize his spine, and transport immediately. B. remove the steel rod, control the bleeding, apply an automated external defibrillator (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
A utility worker was trimming branches and was electrocuted when he accidentally cut a high-power line. He fell approximately 20′ and is lying unconscious on the ground the power line is lying across his chest. You should: A. rapidly assess the patient after ensuring that the power line is not live. B. apply insulated gloves and assume manual control of his c-spine. C. quickly but carefully move the patient away from the power line. D. manually stabilize his head as your partner assesses for breathing.
A
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: A. report the incident to the appropriate authorities. B. administer oxygen via a nonrebreathing mask. C. ask the child's father to try to locate the dog. D. advise the child that he will need rabies shots.
A
Burns are classified according to: A. depth and extent. B. location and pain. C. degree and location. D. extent and location.
A
Burns to pediatric patients are generally considered more serious than burns to adults because: A. pediatric patients have more surface area relative to total body mass. B. pediatric patients are more prone to hyperthermia. C. pediatric patients have a proportionately larger volume of blood. D. most burns in children are the result of child abuse.
A
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
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
The germinal layer of the epidermis contains pigment granules that are responsible for skin: A. color. B. texture. C. moisture. D. temperature.
A
The hair follicles, sweat glands and sebaceous glands are found in the: A. dermis B. germinal layer C. epidermis D. subcutaneous layer
A
The sebaceous glands produce sebum, a material that: A. waterproofs the skin and keeps it supple. B. discharges sweat onto the skin's surface. C. pulls the hair erect when you are cold. D. facilitates shedding of the epidermis.
A
When caring for a patient whose arm is covered with a dry chemical, you should: A. brush away the chemical before flushing with water. B. deactivate the chemical with a 5% vinegar solution. C. use forceful streams of water to remove the chemical. D. quickly irrigate the arm with large amounts of water.
A
Which of the following areas of the body has the thinnest skin? A. Ears B. Back C. Soles of the feet D. Scalp
A
Which of the following is a severe burn in a 35-year-old patient? A. circumferential partial-thickness burn to the chest B. full-thickness burn to 5% of the body surface area (BSA) C. partial-thickness burn to 20% of the BSA D. superficial burn covering 50% of the BSA
A
Which of the following should NOT be used as an occlusive dressing? A. Gauze pads B. Vaseline gauze C. Aluminum foil D. Plastic
A
Which of the following statements regarding electrical burns is correct? A. Entrance wounds are small relative to the amount of internal tissue damage. B. Respiratory or cardiac arrest following an electrical burn is very uncommon. C. The exit wound caused by electrical burns is smaller than the entrance wound. D. The size of the entry and exit wounds is a reliable indicator of internal damage.
A
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
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: A. assess distal circulation and readjust the bandage as needed. B. remove the bandage and dressing and apply another one. C. carefully manipulate her arm until the symptoms subside. D. remove the gauze bandage and replace it with an elastic one.
A
A burn that is characterized by redness and pain is classified as a: A. superficial burn. B. full-thickness burn. C. partial-thickness burn. D. second-degree burn.
A or FIRST-DEGREE BURN
A 30-year-old male experienced a crushing injury when his arm 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
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
A laceration: A. is an injury that separates various layers of soft tissue. B. is a jagged cut caused by a sharp object or blunt force trauma. C. rarely penetrates through the subcutaneous tissue to the muscle. D. is a sharp, smooth cut that is made by a surgical scalpel.
B
A(n) ______ is usually associated with extensive tissue damage. A. contusion B. hematoma C. crushing injury D. avulsion
B
A(n) ______ occurs whenever a large blood vessel is damaged and bleeds. A. contusion B. hematoma C. crushing injury D. avulsion
B
An injury that separates various layers of soft tissue, resulting in complete detachment or a flap of skin, is called a(n): A. incision. B. avulsion. C. laceration. D. amputation.
B
As the cells on the surface of the skin are worn away, now cells form in the _____ layer. A. dermal B. germinal C. epidermal D. subcutaneous
B
During an altercation in a bar, two patrons got into a fist fight. The first patient, a 44-year-old female, was struck in the mouth and refuses EMS care. The second patient, a 39-year-old female, has a small laceration to her left knuckle and also refuses EMS care. Which of the following statements regarding this scenario is MOST correct? A. You should contact the police and have the patients arrested. B. The 39-year-old female is at high risk for an infection. C. The patient struck in the mouth should be immobilized. D. The 44-year-old female is at high risk for an infection.
B
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
In which of the following patients should you remove an impaled object? A. A conscious and alert patient with a fishhook impaled in the eye B. A pulseless and apneic patient with a knife impaled in the back C. A semiconscious patient with an ice pick impaled in the chest D. An apneic patient with a shard of glass impaled in the abdomen
B
The most important consideration when dealing with electrical burns is: A. standard precautions B. scene safety C. level of responsiveness D. airway
B
The skin covering the _____ is quite thick. A. lips B. scalp C. ears D. eyelids
B
What layer of the skin forms a watertight, protective seal for the body? A. dermis B. epidermis C. muscular layer D. subcutaneous layer
B
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? A. Incision B. Abrasion C. Avulsion D. Laceration
B
Which of the following processes occurs during the inflammation phase of the healing process? A. The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. B. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling. C. 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. D. 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.
B
Which of the following statements regarding crush syndrome is correct? A. Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal. B. Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours. C. With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity. D. Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body.
B
______ burns cause intense pain. A. First-degree B. Second-degree C. Superficial D. Third-degree
B
A 17-year-old male was shot in the right anterior chest during an altercation with a gang member. As your partner is applying 100% oxygen, you perform a rapid secondary assessment and find an open chest wound with a small amount of blood bubbling from it. You should: A. place a sterile dressing over the wound and apply direct pressure. B. control the bleeding from the wound and prepare to transport at once. C. apply an occlusive dressing to the wound and continue your assessment. D. direct your partner to assist the patient's ventilations with a bag-mask device.
C
A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should: A. carefully probe the wound to determine if the bleeding is venous or arterial. B. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing. C. replace the avulsed flap to its original position and cover it with a sterile dressing. D. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.
C
A(n) _____ occurs when a great amount of force is applied to the body for a long period of time. A. contusion B. hematoma C. crushing injury D. avulsion
C
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: A. perform an immediate head-to-toe assessment. B. assess his pulse for rate, regularity, and quality. C. open his airway and assess his breathing status. D. apply high-flow oxygen and assess his injuries.
C
Closed soft-tissue injuries are characterized by all of the following EXCEPT: A. pain at the site of the injury B. swelling beneath the skin C. damage of the protective layer of skin D. a history of blunt trauma
C
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
In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is: A. an ischemic stroke. B. a spinal fracture. C. an air embolism. D. nerve fiber damage.
C
Patients with full-thickness (third-degree) burns generally do not complain of pain because: A. blister formation protects the burn. B. he or she is generally not conscious. C. the nerve endings have been destroyed. D. subcutaneous vessels are usually clotted.
C
Treatment for an abdominal evisceration includes: A. pushing the exposed organs back into the abdominal cavity B. covering the organs with dry dressings C. flexing the knees and legs to relieve pressure on the abdomen D. applying moist, adherent dressings
C
When assessing a patient with a closed soft-tissue injury, it is MOST important to: A. manipulate the injury site for signs of a fracture. B. assess circulation distal to the site of the injury. C. remain alert for more severe underlying injuries. D. recognize that the integrity of the skin is broken.
C
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
______ burns involve only the epidermis. A. Full-thickness B. Second-degree C. Superficial D. Third-degree
C
_______ burns may involve the subcutaneous layers, muscle, bone or internal organs. A. Superficial B. Partial-thickness C. Full-thickness D. Second-degree
C
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. A. 36% B. 45% C. 27% D. 18%
D
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? A. Carefully replace the exposed bowel into the abdomen and transport. B. Cover the exposed bowel and keep his legs in a straight position. C. Irrigate it with sterile water and cover it with a dry dressing. D. Cover it with moist, sterile gauze and secure with an occlusive dressing.
D
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: A. palpate his radial pulses. B. perform a neurologic exam. C. apply ice to the hematoma. D. administer high-flow oxygen.
D
A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): A. hematoma. B. abrasion. C. crush injury. D. contusion.
D
A partial-thickness burn involves the outer layer of skin and a portion of the: A. epidermis. B. fatty layer. C. muscle fascia. D. dermal layer.
D
A teenage boy who was involved in a bicycle accident has a puncture wound where the bicycle kickstand impaled his leg. The MOST appropriate method for treating this injury is to: A. remove the kickstand in a circular motion and apply a dry, sterile dressing. B. cut the kickstand off just above the skin, and stabilize it with sterile dressings. C. leave the kickstand attached to the bike until the physician can remove it safely. D. unbolt the kickstand from the bike frame and stabilize it with bulky dressings.
D
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
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: A. .357 magnum. B. handgun. C. .22-caliber pistol. D. shotgun.
D
The hallmark sign of compartment syndrome is: A. a lack of pain despite the severity of the injury. B. extreme redness to the injury site. C. a bounding pulse distal to the injury. D. pain out of proportion to the injury.
D
The sebaceous glands produce sebum, a material that: A. facilitates shedding of the epidermis. B. pulls the hair erect when you are cold. C. discharges sweat onto the skin's surface. D. waterproofs the skin and keeps it supple.
D
Treatment of electrical burns includes: A. maintaining the airway B. monitoring the patient closely for respiratory or cardiac arrest C. splinting any suspected injuries D. all of the above
D
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
Which of the following is a severe burn in a 65-year-old patient? A. Second-degree burn covering 10% of the BSA B. Superficial burn to 30% of the BSA C. Full-thickness burn to 1% of the BSA D. Partial-thickness burn to 20% of the BSA
D
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 all degrees of burn.
D
You and your partner arrive at the scene of a house fire where fire fighters 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