Chapter 26 Soft-Tissue Injuries

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

C. A pulseless and apneic patient with a knife impaled in the back

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

C. Partial-thickness burn to 20% of the BSA

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. perform a neurologic exam. B. palpate his radial pulses. C. administer high-flow oxygen. D. apply ice to the hematoma.

C. administer high-flow oxygen.

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. remove the bandage and dressing and apply another one. B. carefully manipulate her arm until the symptoms subside. C. assess distal circulation and readjust the bandage as needed. D. remove the gauze bandage and replace it with an elastic one.

C. assess distal circulation and readjust the bandage as needed.

The germinal layer of the epidermis contains pigment granules that are responsible for skin:

Color

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.

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

D. brush away the chemical before flushing with water.

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.

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

D. pediatric patients have more surface area relative to total body mass.

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.

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:

administer oxygen and prepare for rapid transport.

In contrast to animal bites, the bite of a human:

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

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:

compartment syndrome.

Burns are classified according to:

depth and extent

In addition to external bleeding, the MOST significant risk that an open soft-tissue injury exposes a patient to is:

infection.

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:

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

Functions of the skin include all of the following, EXCEPT:

the production of key antibodies

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.

Which of the following processes occurs during the inflammation phase of the healing process? A. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling. B. 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. C. The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. D. 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.

A. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling.

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

A. an air embolism.

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.

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 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.

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

B. contusion

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

B. superficial burn.

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%

A 22-year-old male was attacked by a rival gang and has a large knife impaled in the center of his chest. Your assessment reveals that he is apneic and pulseless. You should: A.carefully remove the knife, control any bleeding, begin CPR, and transport. B.stabilize the knife in place, provide rescue breathing, and transport at once. C.remove the knife and control any bleeding, apply the AED, and analyze his rhythm. D.begin CPR, control any external bleeding, and transport rapidly to a trauma center.

Answer: A Rationale: As a rule, impaled objects should be stabilized in place. However, if they interfere with the patient's breathing or your ability to perform CPR, they should be removed. You cannot perform CPR on a patient if a knife is impaled in the center of the chest. Carefully remove the knife, control any bleeding, begin CPR, and transport at once. The AED is not indicated for patients with traumatic cardiac arrest; their arrest is usually caused by massive blood loss, not a primary cardiac dysrhythmia.

A 45-year-old convenience store clerk was shot in the right anterior chest during a robbery. Your assessment reveals that the wound has blood bubbling from it every time the patient breathes. Your MOST immediate action should be to: A.prevent air from entering the wound. B.cover the wound with a bulky dressing. C.assess the patient's back for an exit wound. D.transport the patient promptly to the closest trauma center.

Answer: A Rationale: Immediate treatment for a sucking chest wound (open pneumothorax) involves covering the wound with an occlusive dressing. This will prevent air from being drawn into the chest cavity. After covering the wound, assess for an exit wound, apply high-flow oxygen (if not already done), and transport promptly.

A young male was struck in the forearm with a baseball and complains of pain to the area. Slight swelling and ecchymosis are present, but no external bleeding. Which type of injury does this describe? A.Abrasion B.Contusion C.Hematoma D.Avulsion

Answer: B Rationale: A contusion (bruise) is caused by direct blunt force trauma. The epidermis remains intact, but small blood vessels in the dermis are injured. The depth of the injury varies, depending on the amount of energy absorbed. Pain and swelling occur as fluid and blood leak into the damaged area. The buildup of blood produces a characteristic blue and black discoloration called ecchymosis.

The primary reason for applying a sterile dressing to an open injury is to: A.prevent contamination. B.control external bleeding. C.reduce the risk of infection. D.minimize any internal bleeding.

Answer: B Rationale: Although prevention of contamination is an important reason for applying a sterile dressing to an open injury, the primary reason is to control the external bleeding associated with it.

A 5-year-old boy was burned when he pulled a barbecue grill over on himself. He has partial- and full-thickness burns to his anterior chest and circumferentially on both arms. What percentage of his body surface area has been burned? A.18% B.27% C.36% D.45%

Answer: B Rationale: Using the pediatric rules of nines, the anterior chest accounts for 9% of the BSA (the entire anterior trunk, which includes the chest and abdomen, accounts for 18% of the BSA), and each arm accounts for 9% of the BSA. Therefore, this child has experienced 27% BSA burns.

Which of the following statements regarding chemical burns is FALSE? A.Most chemical burns are caused by strong acids or alkalis. B.Fumes of strong chemicals can cause burns to the respiratory tract. C.Prior to removing a dry chemical, you should flush the area with sterile water. D.You should not attempt to neutralize an acid burn with an alkaline chemical.

Answer: C Rationale: Dry chemicals should be brushed off the patient before irrigating the wound with sterile water or saline. Failure to do so may increase the burning process and cause further tissue damage.

The MOST appropriate way to dress and bandage an open abdominal wound with a loop of bowel protruding from it is to: A.cover the wound with a dry, sterile dressing and apply firm pressure. B.apply a moist, sterile dressing to the wound and apply firm pressure. C.apply a moist, sterile dressing to the wound and secure with an occlusive dressing. D.carefully replace the protruding bowel into the abdomen and cover the wound.

Answer: C Rationale: Treatment for an abdominal evisceration includes applying a moist, sterile dressing to the wound and covering the moist dressing with an occlusive dressing. Do not replace a protruding bowel back into the wound or apply firm pressure, which may force the bowel back into the wound; these actions increase the risk of infection.

What effects will the application of an ice have on a hematoma? A.Vasodilation and increased pain B.Vasodilation and decreased bleeding C.Vasoconstriction and increased swelling D.Vasoconstriction and decreased bleeding

Answer: D Rationale: Applying an ice pack to a closed wound, such as a hematoma, will decrease bleeding, pain, and swelling by causing constriction of the blood vessels.

A compression injury that is severe enough to cut off blood flow below the injury is called: A.a contusion. B.a hematoma. C.a local thrombus. D.compartment syndrome.

Answer: D Rationale: Compartment syndrome can occur when a part of the body has been compressed for a prolonged period of time—usually greater than 4 hours. The injured tissue begins to swell, which can impede arterial blood flow and venous return. As a result, the part of the body distal to the compression site becomes hypoxic and metabolic waste products (ie, lactic acid) begin to accumulate.

Which of the following is considered a severe burn? A.Any full-thickness burn B.20% partial-thickness burn C.10% full-thickness burn with abrasions D.5% full-thickness burn with a fracture

Answer: D Rationale: Severe burns include the following: full-thickness burns involving the hands, feet, face, airway, or genitalia; full-thickness burns covering more than 10% of the body's total surface area (BSA); partial-thickness burns covering more than 30% of the BSA; burns involving the respiratory tract (eg, smoke inhalation); burns complicated by fractures; and burns on patients younger than 5 years or older than 55 years that would otherwise be classified as "moderate" burns on younger adults.