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.