EMT Basic 2019 Chapter 26 Soft-Tissue Injuries

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

C. open his airway and assess his breathing status

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

C. replace the avulsed flap to its original position and cover it with a sterile dressing

Explain how the Skin varies in thickness, depending on the person's age and the skin's location

-Skin is thinner in the very young and the very old. -Skin is thinner on the eyelids, lips, and ears than on the scalp, back, and soles of the feet.

Epidermis

-the tough, external layer that forms a watertight covering for the body -The epidermis is itself composed of several layers.

patient assessment for closed and open injuries: Secondary assessment

1. A more systematic full-body scan or focused examination of the patient 2. Includes assessing interventions and repeating vital signs, which typically occurs en route to the ED 3. Vital signs a. Obtain a series of vital signs to ensure subtle changes are evident. b. Signs that indicate hypoperfusion and indicate the need for rapid transport: i. Tachycardia ii. Tachypnea i. Low blood pressure ii. Weak pulse iii. Cool, moist, and pale skin c. Reassessing vital signs will indicate how well the patient is tolerating the injury and the effectiveness of interventions.

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 correct? A. you should contact the police and have the patients arrested B. the 44-year-old female is at high risk of an infection C. the 39-year-old female is at high risk for an infection D. the patient struck in the mouth should be immobilized

C. the 39-year-old female is at high risk for an infection

patients with full-thickness (third-degree) burns generally do not complain of pain because: A. subcutaneous vessels are usually clotted B. blister formation protects the burn C. the nerve endings have been destroyed D. they are generally not conscious

C. the nerve endings have been destroyed

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

B. Cover it with moist, sterile gauze and secure with an occlusive dressing

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

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

B. assess distal circulation and readjust the bandage as needed

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

B. brush away the chemical before flushing with water

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

B. contusion

A(n)_____________occurs when a great amount of force is applied to the body for a long period of time A. hematoma B. crushing injury C. avulsion D. contusion

B. crushing injury

A partial-thickness burn involves the outer layer of skin and a portion of the: A. epidermis B. dermal layer C. muscle fascia D. fatty layer

B. dermal layer

A laceration: A. rarely penetrates through the subcutaneous tissue to the muscle B. is a jagged cut caused by a sharp object or blunt force trauma C. is a sharp, smooth cut that is made by a surgical scalpel D. is an injury that seperates various layers of soft tissue.

B. is a jagged cut caused by a sharp object or blunt force trauma

You respond to a house fire with the local fire dept. They bring a 48-year-old woman out of the house. She is unconscious but her airway is open. Her breathing is shallow at 30 breaths/minute. Her pulse is 110 beats/minute, strong and regular. Her blood pressure is 108/72 mm Hg. She has been burned over 40% of her body. The burned area appears to be dry and leathery. It looks charred and has pieces of fabric embedded in the flesh. You know that this type of burn is considered a: A. first-degree burn B. second-degree burn C. third-degree burn D. partial thickness burn

C. third-degree burn

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

C. waterproofs the skin and keeps it supple

During the normal wound-healing process, bleeding may occur from even a minor injury because: A. histamines released by the immune system constrict the blood vessels, which increases the pressure within them. B. new capillaries that stem from intact capillaries are delicate and take time to become as stable as the preexisting capillaries C. there is a substantial decrease in the number of platelets in and around the wound, which increases the risk of bleeding D. bacteria and other microorganisms invade the wound site and damage the capillaries, which makes them more prone to bleeding

B. new capillaries that stem from intact capillaries are delicate and take time to become as stable as the preexisting capillaries

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. remain alert for more severe underlying injuries C. assess circulation distal to the site of injury D. recognize that the integrity of the skin is broken

B. remain alert for more severe underlying injuries

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. administer oxygen via a nonrebreathing mask B. report the incident to the appropriate authorities C. advise the child that he will need rabies shots D. ask the child's father to try and locate the dog

B. report the incident to the appropriate authorities

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

B. superficial burn

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. .22-caliber pistol C. handgun D. shotgun

D. shotgun

Dermis

Inner layer of skin that contains the streuctures that give the skin its characteristic appearance

The mechanism of injury from a blast injury is generally due to three factors:

Primary blast injury Secondary blast injury Tertiary blast injury

Abrasion

Scrape of the skin due to something abrasive. skinned knee

Laceration

a jagged cut caused by a sharp object or a blunt force that tears the tissue

Abrasion

a wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface

Avulsion

a wound that separates various layers of soft tissue (usually between the subcutaneous layer and fascia) so that they become either completely detached or hang as a flap a. Often there is significant bleeding. b. Never remove an avulsion skin flap, regardless of its size. c. Amputation: an injury in which part of the body is completely severed

Penetrating wounds and Impaled objects are:

a. May cause damage to structures deep inside the body b. Presence of foreign materials inside the tissue can lead to infection Stabbings/shootings etc blast injuries may result in multiple penetrating injuries

Your first responsibility in caring for a patient with a burn is to stop the __________ __________ and prevent __________ injury.

burning process additional injury

sebaceous glands

produce oil, which waterproofs the skin and keeps it supple

Closed injuries are:

contusions hematoma crush injuries

sweat glands

cool the body by discharging a substance through the pores

laceration

razorcut, a cut, tear

Mucous membranes

secrete a watery substance that lubricates the openings of the mouth and nose

Burn injuries are progressive—the greater the heat energy, the ____________the wound.

deeper

penetrating wound

gunshot wound) an open wound that breaks the skin and enters a body area, organ, or cavity

Inflammation ultimately leads to the removal of

i. Foreign material ii. Damaged cellular parts iii. Invading microorganisms

Burn victims are at high risk for:

i. Infection ii. Hypothermia iii. Hypovolemia iv. Shock

The severity of a thermal injury correlates directly with:

i. Temperature ii. Concentration iii. Amount of heat energy possessed by the object or substance iv. Duration of exposure

The skin is the bodies..........

the body's first line of defense against external forces and infection. 1.It is the largest organ in the body. 2.It is relatively tough, but still susceptible to injury. a.Injuries may expose blood vessels, nerves, and bones.

Dermis

the inner layer of the skin i.Contains the hair follicles, sweat glands, and sebaceous glands ii.Blood vessels in the dermis provide the skin with nutrients and oxygen.

Burns are:

tissue damage and cell death caused by heat, electricity, UV radiation, or chemicals

Epidermis

tough external layer forming a watertight covering for the body

The universal dressing is ideal for covering _________ ___________ wounds

large open wounds

Care for radiation burns

1. Acute radiation exposure has become more than a theoretical issue because the use of radioactive materials has increased in industry and medicine. 2. Potential threats include incidents related to the use and transportation of radioactive isotopes and intentionally released radioactivity in terrorist attacks. 3. First determine if there has been a radiation exposure and then attempt to determine whether ongoing exposure continues to exist. 4. Three types of ionizing radiation: a. Alpha particles i. Have little penetrating energy and are easily stopped by the skin b. Beta particles i. Have greater penetrating power and can travel much farther in air than alpha particles ii. Can penetrate the skin, but can be blocked by simple protective clothing designed for this purpose c. Gamma radiation i. Threat is directly proportional to the wavelength ii. Very penetrating and easily passes through the body and solid materials 5. Most ionizing radiation accidents involve gamma radiation (x-rays). 6. People who have sustained a radiation exposure generally do not pose a risk to others; however, particularly in incidents involving explosions, patients may be contaminated. 7. Management of radiation burns a. Maintain a safe distance and wait for the HazMat team to decontaminate the patient before initiating care. b. Most contaminants can be removed by simply removing the patient's clothes. Call for additional resources. c. Once there is no threat to you, begin treating the ABCs and treat the patient for any burns or trauma. d. Irrigate open wounds. e. Notify the emergency department. f. Identify the radioactive source and the length of the patient's exposure to it. g. Limit your duration of exposure, increase your distance from the source, and attempt to place shielding between yourself and sources of gamma radiation.

Abdominal wounds (open)

1. An open wound in the abdominal cavity may expose internal organs. 2. Evisceration: the organs protrude through the wound a. Cover the wound with sterile gauze moistened with sterile saline solution. b. Secure the gauze with an occlusive dressing. c. Keep the organs moist and warm. 3. Most patients with abdominal wounds require immediate transport to a trauma center.

patient assessment for burns: Primary assessment

1. Begin with a rapid exam. 2. Form a general impression. a. Look for clues to determine the severity of injuries and the need for rapid treatment. b. Be suspicious of clues that may indicate abuse. c. Consider the need for manual spinal stabilization. d. Check for responsiveness using the AVPU scale. e. In all patients whose level of consciousness is less than alert and oriented, administer high-flow oxygen via a nonrebreathing mask and provide immediate transport. 3. Airway and breathing a. Be alert to signs that the patient has inhaled hot gases or vapors: i. Singed facial hair ii. Soot present in or around the airway b. Heavy amounts of secretions and frequent coughing may indicate a respiratory burn. 4. Circulation a. Control significant bleeding. b. If the patient has obvious life-threatening external hemorrhage, control the bleeding first (before airway and breathing), and only then treat the patient for shock as quickly as possible. c. Shock frequently develops in burn patients. 5. Transport decision a. Consider rapid transport for a patient who has: i. An airway or breathing problem ii. Significant burn injuries iii. Significant external bleeding iv. Signs and symptoms of internal bleeding b. Consulting with ALS providers may be appropriate.

Medical care for Thermal Burns

1. Caused by heat 2. Most commonly, caused by scalds or an open flame a. A flame burn is very often a deep burn, especially if the person's clothing catches fire. b. A scald burn is most commonly seen in children and handicapped adults but can happen to anyone, particularly while cooking. 3. Coming in contact with hot objects produces a contact burn. a. Contact burns are rarely deep unless the patient was prevented from drawing away from the hot object. 4. A steam burn can produce a topical (scald) burn. a. Minor steam burns are common when microwaving food covered with plastic wrap. 5. A flash burn is produced by an explosion, which may briefly expose a person to very intense heat. a. Lightning strikes can also cause a flash burn. 6. Management of thermal burns a. Stop the burning source, cool the burned area if appropriate, and remove all jewelry. b. Maintain a high index of suspicion for inhalation injuries. c. Increased exposure time will increase damage to the patient. d. The larger the burn, the more likely the patient is to be susceptible to hypothermia and/or hypovolemia. e. All patients with large surface burns should have a dry sterile dressing applied.

Care for Chemical Burns

1. Chemical burns can occur whenever a toxic substance contacts the body. 2. Most chemical burns are caused by strong acids or strong alkalis. 3. The eyes are particularly vulnerable. 4. The severity of the burn is directly related to the: a. Type of chemical b. Concentration of the chemical c. Duration of the exposure 5. To prevent exposure to hazardous materials, determine if you can safely approach the patient. In some cases, it may be necessary to wait until a hazardous materials (HazMat) team has decontaminated the patient. 6. Wear appropriate chemical-resistant gloves and eye protection whenever you are caring for a patient with a chemical burn. 7. Treatment for chemical burns can be specific to the chemical agent. 8. Management of chemical burns a. The severity of the burn will depend on the type of chemical, its strength, the duration of exposure, and the area of the body exposed. b. To stop the burning process, remove any chemical from the patient. c. Always brush dry chemicals off the skin and clothing before flushing the patient with water. d. Remove the patient's clothing, including shoes, stockings, gloves, and any jewelry or eyeglasses. e. Take great care to ensure you do not come in contact with the chemical. The patient should be properly decontaminated by properly trained personnel. f. For liquid chemicals, immediately begin to flush the burned area with large amounts of water. g. Continue flooding the area with gallons of water for 15 to 20 minutes after the patient says the burning pain has stopped. h. If the patient's eye has been burned, hold the eyelid open (without applying pressure over the globe of the eye) while flooding the eye with a gentle stream of water. i. As with any substance, once the fluid has been contaminated with the chemical, collect it and properly dispose of it. j. Conduct a proper decontamination prior to loading any patient into the ambulance and again prior to entering a hospital

Patient assessment for burns: Classify burn

1. Classification of burns involves determining: a. Source of the burn b. Depth of the burn c. Severity of the burn

Patient assessment for burns: Secondary assessment

1. Physical examination a. Perform an exam of the entire body. b. Assess the patient from head to toe looking for DCAP-BTLS. c. Make a rough estimate, using the rule of nines, of the extent of the burned area. d. Determine which classification of burns the victim has sustained. e. Determine the severity of the burns. f. Package the patient for transport based on your findings. 2. Vital signs a. Obtaining an early set of vital signs will indicate how the patient is tolerating his or her injuries. b. Monitoring devices i. Oxygen saturation monitor ii. Carbon monoxide monitor

Patient assessment for burns: Reassessment

1. Reassess the patient and reevaluate interventions and treatments. 2. Communication and documentation a. Provide hospital personnel with a description of how the burn occurred. b. Describe the extent of the burns: i. Amount of body surface area involved ii. Depth of the burn iii. Location of the burn c. If special areas are involved, they should be specifically mentioned and documented.

Primary assessment for closed and open injuries

1. Focus on identifying and managing life-threatening concerns and identifying the transport priority. 2. Form a general impression. a. Important indicators will alert you to the seriousness of the patient's condition. i. Is the patient awake and interacting with his or her surroundings, or is the patient lying still, making no sounds? ii. Is the patient responding to you appropriately or inappropriately? iii. Is the patient's breathing pattern rapid or slow, deep or shallow? iv. What is the color and condition of the patient's skin? v. Does the patient have any apparent life threats? b. Closed soft-tissue injuries may appear to be minor, but could indicate serious internal injuries. i. Do not be distracted from looking for more serious hidden injuries. c. Check for responsiveness. 3. Airway and breathing a. Providing high-flow oxygen may help reduce the effects of shock and assist in perfusion of damaged tissues, particularly in crush injuries. b. Open soft-tissue injuries of the face and neck have a potential to interfere with the effectiveness of the airway and breathing. 4. Circulation a. Assessment of the pulse and skin provides an indication as to how aggressively you need to treat the patient for shock. 5. Transport decision a. Consider whether transport to the closest hospital is appropriate or whether the patient would be better served by transport to a trauma center. b. Types of patients who need immediate transportation: i. Poor initial general impression ii. Altered level of consciousness iii. Dyspnea iv. Abnormal vital signs v. Shock vi. Severe pain

What are the 4 types of Open soft-tissue injuries

1. Four types of open soft-tissue wounds: a. Abrasions b. Lacerations c. Avulsions d. Penetrating wounds

Care for taser Injuries

1. In recent years, law enforcement has increased its use of Tasers. 2. These weapons fire two small darts (electrodes) that puncture the patient's skin. a. Barbs are generally treated as impaled objects and removed by a physician. b. In some jurisdictions, depending on local protocol, EMTs are permitted to remove these barbs from patients. 3. There are potential complications for the patient when these devices have been used, particularly when the patient is experiencing certain underlying disorders. a. Excited delirium is commonly associated with illegal drug ingestion. b. It is considered a true emergency and warrants assisted ALS response. c. Using a Taser device in patients with true excited delirium has been associated with dysrhythmias and sudden cardiac arrest. 4. Make sure you have access to an AED when you respond to patients who have been exposed to Taser shots.

Care for Inhalation Burns

1. Inhalation injuries can occur when burning takes place in enclosed spaces without ventilation. a. Upper airway damage is often associated with the inhalation of superheated gases. b. Lower airway damage is often associated with the inhalation of chemicals and particulate matter. 2. When treating a patient for inhalation injuries, you may encounter severe upper airway swelling, requiring immediate intervention. a. Consider requesting ALS backup if the patient has signs and symptoms of edema. i. Stridor ii. Hoarse voice iii. Singed nasal hairs iv. Burns of the face v. Carbon particles in the sputum b. Apply cool mist, aerosol therapy, or humidified oxygen to help reduce minor edema. c. Apply an ice pack to the throat to reduce swelling, provided the tissue in that area does not have burns. 3. The combustion process produces a variety of toxic gases. a. The less efficient the combustion process, the more toxic the gases that may be created. 4. Carbon monoxide (CO) intoxication should be considered whenever a group of people in the same place all report a headache or nausea. 5. Cherry red skin, lips, and nail beds are commonly observed in patients who have died from CO exposure a. Do not rule out CO exposure simply because the patient's skin is not cherry red. 6. Hydrogen cyanide (HCN) is generated by combustion. a. Signs and symptoms of HCN poisoning involve the central nervous, respiratory, and cardiovascular systems of the body: i. Faintness ii. Anxiety iii. Abnormal vital signs iv. Headache vi. Seizures vii. Paralysis viii. Coma 7. Management of inhalation burns a. First ensure your own safety and the safety of your coworkers. b. Prehospital treatment of a patient with suspected hydrogen cyanide poisoning includes decontamination and supportive care until an antidote can be administered by ALS providers. c. Care for any toxic gas exposure: i. Recognition ii. Identification iii. Supportive treatment

Patient assessment for burns: History Taking

1. Investigate the chief complaint. a. Be alert for signs or symptoms of other injuries due to the MOI. b. If the patient was burned in a confined space, suspect an inhalation injury. c. When burns result from explosive forces, be alert for other internal injuries and fractures. d. Obtain a medical history and be alert for injury-specific signs and symptoms and pertinent negatives. 2. SAMPLE history a. Along with the SAMPLE history, ask the following questions: i. Are you having any difficulty breathing? ii. Are you having any difficulty swallowing? iii. Are you having any pain? b. Check whether the patient has an emergency medical identification device.

care for impaled objects

1. Leave the object in place 2. Expose the area. Cut away clothing surrounding the injury, shorten object is possible 3. Stabilize the object with bulky dressings, clean cloths, or a donut 4. Seek medical care 5. rapid transport

Care for Electrical Burns

1. May be the result of contact with high- or low-voltage electricity a. High-voltage burns may occur when utility workers make direct contact with power lines. b. Ordinary household current can cause severe burns and cardiac arrhythmias. 2. For electricity to flow, there must be a complete circuit between the electrical source and the ground. a. Insulator: any substance that prevents this circuit from being completed b. Conductor: any substance that allows a current to flow through it c. The human body is a good conductor. d. Electrical burns occur when the body, or a part of it, completes a circuit connecting a power source to the ground. 3. The type of electric current, magnitude of current, and voltage influence the seriousness of burns. 4. Your safety is of particular importance when you are called to the scene of an emergency involving electricity. 5. A burn injury appears where the electricity enters and exits the body. a. Two dangers specifically associated with electrical burns: i. A large amount of deep tissue injury ii. Cardiac or respiratory arrest from the electric shock 6. Management of electrical burns a. Electrical current can cross the chest and cause cardiac arrest or arrhythmias. b. If indicated, begin CPR on the patient and apply the automated external defibrillator (AED). c. Be prepared to defibrillate if necessary. d. Give supplemental oxygen and monitor the patient closely for respiratory and cardiac arrest. e. Treat soft-tissue injuries by applying dry, sterile dressing on all burn wounds and splinting suspected fractures. f. Provide prompt transport.

Care for open wound neck injuries

1. Open neck injuries can be life threatening. 2. If the veins of the neck are open to the environment, they may suck in air. a. If enough air is sucked into a blood vessel, it can block the flow of blood in the lungs and cause cardiac arrest. b. This condition is called air embolism. 3. Cover the wound with an occlusive dressing. 4. Apply manual pressure but do not compress both carotid arteries at the same time. a. This could impair circulation to the brain and cause a stroke. 5. Use caution with patients suffering from a neck injury depending on the MOI involved. a. Immobilize the C-spine if indicated, including placing a cervical collar.

patient assessment for closed and open injuries: Reassessment

1. Reassessment should be conducted regularly during transport. 2. Repeat the primary assessment and pay extra attention to areas of concern identified in the initial assessment. 3. Assess the effectiveness of prior treatments. 4. Reassess vital signs and the chief complaint. 5. Identify and treat changes in the patient's condition. 6. Communication and documentation a. Communication and documentation must include a description of the MOI and the position in which you found the patient when you arrived on scene. b. Report blood loss using terms that you are comfortable with and that will be easily understood by other personnel. c. Include the location and description of any soft-tissue injuries or other wounds you have located and treated. d. Describe the size and depth of the injury. e. Provide an accurate account of how you treated these injuries.

patient assessment for closed and open injuries scene size up

1. Scene safety 2. Mechanism of injury (MOI) a. Look for indicators of the MOI as you assess the scene. i. Helps develop an early index of suspicion for underlying injuries. ii. Interactions with the patient and your assessment will provide you with additional information about the extent of the injuries. b. The MOI may provide information about potential safety threats. c. Use all available information to evaluate scene safety and consider whether additional resources may be necessary.

patient assessment for burns: Scene size-up

1. Scene safety b. Ensure that the factors that led to the patient's burn injury do not pose a hazard to you and your crew. 2. Mechanism of injury a. Attempt to determine the type of burn that has been sustained and the MOI. b. What the patient reports will often provide some important information about the extent of the injury. c. Assess the scene for any environmental hazards. d. Determine the number of patients. e. Call for additional resources early, if necessary. f. Consider the potential for spinal injuries, broken bones, inhalation injuries, and other injuries.

Care for bites (open wound)

1. Small-animal bites and rabies a. Consider the scene and crew safety prior to entering the environment. b. A small animal's mouth is heavily contaminated with virulent bacteria. c. Consider all small-animal bites to be contaminated and potentially infected wounds. d. All small-animal bites should be evaluated by a physician. e. A major concern is the spread of rabies, an acute, potentially fatal viral infection of the central nervous system that can affect all warm-blooded animals. f. Children, particularly young ones, may be seriously injured or even killed by dogs. i. The animal may turn and attack you as well. ii. Do not enter the scene until the animal has been secured by the police or an animal control officer. 2. Human bites a. The human mouth, more so than even the small animal's mouth, contains an exceptionally wide range of bacteria and viruses. b. Consider any human bite that has penetrated the skin to be a very serious injury. c. Any laceration caused by a human tooth can result in a serious, spreading infection. d. Emergency treatment: i. Apply a dry, sterile dressing. ii. Promptly immobilize the area with a splint or bandage. iii. Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy.

patient assessment: History taking for closed and open injuries

1.Investigate the chief complaint. a.Chronic medical conditions such as anemia and hemophilia as well as a host of other medical conditions can complicate open soft-tissue injuries.

Emergency Medical Care for Closed Injuries

A. Small contusions generally require no special emergency medical care, but you should note their presence to determine the extent of the patient's injuries. B. More extensive closed injuries may involve significant swelling and bleeding beneath the skin, which could lead to hypovolemic shock. C. The injuries might not have had time to cause swelling or bruising. D. Closely watch any area of injury throughout the time you are caring for the patient, no matter how minor it may look upon initial assessment. E. Treat a closed soft-tissue injury using the RICES mnemonic: 1. Rest 2. Ice 3. Compression 4. Elevation 5. Splinting F. Be alert for signs of developing shock: 1. Anxiety or agitation 2. Changes in mental status 3. Increased heart rate 4. Increased respiratory rate 5. Diaphoresis 6. Cool or clammy skin 7. Decreased blood pressure G. If the patient exhibits signs and symptoms of shock, treat accordingly and aggressively.

What layer of the skin forms a watertight, protective seal for the body? A. epidermis B. subcutaneous C. muscular layer D. dermis

A. epidermis

When a person is exposed to a cold environment: A. peripheral vessels constrict and divert blood away from the skin B. sweat is produced and is warmed when the vessels constrict C. blood vessels dilate and divert blood to the core of the body D. the skin becomes flushed secondary to peripheral vasodilation

A. peripheral vessels constrict and divert blood away from the skin

A utility worker was trimming branches and was electrocuted when he accidentally cut a high-power line. He fell approximately 20 feet and is lying unresponsive 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. manually stabilize his head as your partner assesses for breathing D. quickly but carefully move the patient away from the power line

A. rapidly assess the patient after ensuring that the power line is not live

The skin covering the_____________is quite thick A. scalp B. ears C. eyelids D. lips

A. scalp

Emergency Medical Care for Open Injuries

Before you begin to care for a patient with an open wound, follow standard precautions. 1. If life-threatening bleeding is observed, assign a team member to apply direct pressure over the wound to control the bleeding. 2. If the wound is in the chest, upper abdomen, or upper back, cover it with an occlusive dressing. 3. Control bleeding using: a. Direct, even pressure and elevation b. Pressure dressings and/or splints c. Tourniquets All open wounds should be assumed to be contaminated and to present a risk of infection. 1. Apply a sterile dressing to reduce the risk of further contamination. 2. Do not remove material from an open wound, no matter how dirty the wound is. 3. Small wound surfaces without significant bleeding can be flushed with sterile saline prior to applying a dressing. 4. In most circumstances, hospital personnel, rather than EMTs, will clean open wounds. C. In some cases, you can better control bleeding from open soft-tissue wounds by splinting the extremity, even if there is no fracture.

An open neck injury may result in _______________ if enough air is sucked into a blood vessel A. subcutaneous B. hypovolemic shock C. air embolism D. tracheal deviation

C. air embolism

A 17-year-old male was shot in the right anterior chest during an altercation. As your partner is applying oxygen, you perform a rapid assessment and find an open chest wound with a small amount of blood bubbling from it. You should: A control the bleeding from the wound and prepare to transport at once. B. direct your partner to assist the patient's ventilations with a BVM C. apply an occlusive dressing to the wound and continue your assessment D. place a sterile dressing over the wound and apply direct pressure

C. apply an occlusive dressing to the wound and continue your assessment

An injury that seperates various layers of soft tissue, resulting in complete detachment or a flap of skin, is called a(n): A. amputation B. laceration C. avulsion D. incision

C. avulsion

A 38-year-old male was electrocuted while attempting to wire a house. Your assessment reveals that he is unresponsive, pulseless, and apneic. A coworker has shut off the power to the house. you should: A. begin CPR and transport at once B. fully immobilize his spinal column C. begin CPR and apply the AED D. assess for entry and exit wounds

C. begin CPR and apply the AED

Which of the following statements regarding crush syndrome is correct? A. tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body B. with crush syndrome, massive blood vessels damage occurs following severe soft-tissue injuries, such as amputation of an extremity C. compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours D. provided that a patient with crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal.

C. compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours

The skin regulates temperature in a cold environment by: A. increasing the amount of heat that is radiated from the body's surface B. secreting sweat through sweat glands C. constricting the blood vessels D. dilating the blood vessels

C. constricting the blood vessels

Which of the following areas of the body has the thinnest skin? A. back B. soles of the feet C. ears D. scalp

C. ears

____________burns may involve the subcutaneous layers, muscle, bone, or internal organs A. second-degree B. partial-thickness C. full-thickness D. superficial

C. full-thickness

All of the following body structures are lined with mucous membranes, EXCEPT for the: A. mouth B. nose C. lips D. anus

C. lips

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. laceration C. avulsion D. abrasion

D. abrasion

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. apply ice to the hematoma C. palpate his radial pulses D. administer high-flow oxygen

D. administer high-flow oxygen

Splinting an extremity even when there is no fracture can help to: A. reduce pain B. minimize damage to an already-injured extremity C. make it easier to move the patient D. all of these answers are correct

D. all of these answers are correct

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

D. an air embolism

Which of the following is a severe burn in a 65-year-old patient? A. full-thickness burn to 1% of the BSA B. superficial burn to 30% of the BSA C. second-degree burn covering 10% of the BSA D. partial-thickness burn to 20% of the BSA

D. partial-thickness burn to 20% of the BSA

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

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

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

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

Primary blast injury

Damage is caused by the blast wave itself and the sudden pressure changes of the explosion.

Secondary blast injury

Damage results from flying debris that cause multiple penetrating wounds.

Tertiary blast injury

The victim is thrown by the explosion, perhaps into an object.

Skin serves many functions they are:

a. Barrier against infection b. Helps maintain fluid balance c. Assists with the regulation of body temperature d. Sensory organ

Three types of soft-tissue injuries

a. Closed injuries b. Open injuries c. Burns

remove an Impaled object on when......

a. Is in the cheek or mouth and obstructs the airway b. Is in the chest and directly interferes with CPR

Crush Injuries

a. The extent of the damage depends on: i. How much force is applied ii. How long the force is applied b. Continued compression of the soft tissues will cut off circulation, producing further tissue destruction. 5. When an area of the body is trapped for longer than 4 hours and arterial blood flow is compromised, crush syndrome can develop. 6. When a patient's tissues are crushed beyond repair, muscle cells die and release harmful substances into the surrounding tissues. a. Harmful substances are released into the body's circulation after the limb is freed and blood flow is returned. b. Advanced life support (ALS) providers should administer IV fluid before the crushing object is lifted off the body. c. Freeing the body part from entrapment creates the potential for cardiac arrest and renal failure. d. Consider requesting ALS assistance for situations of prolonged entrapment prior to extrication. 7. Compartment syndrome develops when edema and swelling result in increased pressure within a closed soft-tissue compartment. a. Pressure increases within the compartment, which interferes with circulation. b. Delivery of nutrients and oxygen is impaired and by-products of normal metabolism accumulate. c. There is pain, especially on passive movement. d. The longer this situation persists, the greater the chance for tissue death. e. The EMT must continually reassess skin color, temperature, and pulses distal to the injury site if crush injury is suspected. 8. Severe closed injuries can damage internal organs.

Dressings and bandages have three functions:

a. To control bleeding b. To protect the wound from further damage c. To prevent further contamination and infection

Most wounds will be covered by:

a. Universal dressings b. Conventional 4″ 4″ and 4″ 8″ gauze pads c. Assorted small adhesive-type dressings and soft self-adherent roller dressings

Five factors help determine the severity of a burn (the first two factors are the most important):

a. What is the depth of the burn? b. What is the extent of the burn? c. Are any critical areas involved? i. Face, upper airway, hands, feet, genitalia d. Does the patient have any preexisting medical conditions or other injuries? e. Is the patient younger than 5 years or older than 55 years? 2. Burns to the face are of particular importance due to the potential for airway involvement. 3. Burns to the hands or feet or over joints are considered serious because of the potential for loss of function as the result of scarring. 4. Depth of burns a. Superficial (first-degree) burns i. Involve only the top layer of skin, the epidermis ii. The skin turns red but does not blister or burn through this top layer. iii. The burn site is often painful. iv. Example: sunburn b. Partial-thickness (second-degree) burns i. Involve the epidermis and some portion of the dermis ii. These burns do not destroy the entire thickness of the skin, nor is the subcutaneous tissue injured. iii. Typically, the skin is moist, mottled, and white to red. iv. Blisters are present. v. Can cause intense pain c. Full-thickness (third-degree) burns i. Extend through all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs ii. The burned area is dry and leathery and may appear white, dark brown, or even charred. iii. If the nerve endings have been destroyed, a severely burned area may have no feeling. iv. The surrounding, less severely burned areas may be extremely painful. d. Significant airway burns are serious. i. May be associated with singed hair within the nostrils, soot around the nose and mouth, hoarseness, and hypoxia ii. These patients should be rapidly transported to an ED or facility capable of advanced airway management. 5. Extent of burns a. Rule of palm: Estimate the surface area that has been burned by comparing it to the size of the patient's palm, which is roughly equal to 1% of the patient's total body surface area. b. Rule of nines: Estimate the extent of a burn by dividing the body into sections, each representing approximately 9% of the total body surface area. c. The proportions differ for infants, children, and adults. d. When you calculate the extent of burn injury, include only partial- and full-thickness burns. Document superficial burns, but do not include them in the body surface area estimation of extent of burn injury.

Hematoma

a.A collection of blood within damaged tissue or in a body cavity b.Occurs whenever a large blood vessel is damaged and bleeds rapidly c.Usually associated with extensive tissue damage

Contusions

a.Result from blunt forces striking the body b.The epidermis remains intact, but cells within the dermis are damaged, and small blood vessels are usually torn. c.The buildup of blood produces a characteristic blue or black discoloration called ecchymosis.