Chapter 27 Soft Tissue Injuries: (study)
Which of the following is considered a severe burn? Any full-thickness burn 20% partial-thickness burn 10% full-thickness burn with abrasions 5% full-thickness burn with a fracture
5% full-thickness burn with a fracture
You are responding to a fight at a restaurant and find a man, conscious and alert. His face is mottled with blisters and abrasions, and he has blood on his shirt. He tells you he was trying to stop the fight when he was hit in the face with scalding hot coffee and fell backwards over a chair. According to the rule of nines, what percentage of the patient's skin surface is burned? 4.5% 9% 12% 18%
9%
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. Damage to the cervical spine B. Damage to the brain C. A punctured lung D. Injury to abdominal organs
A punctured lung
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. 18% B. 45% C. 27% D. 36%
A. 18% Chapter 26, pages 926-927, Burns
Which of a patient's soft-tissue injuries is LEAST likely to result in infection? A. Contusion on the right lateral chest B. Abdominal laceration C. Burns to the face D. Abrasions to the face
A. Contusion on the right lateral chest
While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced: A. neck and facial injuries. B. lower extremity fractures. C. blunt trauma to the head. D. open abdominal trauma.
A. neck and facial injuries.
His face is mottled with blisters and abrasions, and he has blood on his shirt. He tells you he was trying to stop the fight when he was hit in the face with scalding hot coffee and then he fell backward into a chair. Physical examination shows a jagged laceration measuring approximately 2 inches on his abdomen. It is still bleeding, and you notice bruising on the right lateral chest. What is the classification of this burn? A. Superficial B. Partial-thickness C. Full-thickness D. Thermal 2.
B. Partial-thickness
What kind of burn is this? (coffee burn) A. Inhalation burn B. Thermal burn C. Radiation burn D. Chemical burn
B. Thermal burn
In bandaging a hand wound, what important consideration is necessary? A. The dressing does not need to be sterile because the hand is typically not clean. B. The arm should be wrapped with elastic gauze from the elbow toward the fingertips. C. Bandage the lower arm, wrist, and hand, including the fingertips. D. Bandage the hand in the position of function.
Bandage the hand in the position of function.
Your patient has sustained a chemical burn to her hands from dry lime. How is this treated in the field? A. Use baby oil to flush the injury. B. Brush off the powder before using water to flush. C. Flush the patient immediately with water. D. Use only sterile water to flush the patient.
Brush off the powder before using water to flush.
How does the skin provide temperature regulation? A. By opening temperature pores in the skin B. By increasing or decreasing the metabolism within the skin structures C. By thickening or thinning the layers of the skin D. By altering the blood flow to the skin and by controlling perspiration
By altering the blood flow to the skin and by controlling perspiration
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. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing. C. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing. D. replace the avulsed flap to its original position and cover it with a sterile dressing.
D. replace the avulsed flap to its original position and cover it with a sterile dressing. Chapter 26, page 909, Pathophysiology of Closed and Open Injuries
If the burns are just on a patients face according to the rule of nines, what percentage of the patient's skin surface is burned? A. 4.5% B. 7.5% C. 9% D. 18%
C. 9%
When caring for a patient whose arm is covered with a dry chemical, you should: A. use forceful streams of water to remove the chemical. B. quickly irrigate the arm with large amounts of water. C. brush away the chemical before flushing with water. D. deactivate the chemical with a 5% vinegar solution.
C. brush away the chemical before flushing with water. Chapter 26, page 934, Emergency Medical Care for Burns
A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): A. abrasion. B. crush injury. C. contusion. D. hematoma.
C. contusion. Chapter 26, pages 907-908, Pathophysiology of Closed and Open Injuries
The sebaceous glands produce sebum, a material that: A. pulls the hair erect when you are cold. B. facilitates shedding of the epidermis. C. waterproofs the skin and keeps it supple. D. discharges sweat onto the skin's surface.
C. waterproofs the skin and keeps it supple. Chapter 26, page 906, Anatomy and Physiology of the Skin
Which of the following is the final stage of wound healing? Cessation of blood loss Collagen production Formation of new capillaries Inflammation
Collagen production
You are assessing a 28-year-old male with a rigid cast extending the length of his left leg. The patient is complaining of pain on passive movement, and he is showing signs of impaired circulation. What do you suspect? Ecchymosis Compartment syndrome Crush syndrome Avulsion
Compartment syndrome
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. ask the child's father to try to locate the dog. B. advise the child that he will need rabies shots. C. administer oxygen via a nonrebreathing mask. D. report the incident to the appropriate authorities.
D. report the incident to the appropriate authorities. Chapter 26, pages 922-923, Emergency Medical Care for Open Injuries
A 50-year-old male has a large shard of glass impaled in his shoulder after a fall through a plate glass window. The area is bleeding heavily. To control the bleeding, you should first: A apply a tourniquet. B remove the glass shard. C apply pressure on top of the shard. D apply pressure on either side of the object.
apply pressure on either side of the object.
Your patient suffered a severe electrical burn injury. In your emergency care, you should always: A. assess for an entrance and an exit wound. B. pull the patient off the electrical source as soon as possible. C. hose the patient down to stop the burning reaction. D. administer oxygen by a positive-pressure ventilator.
assess for an entrance and an exit wound.
You should never remove an
avulsion skin flap, regardless of its size.
The emotional and psychological damage from burn injuries: A. are not a concern for EMTs. B. usually occurs only with the most severe injuries. C. begins at the emergency scene. D. typically are not long lasting.
begins at the emergency scene.
When crushed, the liver and spleen: A. cause contusions on the surface of the skin. B. cause severe inflammation and sepsis. C. cause muscle, nerve, and tissue damage. D. bleed profusely and cause shock.
bleed profusely and cause shock.
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: carefully remove the knife, control any bleeding, begin CPR, and transport. stabilize the knife in place, provide rescue breathing, and transport at once. remove the knife and control any bleeding, apply the AED, and analyze his rhythm. begin CPR, control any external bleeding, and transport rapidly to a trauma center.
carefully remove the knife, control any bleeding, begin CPR, and transport.
An internal injury with no open pathway from the outside is called: A. second degree. B. simple. C. closed. D. partial.
closed
A compression injury that is severe enough to cut off blood flow below the injury is called: a contusion. a hematoma. a local thrombus. compartment syndrome.
compartment syndrome.
For a young child with isolated genital injuries, you should: A. consider the possibility of abuse and treat the child with sensitivity. B. challenge the parents directly about the possibility of child abuse. C. avoid questioning the child about the cause of the injuries so as not to embarrass the child. D. withhold care until law enforcement arrives.
consider the possibility of abuse and treat the child with sensitivity.
The primary reason for applying a sterile dressing to an open injury is to: prevent contamination. control external bleeding. reduce the risk of infection. minimize any internal bleeding.
control external bleeding.
A 20-year-old male has impaled himself on a 2-inch diameter fence post after a fall. The fence post has penetrated the patient's chest, but it is still attached to the fence. To best treat this patient, you should: A gently lift the patient off the fence post. B cut the fence post and remove the object from the patient's chest. C cut the fence post but leave the impaled object in place. D rapidly pull the impaled object from the patient.
cut the fence post but leave the impaled object in place.
The layer of skin that is rich with blood vessels, nerves, and specialized structures is the: A. subcutaneous. B. fascia. C. dermis. D. epidermis.
dermis
To control bleeding, start with: A. a hemostatic dressing. B. direct pressure and elevation. C. a tourniquet. D. an occlusive dressing.
direct pressure and elevation.
The sterile material that is placed directly on a wound is termed the: A. dressing. B. bandage. C. cravat. D. self-adherent roller gauze.
dressing
The outermost layer of the skin is known as: A epidermis. B dermis. C subcutaneous layer. D endodermis.
epidermis
The skin is the largest organ of the body. It is composed of three layers, including the: A. superior dermis. B. subdermis. C. epidermis. D. sebaceous layer.
epidermis
Generally when providing emergency care of open wounds, the first thing you would do is: A. clean the wound surface. B. bandage a dressing in place. C. expose the wound. D. control the bleeding.
expose the wound
White and dry to dark brown or black and charred skin is a sign of a: A. full thickness burn. B. superficial burn. C. second-degree burn. D. partial thickness burn.
full thickness burn.
Which of the following is true about electrical burns? They are always more severe than the external signs indicate. They always have an entrance wound but only occasionally have an exit wound. The patient can go into cardiac arrest at any time within 24 hours of contact with electricity. Seriousness of electrical burns depends on the type of current, amperage, and conductivity.
They are always more severe than the external signs indicate.
A burn injury should be considered to be: A. primarily an emotionally scarring event. B. an airway problem in the most severe cases. C. an injury with the potential for many far-reaching effects. D. a simple issue of tissue damage.
an injury with the potential for many far-reaching effects.
The MOST appropriate way to dress and bandage an open abdominal wound with a loop of bowel protruding from it is to: cover the wound with a dry, sterile dressing and apply firm pressure. apply a moist, sterile dressing to the wound and apply firm pressure. apply a moist, sterile dressing to the wound and secure with an occlusive dressing. carefully replace the protruding bowel into the abdomen and cover the wound.
apply a moist, sterile dressing to the wound and secure with an occlusive dressing.
Burns involving the airway often lead to: A. respiratory compromise B. hypoglycemia. C. bradycardia. D. hypertensive crisis.
respiratory compromise
What is the primary risk for electrical injury patients? A. Massive burn injuries B. Orthopedic injuries C. Respiratory or cardiac arrest D. Paralysis
respiratory or cardiac arrest
How should you treat a closed injury?
rest, ice, compression, elevation, and splinting.
Which of the following is the most common type of blast injury? A Crush injuries B Hematomas C Destruction of solid organs D Rupture of hollow organs
rupture of hollow organs
Which layer of the skin provides shock absorption and insulation? A. Dermis B. Adipose C. Subcutaneous D. Epidermis
subcutaneous
Which of the following layers of the skin is rich with nerves, blood vessels, and specialized structures such as sweat glands? A The epidermis B The dermis C The subcutaneous layer D The subdermis
the dermis
In a contusion, what remains intact? A. The dermis B. Blood vessels C. The epidermis D. Cells
the epidermis
The goal of the inflammation phase of wound healing is
the removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site.
Burns pose greater risks to infants and children than to adults because: A. their skin is more porous and less resilient. B. they are more prone to airway obstructions. C. their body surface area is greater in relation to their total body size. D. they have little adipose tissue.
their body surface area is greater in relation to their total body size.
A bruise on the abdomen could indicate injury to which of the following? A. Lungs and trachea B. Spleen, liver, or kidneys C. Reproductive organs D. Heart
Spleen, liver, or kidneys
What is the priority for treating an open wound on a patient's abdomen? A. Clean it. B. Flush it with sterile saline. C. Probe it. D. Stop the bleeding.
D. Stop the bleeding.
Your patient has burns to the entire right arm and the anterior chest. What is the estimated surface area involved? A. 16 percent B. 13.5 percent C. 9.5 percent D. 18 percent
18 percent
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? A. 22.5 percent B. 27 percent C. 13.5 percent D. 18 percent
22.5 percent
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? 18% 27% 36% 45%
27%
Partial-thickness burns involving over ___ percent of the body would be considered critical. Burns to areas of the body that can result in a significant loss of function are also considered critical, independent of the total BSA involved.
30
Which of the following injuries is characterized by an intact dermis, ruptured blood vessels, and dead cells in the dermis? A A contusion B A laceration C An incision D An avulsion
A contusion
You are treating an 8-year-old boy who fell while riding his bike on a gravel road. The wound on his arm is seeping blood and is about 7 inches long, and there is a lot of dirt and gravel in it. How should you treat this injury? Flush the area with sterile saline. Manually brush/pick the foreign material out. Apply occlusive dressing. Apply sterile dressing.
Apply sterile dressing.
A way of identifying the seriousness of a burn is by its degree. Which of the following statements is TRUE? A. A first-degree burn is the most serious and the deepest. B. A second-degree burn is characterized by red, dry, smooth skin. C. A superficial burn is also called a second-degree burn. D. A full-thickness burn is also known as a third-degree burn.
A full-thickness burn is also known as a third-degree burn.
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? A. Contact medical control and ensure someone stabilizes the object while it is gently cut to the desired length. B. Immediately remove the rebar in a single motion. C. Summon a surgeon to the scene to manage this situation. D. Stabilize the rebar and transport the patient.
Contact medical control and ensure someone stabilizes the object while it is gently cut to the desired length.
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? Abrasion Contusion Hematoma Avulsion
Contusion
Which type of soft tissue injury is least likely to result in infection? Contusions on the left lateral chest Abdominal laceration Burns to the face Abrasions to the face
Contusions on the left lateral chest
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? A. Remove any rings or other jewelry from the patient's hand and wrist B. Check the patient's pulse and blood pressure in the affected extremity C. Cool the burned area to stop the burning process. D. Apply a topical analgesic ointment to the burn area to reduce the pain
Cool the burned area to stop the burning process.
A patient has partial thickness burns over 18 percent of his body, including both feet. Which of the following classifications does this patient's burns fall under? A. Moderate B. Minor C. Superficial D. Critical
Critical
A patient has partial-thickness burns over 35 percent of her body, including both feet. Which of the following classifications does this patient's burns fall under? A. Critical B. Minor C. Superficial D. Moderate
Critical
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. Laceration B. Incision C. Avulsion D. Abrasion
D. Abrasion Chapter 26, page 909, Pathophysiology of Closed and Open Injuries
The severity of a thermal injury directly correlates with temperature, concentration, and what other factor? Source of thermal energy Duration of exposure Chemical reaction Current
Duration of exposure
Which of the following statements about puncture wounds is correct? A. A puncture wound is not serious unless it is deep. B. If there is little external evidence of bleeding, internal bleeding is unlikely. C. Even insignificant-looking puncture wounds can cause devastating injuries. D. Puncture wounds carry a much lower risk of infection than other open wounds.
Even insignificant-looking puncture wounds can cause devastating injuries.
You are assessing a patient who has been in a high-impact T-bone collision. She is bleeding from the abdomen, and you can see part of her large intestine outside her body. What is this type of injury called? Avulsion Ecchymosis Evisceration Impalement
Evisceration
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? A. Gloves and a gown B. Gloves and a face shield C. Gloves only D. Gown and mask
Gloves and a face shield
When using the rule of nines, which of the following do you need to include in your calculations? Only full-thickness burns Full- and partial-thickness burns Superficial, full, and partial-thickness burns Superficial and full-thickness burns
Full- and partial-thickness burns
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? A. Evaluate the electrical burns. B. Fully immobilize the patient. C. Apply oxygen by nonrebreather mask at 12 to 15 lpm. D. Apply sterile dressings to the burn sites.
Fully immobilize the patient.
What is an example of classifying a burn by agent and source? A. Thermal burn from excessively hot coffee B. Superficial burn of less than 50 percent total body area C. Partial thickness burn D. Superficial burn
Thermal burn from excessively hot coffee
Your patient has a large bump on the forehead from being hit by a baseball. What type of injury is this? A. Contusion B. Crush injury C. Stellate D. Hematoma
Hematoma
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? A. Irrigate both eyes with copious amounts of water for at least 20 minutes or until you arrive at the medical facility. B. Cover both eyes with dry, sterile dressing and transport immediately to the nearest appropriate facility. C. Cover both eyes with a moist, sterile dressing. D. Neutralize the acid immediately with vinegar or baking soda.
Irrigate both eyes with copious amounts of water for at least 20 minutes or until you arrive at the medical facility.
For which injury would you use an occlusive dressing? Avulsion Evisceration Impaled object Open neck injury
Open neck injury
Which of the following statements regarding chemical burns is FALSE? Most chemical burns are caused by strong acids or alkalis. Fumes of strong chemicals can cause burns to the respiratory tract. Prior to removing a dry chemical, you should flush the area with sterile water. You should not attempt to neutralize an acid burn with an alkaline chemical.
Prior to removing a dry chemical, you should flush the area with sterile water.
What is your first responsibility when treating a burn patient? Identifying life-threatening injuries Administering high-flow oxygen Stopping the burning Preventing loss of body heat
Stopping the burning
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 still lying on the ground. Based on the patient's presentation, how should you manage this patient's injury? A. Immediately place an AED on the patient. B. Evaluate the source of the electrical burn prior to assessing the patient. C. Withhold oxygen until you are able to perform a full assessment. D. This patient should be fully immobilized.
This patient should be fully immobilized.
What effects will the application of an ice have on a hematoma? Vasodilation and increased pain Vasodilation and decreased bleeding Vasoconstriction and increased swelling Vasoconstriction and decreased bleeding
Vasoconstriction and decreased bleeding
Which of the following is a guideline for the treatment of chemical burns? A. Wet the burned area with water and then let dry. B. Wash away the chemical with flowing water. C. Immediately flush dry chemicals off the skin with copious amounts of water. D. Brush a chemical out of the eye from the corner of the eye to the bridge of the nose.
Wash away the chemical with flowing water.
Possible injury to the cervical spine or brain could be indicated by: A. a contusion to the trunk. B. a bruise on the head or neck. C. an avulsion of an extremity. D. a penetration of the sternum.
a bruise on the head or neck.
A 45-year-old male was lifting an engine block on a winch when the mechanism fell and trapped his arm beneath it. The engine block was lifted from the arm before your arrival and now you note swelling, bruising, and pain in the extremity. The skin remains intact and there is no bleeding. Given this mechanism and the stated findings, you should suspect: A shock. B open wounds. C an amputation. D a crush injury.
a crush injury
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. a contusion. B. a hematoma. C. an ecchymosis. D. a blood blister.
a hematoma.
When assessing a patient, consider the possibility of closed soft-tissue injuries whenever there is swelling, pain, or deformity, as well as A. signs of underlying fractures. B. a medical condition that would explain this presentation. C. penetrating trauma. D. a mechanism of blunt trauma.
a mechanism of blunt trauma.
What is the rule of nines?
a system that assigns percentages to sections of the body, allowing calculation of the amount of skin surface involved in the burn area.
All burns are to be treated as more serious if: A. they are from a thermal source. B. accompanied by other injuries or medical problems. C. they are accompanied by reddening of the skin. D. they involve the epidermis.
accompanied by other injuries or medical problems.
A 22-year-old male has been shot in the neck. You find the patient awake, ambulatory, and note that the wound in not bleeding externally. Based on the location of the penetrating trauma and your current findings, you should suspect: A shock. B airway issues. C spinal injuries. D brain injury.
airway issues
When a flap of tissue is traumatically removed, this condition is called: A. a laceration. B. a puncture. C. an incision. D. an avulsion.
an avulsion
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? A. Laceration B. Abrasion C. Avulsion D. Contusion
laceration
Damage to which of the following organs is LEAST likely in the case of abdominal bruising? A. Lungs B. Liver C. Spleen D. Kidneys
lungs
In treating open wounds to the neck or abdomen, which type of dressing is preferred? A. Hemostatic dressing B. Occlusive dressing C. Universal dressing D. Pressure dressing
occlusive dressing
Burns to the face are considered critical because: A. of the potential for respiratory compromise or eye injury. B. they involve possible disfigurement. C. the patient's speech may be affected. D. a large surface is area involved.
of the potential for respiratory compromise or eye injury.
You are assessing a patient and notice red discoloration with blisters on the legs. This type of burn would be classified as: A. subcutaneous. B. superficial. C. full thickness. D. partial thickness.
partial thickness.
Swelling or deformity at the site of a bruise indicates a: A. possible rupture of the patient's liver, spleen, or kidneys. B. possible compression injury. C. possible underlying fracture. D. possible concussion.
possible underlying fracture.
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: prevent air from entering the wound. cover the wound with a bulky dressing. assess the patient's back for an exit wound. transport the patient promptly to the closest trauma center.
prevent air from entering the wound.
A 21-year-old male has an extensive abrasion on his right leg after crashing his motorcycle at moderate speed. After confirming that he has no further injuries, the goal of your care for this specific type of injury would be to: A stop the bleeding. B prevent contamination of the wound. C retrieve the severed part. D replace the displaced tissue.
prevent contamination of the wound.
The skin serves which of the following functions? A. RBC production B. Protection C. Gas exchange D. Respiration
protection
In caring for an amputated part, it is important to: A. place the part in milk. B. wrap the part in sterile gauze and pack it in ice. C. place the part in ice water. D. wrap the part in sterile gauze and keep it cool.
wrap the part in sterile gauze and keep it cool.
A 30-year-old male has been stabbed in the face with a steak knife. The knife remains in place. You should remove the knife only if: A it is causing severe bleeding. B it is causing severe pain. C you can visualize both ends as it passes through the cheek. D its distal end threatens to enter the posterior pharynx.
you can visualize both ends as it passes through the cheek.
In treating a puncture wound of the eye, if you bandage both eyes, it is because: A. any light can damage both eyes in a puncture injury. B. you do not know whether the other eye is injured. C. you want to avoid sympathetic eye movement. D. you want to offer sympathetic care to the patient.
you want to avoid sympathetic eye movement.
