EMT - Chapter 18: Soft-Tissue Trauma

What is an example of classifying a burn by agent and​ source?

Thermal burn from excessively hot coffee

Singed nasal hairs in a burned patient are an ominous sign​ because:

They could indicate airway damage

Burns involving the airway often lead​ to:

Respiratory compromise

What is the primary risk for electrical injury​ patients?

Respiratory or cardiac arrest

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

The skin serves which of the following​ functions?

Protection

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

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 (Each leg is 9)

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 (It's doubled because they have a smaller body surface/9 percent would be the percentage of an infant or​ child's entire arm being burned)

Which of the following is not a type of​ avulsion?

A finger is cut off with a​ butcher's saw

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

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

If a child pulled a pot of boiling water off the stove and was burned by​ it, this burn would​ be:

A thermal burn

A burn injury should be considered to​ be:

An injury with the potential for many​ far-reaching effects

A simple scratch or scrape of the outer layer of the skin is called​ a(n):

Abrasion

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

Which of the following is true concerning​ lacerations?

All answers are correct

Which of the following injuries requires the use of an occlusive​ dressing?

All of the above

Which of the following is a consideration in determining a​ burn's severity?

All of the above

Which of the following is appropriate in caring for a patient with closed​ soft-tissue injuries and a significant mechanism of injury​ (MOI)?

All of the above

Which of the following is of concern with a puncture​ wound?

All of the above

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 (Application of a dry sterile dressing is part of burn management in the prehospital environment/We don't apply antibiotic ointments)

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 (Not ice, because it can constrict the blood vessels causing more damage/Ice is not applied to a burn in the prehospital environment)

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 (Provide care right away)

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

our patient suffered a severe electrical burn injury. In your emergency​ care, you should​ always:

Assess for an entrance and an exit wound

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 (Personal safety first)

Your​ 24-year-old patient was riding an ATV through the woods and impaled herself on a dead tree branch. The​ one-inch diameter branch went in through her mouth and out her right cheek before breaking from the tree. You can see both ends of the penetrating branch. On your​ arrival, the patient is bleeding heavily into her mouth and is struggling to breathe unless she is leaning forward. To gain control of the​ patient's bleeding and thereby her​ airway, you​ should:

Attempt to remove the object (You may remove an object that is impaled in the cheek if you find perforation and you can see both ends of the object. Pull it out in the direction it entered the cheek. If this cannot be easily​ done, leave the object in place)

A degloving injury is an example of​ a(n):

Avulsion

When a flap of tissue is traumatically​ removed, this condition is called​ a(n):

Avulsion

A way of identifying the seriousness of a burn is by its degree. Which of the following statements is​ true?

A​ full-thickness burn is also known as a​ third-degree burn (The older description of burns was by degrees. In that classification​ system, a​ third-degree burn has the same characteristics as a​ full-thickness burn, as both represent injuries that involve all three layers of the skin)

In bandaging a hand​ wound, what important consideration is​ necessary?

Bandage the hand in the position of function (It is important to bandage the hand in the position of​ function, wrapping distal to proximal)

Your patient was involved in a serious industrial​ accident, and sustained critical electrical burns to both his hands when he accidentally grabbed a live wire. Despite the severity of his​ burns, the patient says he​ doesn't feel that bad. This patient will need​ to:

Be transported as soon as possible

The emotional and psychological damage from burn​ injuries:

Begins at the emergency scene (In addition to the physical damage caused by​ burns, patients often suffer emotional and psychological problems that begin at the emergency scene and may last a lifetime)

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

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

What is the first step in removing dry chemicals from the​ body?

Brush off the excess material

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

The layer of skin that is rich with blood​ vessels, nerves, and specialized structures is​ the:

Dermis

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 (The skin achieves 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 (Care must still be rendered for the burn prior to loading the patient for transport)

Which of the following is not considered soft​ tissue?

Cartilage (A harder tissue)

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

For a young child with isolated genital​ injuries, you​ should:

Consider the possibility of​ abuse, and treat the child with sensitivity

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

An injury in which the epidermis remains​ intact, but blood vessels and cells in the dermis are​ injured, is called​ a(n):

Contusion (A hematoma occurs when larger blood vessels are damaged and large amounts of blood collect at the site of an injury)

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

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

Bleeding from​ soft-tissue injuries should initially be controlled with which one of the following​ techniques?

Direct pressure

To control​ bleeding, start​ with:

Direct pressure and elevation

The sterile material that is placed directly on a wound is termed​ the:

Dressing

The skin is the largest organ of the body. It is composed of three​ layers, including​ the:

Epidermis

Which of the following is the outermost layer of the​ skin?

Epidermis

In a​ contusion, what remains​ intact?

Epidermis (That is the most outer layer of skin, and a contusion is always closed)

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 (Because she was thrown and it was witnessed)

Which of the following statements about puncture wounds is​ correct?

Even​ insignificant-looking puncture wounds can cause devastating injuries

​Generally, when providing emergency care of open​ wounds, the first thing you would do​ is:

Expose the wound (Then clean and control the bleeding)

Which of the following best describes an​ avulsion?

Flap of skin that is partially or completely torn away from the underlying tissue

Chemical burns to the eyes should​ be:

Flushed with water

A burn extending into the subcutaneous fat would be classified as which type of​ burn?

Full thickness

White and dry to dark brown or black and charred skin is a sign of​ a:

Full-thickness burn

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 (The situation may be more complex than a simple puncture because machinery was involved)

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

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 (A hematoma is similar to a contusion except that hematomas involve a larger amount of tissue​ damage, including damage to larger blood vessels with greater internal blood loss. Whereas a contusion may cause some minor injury to small blood​ vessels, a hematoma is characterized by much more severe internal bleeding and the collection of a larger volume of blood beneath the skin)

Your patient has a large bump on the forehead from being hit by a baseball. What type of injury is​ this?

Hematoma (A hematoma is similar to a contusion except that it usually involves damage to a larger blood vessel and a larger amount of tissue. It is characterized by more severe internal bleeding and the collection of a larger volume of blood beneath the skin than is seen with a​ contusion, which is a simple bruise)

A patient with an electrical injury is least likely to present with which of the following signs and​ symptoms?

Hypertension (Hypotension is not a common sign of an electrical​ injury, but visual​ difficulties, restlessness or​ irritability, and muscle tenderness are common signs and symptoms)

Which of the following statements is false regarding an electrical​ injury?

Injury is usually limited to the area around the source and ground burns

Abdominal bruising should be considered a sign of​ possible:

Internal organ damage

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 (You cannot see both ends of it)

Damage to which of the following organs is least likely in the case of abdominal​ bruising?

Lungs

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

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?

None of the above (You can't see the end of the nail)

In treating open wounds to the neck or​ abdomen, which type of dressing is​ preferred?

Occlusive dressing

Burns to the face are considered critical​ because:

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:

Partial-thickness

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 (They can't compensate at times)

A puncture wound that is shallow or deep is​ a:

Penetrating puncture wound

To stabilize an object impaled in an​ eye, you​ should:

Place a roll of​ 3-inch gauze bandage or folded 4 × 4s on either side of the​ object, along the vertical axis of the​ head, in a manner that will stabilize the object

Swelling or deformity at the site of a bruise indicates​ a:

Possible underlying fracture

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

After treating an actively bleeding head laceration with a sterile dressing and​ bandage, you notice that the dressing has become​ blood-soaked and that blood is seeping through the bandage. You​ should:

Reapply pressure and place additional sterile dressings over the​ blood-soaked dressing

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 (Cold can cause vasoconstriction), 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 (It is important to remember that the skin plays a fundamental role in our interactions each day. Nerve endings provide us with sensory input in the form of tactile​ (touch) stimulation. We sense temperature and pleasurable and painful stimuli)

Lacerations are cuts that​ are:

Smooth or jagged

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 (Because you can't see the other end)

Which of the following is a desirable characteristic of dressings used in the prehospital management of most open​ wounds?

Sterile

It is characteristic of hemostatic dressings​ to:

Stop or slow bleeding

Which layer of the skin provides shock absorption and​ insulation?

Subcutaneous (The subcutaneous layer is just below the dermis​ layer, and provides shock absorption and insulation by way of adipose tissue)

Which of the following layers of the skin is the most important in insulating the body against heat​ loss?

Subcutaneous layer

The structures within the dermis​ include:

Sweat glands

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 (The player should not walk to the ambulance due to the​ MOI, but should be loaded onto the stretcher for moving to the back of the ambulance)

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

The meatus​ (An exit) is:

The external opening of the urethra

Which of the following statements about a​ partial-thickness burn is​ true?

The formation of blisters is common

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 best describes a partial thickness​ burn?

The skin is red and moist with blister formation

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 (Only brush off dry chemicals first, since rinsing isn't enough)

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 (The primary​ assessment, along with treatments like oxygen​, are done on the scene prior to loading the patient for transport)

In caring for an amputated​ part, it is important​ to:

Wrap the part in sterile gauze and keep it cool (Do not immerse the amputated part directly in water or saline. In​ addition, do not let the part come in direct contact with​ ice, or it may freeze)

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 (The reason to expose the wound is to be able to control bleeding. Any embedded particles are left in place for ED removal)

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% (The anterior torso is 9​ + 9​ (chest +​ abdomen), and an entire arm would be​ 9, but only the anterior surface of the​ patient's arm​ (about one-half) is​ burned, so that would be​ 4.5%. Therefore 9​ + 9​ + 4.5​ = 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 (Has to do with his chest)

Your patient has burns to the entire right arm and the anterior chest. What is the estimated surface area​ involved?

​18% (The anterior of the arm is 4.5 and the posterior is also 4.5 + 9 from the chest equals 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

A bruise on the abdomen could indicate injury to which of the​ following?

​Spleen, liver, or kidneys