EMT Chapter 26 - Soft Tissue Injuries

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

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

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: Select one: A. .22-caliber pistol. B. handgun. C. shotgun. D. .357 magnum.

C. shotgun.

contusion

A bruise from an injury that causes bleeding beneath the skin without breaking the skin.

flame burn

A burn caused by an open flame.

contact burn

A burn caused by direct contact with a hot object.

steam burn

A burn caused by exposure to hot steam.

flash burn

A burn caused by exposure to very intense heat, such as in an explosion.

scald burn

A burn caused by hot liquids.

laceration

A deep, jagged cut in the skin.

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.

A major danger associated with electrical burns is the amount of deep tissue damage done. Electrical burns are always more severe than the external signs indicate.

excited delirium

A serious behavioral condition in which a person exhibits agitated behavior combined with disorientation, hallucinations, or delusions; also called agitated delirium or exhaustive mania.

incision

A sharp, smooth cut in the skin.

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.

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? Select one: A. Abrasion B. Avulsion C. Incision D. Laceration

A. Abrasion

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

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

Which of the following areas of the body has the thinnest skin? Select one: A. Ears B. Scalp C. Back D. Soles of the feet

A. Ears

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

A. superficial burn.

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

A. waterproofs the skin and keeps it supple.

amputation

An injury in which part of the body is completely severed.

Avulsion

An injury in which soft tissue is torn completely loose or is hanging as a flap.

penetrating wound

An injury resulting from a sharp, pointed object.

crushing injury

An injury that occurs when a great amount of force is applied to the body.

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

B. administer high-flow oxygen.

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

B. an air embolism.

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

B. contusion.

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

Calculating burn area includes partial- and full-thickness burns. You should document superficial burns but do not include them in the body surface estimation.

You are assessing a 28-year-old 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 commonly develops in the extremities and may occur in conjunction with open or closed injuries or when swelling occurs under restrictive immobilization devices such as a cast.

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

B. 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: Select one: A. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing. B. replace the avulsed flap to its original position and cover it with a sterile dressing. C. carefully probe the wound to determine if the bleeding is venous or arterial. D. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.

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

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

D. report the incident to the appropriate authorities.

A hematoma is an open injury that occurs whenever a large blood vessel is damaged and bleeds rapidly. TrueFalse

False Correct. A hematoma does occur whenever a large blood vessel is damaged and bleeds rapidly, but it is a closed injury.

You are treating an 8-year-old who fell while riding his bike on a gravel road. The wound on his arm is seeping blood, 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.

In general, you should not remove material from an open wound, no matter how dirty the wound is. By applying a sterile dressing, you are reducing the risk of further contamination. This keeps foreign material, such as hair, clothing, and dirt, out of the wound and decreases the risk of infection.

Which of the following is the final stage of wound healing? Cessation of blood loss Collagen production Formation of new capillaries Inflammation

In the last stage of wound healing, collagen provides stability to damaged tissue and joins wound borders, closing the open tissue.

closed injuries

Injuries in which damage occurs beneath the skin or mucous membrane but the surface remains intact.

burns

Injuries in which soft-tissue damage occurs as a result from thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation.

open injuries

Injuries in which there is a break in the surface of the skin or the mucous membrane, exposing deeper tissue to potential contamination.

Abrasion

Loss or damage of the superficial layer of skin as a result of a body part rubbing or scraping across a rough or hard surface.

impaled objects

Objects that penetrate the skin but remain in place.

crush syndrome

Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods. This can lead to renal failure and death.

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 is your first responsibility when treating a burn patient.

compartment syndrome

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.

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. TrueFalse

T Correct. 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.

When possible, ALS providers should administer IV fluid within 3 minutes after the crushing object is lifted off the body. TrueFalse

T Correct. When possible, ALS providers should administer IV fluid before the crushing object is lifted off the body.

You should never remove an avulsion skin flap, regardless of its size. TrueFalse

T Correct. You should never remove an avulsion skin flap, regardless of its size. Removing the flap could lead to contamination.

For which injury would you use an occlusive dressing directly on the wound? Avulsion Evisceration Impaled object Open neck injury

open neck injury Correct. If the veins of the neck are open to the environment, they may suck in air, leading to an air embolism. To control bleeding and prevent the possibility of air embolism, cover the wound with an occlusive dressing.

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%

The burns are on his face, which, according to the rule of nines, constitutes 9% of an adult's body area.

evisceration

The displacement of organs outside of the body.

fascia

The fiberlike connective tissue that covers arteries, veins, tendons, and ligaments.

superficial (1st degree) burns

burns that affect only the epidermis, characterized by skin that is red but not blistered or actually burned through

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 are closed injuries and are less likely to become infected.

Which of the following factors will help you to determine the severity of a burn? Depth of the burn Extent of the burn Involvement of any critical body areas (face, upper airway, hands, feet, genitalia) Preexisting medical conditions

Correct. All of these are factors in determining the severity of a burn.

Which of the following patients is likely to have injuries with entrance and exit wounds? A technician who has been exposed to gamma radiation A do-it-yourselfer who touched a live wire while repairing a light fixture A 19-year old who has been hit by high-caliber gunfire A drug user who has been TASERed

Correct. Electrical burns and high-caliber gunshots leave entrance and exit wounds.

occlusive dressing

dressings made of petroleum (Vaseline) gauze, aluminum foil, or plastic that prevent air and liquids from entering or exiting a wound

rabid

infected with rabies

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. Select one: A. 18% B. 27% C. 36% D. 45%

18%

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

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

Hematoma

Blood collected within the body's tissues or in a body cavity.

thermal burns

Burns caused by heat.

full thickness (3rd degree) burn

Burns that affect all skin layers and may affect the subcutaneous layers, muscle, bone, and internal organs, leaving the area dry, leathery, and white, dark brown, or charred.

partial-thickness (2nd degree) burns

Burns that affect the epidermis and some portion of the dermis but not the subcutaneous tissue, characterized by blisters and skin that is white to red, moist, and mottled.

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

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

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

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

Which of the following processes occurs during the inflammation phase of the healing process? Select one: 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 blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. C. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling. D. The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound.

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

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

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

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

D. brush away the chemical before flushing with water.

Ecchymosis

Discoloration associated with a closed wound; signifies bleeding.

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 injury called? Avulsion Ecchymosis Evisceration Impalement

Evisceration is the displacement of organs outside the body.

Dermis

The inner layer of the skin, containing hair follicles, sweat glands, nerve endings, and blood vessels.

mucous membranes

The linings of body cavities and passages that are in direct contact with the outside environment.

epidermis

The outer layer of skin that acts as a watertight protective covering.

contamination

The presence of infective organisms or foreign bodies such as dirt, gravel, or metal.

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

The severity of a thermal injury directly correlates with temperature, concentration, and duration.