Chapter 25- Soft-Tissue Injuries

When administering IV crystalloid boluses to a patient with an electrical injury, you should give enough fluid to maintain a urine output of: Select one: A. 1 mL/kg per hour. B. 2 mL/kg per hour. C. 3 mL/kg per hour. D. 4 mL/kg per hour.

A. 1 mL/kg per hour.

On the basis of the Parkland formula, how much crystalloid should you administer per hour to a 70-kg patient with severe burns to 50% of his BSA? Select one: A. 700-800 mL B. 800-900 mL C. 900-1,000 mL D. 1,000-1,100 mL

B. 800-900 mL

Appropriate management of a patient with an abdominal evisceration includes: Select one: A. covering the exposed organs with a moist, sterile dressing and securing the dressing in place with a dry, sterile dressing. B. avoiding flexion of the patient's knees as this may exacerbate bleeding and enlarge the evisceration. C. carefully irrigating the exposed organs with sterile saline and replacing them back into the abdomen. D. applying and inflating all compartments of the PASG to protect the exposed organs and treat for shock.

A. covering the exposed organs with a moist, sterile dressing and securing the dressing in place with a dry, sterile dressing.

The layer of the skin that plays a key role in the cooling of the body is the: Select one: A. dermis. B. epidermis. C. germinal layer. D. sebaceous layer.

A. dermis.

When assessing a patient with multiple gunshot wounds, you should: Select one: A. identify the number and location of all wounds. B. control the bleeding that you see and then transport. C. distinguish between entrance and exit wounds. D. carefully assess the patient to predict the bullet's path.

A. identify the number and location of all wounds.

The "rule of palms" for estimating the extent of the body surface area (BSA) burned is especially useful with: Select one: A. irregularly-shaped burns. B. partial-thickness burns. C. circumferential burns. D. burns to multiple body sites.

A. irregularly-shaped burns.

All patients with closed soft-tissue injuries should be assessed for: Select one: A. serious hidden injuries. B. intra-abdominal bleeding. C. trauma to the spinal cord. D. signs of impending infection.

A. serious hidden injuries.

A 4-year-old boy pulled a pot of boiling water from the stovetop. He has superficial and partial-thickness burns to his head, left anterior trunk, and entire left arm. On the basis of the "rule of nines," what percentage of this child's body surface area (BSA) has been burned? Select one: A. 27% B. 30% C. 36% D. 45%

B. 30%

Which of the following is NOT a function of the skin? Select one: A. Temperature regulation B. Destruction of sebum C. Maintenance of water balance D. Protection from harmful agents

B. Destruction of sebum

Which of the following statements regarding electrical burns is correct? Select one: A. When exposed to electricity, the human body is an excellent insulator because it is comprised primarily of water. B. Internal injury caused by an electrical burn is usually more severe than the external burns indicate. C. Ordinary household current can cause an electrical injury, but the burns are usually not severe. D. The size of entrance and exits wounds provides an indicator as to the degree of internal injury.

B. Internal injury caused by an electrical burn is usually more severe than the external burns indicate.

Which of the following would be classified as a moderate burn in an infant or child? Select one: A. Full-thickness burns covering 1% of the BSA B. Partial-thickness burns covering 15% of the BSA C. Superficial burns covering 30% of the BSA D. Partial-thickness burns to the hands, face, or genitalia

B. Partial-thickness burns covering 15% of the BSA

When assessing a conscious patient who experienced an electrical injury, you note irregularity in his pulse. This is MOST indicative of: Select one: A. decreased perfusion. B. a cardiac dysrhythmia. C. ventricular fibrillation. D. impending respiratory arrest.

B. a cardiac dysrhythmia.

A 28-year-old female was the unrestrained driver of a car that struck the rear end of another car while traveling at 35 mph. She is conscious and alert and complains of pain to the anterior chest. During your assessment, you note a large ecchymotic area over the superior aspect of the anterior chest. As your partner assumes manual stabilization of her head, you should: Select one: A. open her airway with the jaw-thrust maneuver. B. apply 100% oxygen via a nonrebreathing mask. C. obtain vital signs to assess for signs of shock. D. rapidly extricate her from the car and transport.

B. apply 100% oxygen via a nonrebreathing mask.

Heat that is generated by an electrical injury can cause coagulation and vascular occlusion, resulting in: Select one: A. massive infection. B. compartment syndrome. C. spontaneous hemorrhage. D. spinal cord inflammation.

B. compartment syndrome.

During your assessment of a patient with blunt chest trauma, you note the presence of ecchymosis to the area of impact. This finding is MOST characteristic of a/an: Select one: A. abrasion. B. contusion. C. hematoma. D. crush injury.

B. contusion.

When caring for an open wound that has small pieces of glass and other debris inside of it, you should: Select one: A. irrigate the wound with sterile water. B. cover the wound with a sterile dressing. C. remove the glass and debris with hemostats. D. leave the wound open unless it is bleeding.

B. cover the wound with a sterile dressing.

The mouth, nose, and other body orifices are lined with ___________________, which secrete a watery substance and provide a protective barrier against harmful agents. Select one: A. sebaceous glands B. mucus membranes C. melanin granules D. germinal cells

B. mucus membranes

A 40-year-old patient has sustained circumferential burns to the chest. The MOST serious complication associated with this type of burn injury is: Select one: A. compartment syndrome. B. ventilatory insufficiency. C. increased chest excursion. D. cardiac dysrhythmias.

B. ventilatory insufficiency.

Which of the following weapons would MOST likely result in the largest surface area of tissue damage? Select one: A. 357 magnum B. 9.0 mm handgun C. 12-gauge shotgun D. .22 caliber handgun

C. 12-gauge shotgun

Why does the skin become flushed or red when a person is exposed to a hot environment? Select one: A. Sweat glands produce sebum, resulting in heat evaporation. B. The blood is hyperoxygenated and assumes a bright color. C. Blood vessels dilate and heat radiates to the skin surface. D. Vasoconstriction shunts blood to the surface of the skin.

C. Blood vessels dilate and heat radiates to the skin surface.

Which of the following physiologic responses occurs initially following a burn injury? Select one: A. Electrolyte derangements and significant hypovolemia B. Massive edema as the fluid shifts into the extravascular space C. Vasoconstriction and decreased blood flow to the burned area D. An inflammatory response and increased capillary permeability

C. Vasoconstriction and decreased blood flow to the burned area

A young male tripped on a garden hose, fell, and struck his head on a concrete sidewalk. He is unresponsive and has a large hematoma to his forehead. His respirations are slow and shallow. You should: Select one: A. administer oxygen via nonrebreathing mask. B. apply ice to the injury to reduce bleeding. C. assist his ventilations with 100% oxygen. D. start an IV and administer a 20 mL/kg bolus.

C. assist his ventilations with 100% oxygen.

You are dispatched to an industrial plant for a worker who was exposed to an unknown chemical. Upon arrival, you find the patient sitting outside of the plant. He has a white, dry powder covering his right arm. Care for this patient's exposure includes: Select one: A. removing the patient's clothing and flushing with copious amounts of water. B. immediately flushing the area with sterile saline to stop the burning process. C. brushing the chemical from the patient's arm and then irrigating with water. D. removing the patient's clothing and immersing his arm in a container of water.

C. brushing the chemical from the patient's arm and then irrigating with water.

Priority treatment for a patient with an open soft-tissue injury includes: Select one: A. IV crystalloid fluid boluses. B. prevention of hypothermia. C. control of active bleeding. D. wound decontamination.

C. control of active bleeding.

A 20-year-old male was shot multiple times during a drive-by shooting. You arrive at the scene, which has been secured by law enforcement, and approach the patient. He is semiconscious and is bleeding heavily from the chest. You should: Select one: A. perform a primary assessment. B. immediately control all bleeding. C. follow proper standard precautions. D. ensure the patient's airway is patent.

C. follow proper standard precautions.

A full-thickness burn is typically characterized by all of the following, EXCEPT: Select one: A. eschar. B. leathery skin. C. intense pain. D. muscle involvement.

C. intense pain.

Appropriate management for a patient with a serious closed injury and signs of shock includes all of the following, EXCEPT: Select one: A. IV fluid boluses to maintain perfusion. B. high-flow oxygen or assisted ventilation. C. prompt transport to a local trauma center. D. 15" to 20" elevation of the lower extremities.

D. 15" to 20" elevation of the lower extremities.

Which of the following patients has experienced a critical burn? Select one: A. A 10-year-old with 45% superficial burns involving the chest and back B. A 31-year-old with 27% partial-thickness burns who takes antidepressants C. A 50-year-old with 9% full-thickness burns involving an upper extremity D. A 65-year-old with 18% partial-thickness burns to both upper extremities

D. A 65-year-old with 18% partial-thickness burns to both upper extremities

Which of the following statements regarding the dermal layer of the skin is correct? Select one: A. The dermis forms a watertight covering for the body. B. Cells of the dermis are constantly worn away and replaced. C. Most of the skin's melanin granules are contained in the dermis. D. Blood vessels in the dermis do not penetrate into the epidermis.

D. Blood vessels in the dermis do not penetrate into the epidermis.

Which of the following is the MOST significant acute complication associated with a laceration to the forearm? Select one: A. Severe pain B. Internal bleeding C. Severe infection D. External bleeding

D. External bleeding

A 22-year-old male, who was trapped in a confined space during a structural fire, is conscious and alert and refuses EMS treatment and transport. He is breathing without difficulty, but has singed nasal hair and facial redness. Which of the following statements regarding this patient is correct? Select one: A. You should encourage this patient to drive himself to the hospital. B. It is likely that this patient has not experienced a serious airway burn. C. Signs and symptoms of upper airway swelling are rapidly progressing. D. The patient may die several hours later due to pulmonary complications.

D. The patient may die several hours later due to pulmonary complications.

You are assessing a 4-year-old male who was electrocuted when he stuck a pin into an electrical socket. He is conscious and alert and complains of pain to his left hand, where you find a small entrance wound. When treating this child, you should: Select one: A. fully immobilize his spinal column. B. apply an AED and monitor the child. C. flush the wound with sterile saline. D. anticipate extensive internal injuries.

D. anticipate extensive internal injuries.

You arrive at the scene of a residential fire where the occupant, a 48-year-old male, has sustained partial- and full-thickness burns to his lower extremities and lower torso. Firefighters removed the patient's smoldering clothing and stopped the burning process prior to your arrival. The patient is conscious, but restless, and complains of intense pain to the burned areas. After taking the standard precautions, you should: Select one: A. immerse the burned areas in sterile water. B. rapidly estimate the extent of the patient's burns. C. perform a secondary assessment and start an IV. D. apply supplemental oxygen and monitor his airway

D. apply supplemental oxygen and monitor his airway

Small muscles within the dermis that pull the hair into an erect position when you are cold or frightened are called the: Select one: A. erector ducts. B. sebum muscles. C. hair follicles. D. erector pili.

D. erector pili.

A 34-year-old male was involved in a motor-vehicle crash. During the crash, his vehicle caught fire. Bystanders removed the patient from his vehicle prior to your arrival. The patient is conscious with adequate breathing. He has partial-thickness burns to his face and neck, and an open femur fracture with severe bleeding. Immediate management for this patient should include: Select one: A. maintaining body temperature. B. providing assisted ventilation. C. performing a secondary assessment. D. controlling the bleeding from his leg.

D. controlling the bleeding from his leg.

A 62-year-old female with a history of type 2 diabetes has sustained partial-thickness burns to 27% of her body surface area (BSA). This burn should be classified as a: Select one: A. minor burn. B. first-degree burn. C. moderate burn. D. critical burn

D. critical burn

In contrast to upper-airway injury following a burn, lower-airway injury is usually the result of: Select one: A. interstitial fluid shifts and pulmonary edema. B. inhalation of superheated gases. C. diffuse collapsing of the alveoli. D. inhalation of chemicals and particulate matter.

D. inhalation of chemicals and particulate matter.

When managing a critically-burned patient, it is important to: Select one: A. perform a detailed physical exam at the scene to look for occult injuries. B. break the integrity of any formed blisters as these can result in infection. C. administer topical analgesia to the burned areas to afford the patient pain relief. D. rapidly estimate the burn's severity and then cover with dry, sterile dressings.

D. rapidly estimate the burn's severity and then cover with dry, sterile dressings.

A burn occurs when the soft tissue of the skin: Select one: A. is exposed to caustic or corrosive chemicals. B. is severely damaged by thermal or friction heat. C. degrades due to exposure to radioactive substances. D. receives more energy than it can absorb without injury.

D. receives more energy than it can absorb without injury.

Cardiac arrest following an electrical burn would MOST likely occur if: Select one: A. the patient is older than 50 years of age. B. there is an entrance and an exit wound. C. the patient is exposed to direct current. D. the electricity flows from arm to arm.

D. the electricity flows from arm to arm.