Chapter 26*
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)?
A) 1%
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?
A) 18%
Which of the following is of concern in a patient who received burns to his hand when he grabbed a live electrical wire?
A) The extent of tissue damage may be much greater than it appears on the surface.
) 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):
A) abrasion.
The meatus is:
A) an orifice of the urethra.
An injury in which the epidermis remains intact, but blood vessels and cells in the dermis are injured, is called a(n):
A) contusion.
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 muscle cells and the accumulation of waste products in the tissue is called a(n):
A) crush injury.
Which of the following patients has the greatest likelihood of being cared for in a burn center?
B) 30-year-old woman who has deep partial thickness burns on her hand and arm as a result of spilling hot cooking oil on herself
) Which of the following is NOT a type of avulsion?
B) A finger is cut off with a butcher's saw.
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)?
B) Airway
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?
B) Application of antibiotic ointment
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?
B) Brush the powder off the patient's arm and hand, and then flush with copious amounts of water.
Which of the following is NOT an open tissue injury?
B) Contusion
Bleeding from soft-tissue injuries should initially be controlled with which one of the following techniques?
B) Direct pressure
Which of the following is the outermost layer of the skin?
B) Epidermis
Which of the following BEST describes an avulsion?
B) Flap of skin that is partially or completely torn away from the underlying tissue
A burn extending into the subcutaneous fat would be classified as which type of burn?
B) Full thickness
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?
B) Leave the hook in place and try not to disturb it.
Burns pose a greater risk to infants and children for which of the following reasons?
B) Pediatric patients have a greater risk of shock from the burn.
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?
B) Remove the ice from the wound, then elevate and splint the limb. Transport the patient high priority.
Which of the following layers of the skin is the MOST important in insulating the body against heat loss?
B) Subcutaneous layer
) 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?
B) The palm of the patient's hand equals about 1% of the body's surface area.
Which of the following is required in the management of all open soft-tissue injuries?
B) Use of Standard Precautions by the EMT
When managing an electrical burn, the EMT should:
B) check for a source and ground burn injury.
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?
C) 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.
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?
C) Care for the burn and do a complete patient assessment, including cervical spine precautions.
Which of the following statements is incorrect regarding an electrical injury?
C) Injury is usually limited to the area around the source and ground burns.
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?
C) Medical conditions may be aggravated by the burn.
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 his 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?
C) 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?
C) Puncture
Which of the following is recommended when caring for an amputated part?
C) Seal the part in a plastic bag and place it in a pan of water cooled by an ice pack.
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?
C) 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?
C) 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.
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?
D) 16-year-old male whose shirt caught on fire, resulting in circumferential burns of his chest
) 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?
D) 18%
Which of the following injuries requires the use of an occlusive dressing?
D) All of the above
Which of the following is a consideration in determining a burn's severity?
D) All of the above
Which of the following is of concern with a puncture wound?
D) All of the above
Which of the following is NOT appropriate in caring for a patient with closed soft-tissue injuries and a significant mechanism of injury?
D) Allow the patient to have small sips of water.
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?
D) Apply a dry sterile dressing.
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?
D) Apply a pressure dressing to control bleeding, stabilize the foot by splinting, apply oxygen, and transport as a priority patient.
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?
D) 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?
D) 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.
Which of the following is NOT considered soft tissue?
D) Cartilage
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?
D) High-pressure injection
Which of the following statements is NOT true concerning the proper transport of an avulsed ear?
D) It should be in a dry sterile dressing.
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?
D) None of the above
Which of the following is NOT a major function of the skin?
D) Regulates the pH balance of the body
Which of the following is a desirable characteristic of dressings used in the prehospital management of most open wounds?
D) Sterile
Which of the following BEST describes a partial thickness burn?
D) The skin is red and moist with blister formation.
Which of the following is NOT true concerning lacerations?
D) They may be degloving injuries to the skin or tissue.
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:
D) their body surface area is greater in relation to their total body size.
Which of the following is a description of the rule of nines for an adult?
The rule of nines assigns 9% 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% to the genital region.
