PHARM 5
The emotional and psychological damage from burn injuries:
begins at the emergency scene.
When crushed, the liver and spleen:
bleed profusely and cause shock.
In a contusion, what remains intact?
the epidermis
The layer of skin that is rich with blood vessels, nerves, and specialized structures is the:
dermis
When managing an electrical burn, the EMT should:
ensure the scene is safe before entering.
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
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.
Which of the following is MOST likely to be the consequence of a closed crush injury?
internal organs are ruptured
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 and fingers equal about what percentage of the body's surface area (BSA)?
1%
Your patient has burns to the entire right arm and the anterior chest. What is the estimated surface area involved?
18 percent
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%
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%
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 percent
While assessing a patient with partial thickness burns to his chest and neck, after stopping the burning process, what should be your HIGHEST priority (even if there are no symptoms presently)?
Airway
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.
In bandaging a hand wound, what important consideration is necessary?
Bandage the hand in the position of function.
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.
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.
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?
Critical
Which of the following statements about puncture wounds is correct?
Even insignificant-looking puncture wounds can cause devastating injuries.
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?
Fully immobilize the patient.
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 patient with an electrical injury is LEAST likely to present with which of the following signs and symptoms?
Hypotension
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.
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
Damage to which of the following organs is LEAST likely in the case of abdominal bruising?
Lungs
In treating open wounds to the neck or abdomen, which type of dressing is preferred?
Occlusive 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, 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 kept cool with cold packs.
Which of the following layers of the skin is the MOST important in insulating the body against heat loss?
Subcutaneous layer
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.
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?
The nail should not be removed.
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?
This patient should be fully immobilized.
Possible injury to the cervical spine or brain could be indicated by:
a bruise on the head or neck.
An injury in which the epidermis remains intact, but blood vessels and cells in the dermis are injured, is called:
a contusion
Which of the following is NOT a type of avulsion?
a finger is cut off with a butchers saw
Which of the following BEST describes an avulsion?
a flap of skin that is partially or completely torn away from the underlying tissue
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 hematoma.
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
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:
abrasion
All burns are to be treated as more serious if:
accompanied by other injuries or medical problems.
Which of the following statements about electrical burns is TRUE?
all tissues between he entrance and the exit wounds will potentially be injured
When a flap of tissue is traumatically removed, this condition is called:
an avulsion.
A burn injury should be considered to be:
an injury with the potential for many far-reaching effects.
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
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
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
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?
asses for additional injuries, brush away large pieces of debris with a sterile dressing, place dressings on the abrasions, bandage them in place, and transport
Your patient suffered a severe electrical burn injury. In your emergency care, you should always:
assess for an entrance and exit wound
When would you use your stethoscope to listen for equal air entry and unusual breath sounds?
bruising on the trunk or signs of damage to the ribs or sternum
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
How does the skin provide temperature regulation?
by altering the blood flow to the skin and controlling perspiration
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
Which of the following is NOT considered soft tissue?
cartilage
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.
Which of the following is NOT an open tissue injury?
contusion
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 bburned 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?
critical
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
Generally when providing emergency care of open wounds, the first thing you would do is:
expose the wound
Which of the following statement is TRUE?
geriatric patients might not survive burn injuries of an intensity and body area involvement that younger patients would
A wound under the skin that involves the collection of blood from injury to a large blood vessel is called a:
hematoma
Your patient has a large bump on the forehead from being hit by a baseball. What type of injury is this?
hematoma
You are assessing a 30-year-old male patient who was accidentally injured by a high-pressure industrial sprayer. 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
Which of the following statements regarding an electrical injury is FALSE?
injury is usually limited to the area around the source and ground burns
Which of the following statements concerning the proper transport of an avulsed ear is FALSE?
it should be wrapped in a dry sterile dressing
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
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 aggrevated by the burn
You are assessing a patient and notice red discoloration with blisters on the legs. This type of burn would be classified as:
partial thickness.
Swelling or deformity at the site of a bruise indicates a:
possible underlying fracture
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
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. This patient is showing signs of all of the following possibilities EXCEPT which one?
punctured lung
You are called to an injured person to find a 27-year-old male with a laceration on his anterior forearm. Bleeding is dark red, steady, and fast. You control bleeding with direct pressure and then dress the wound. After you dress the wound, the bleeding restarts. You should:
reapply pressure and apply additional dressing material over the top of the original dressing
What is the primary risk for electrical injury patients?
resp or cardiac arrest
Burns involving the airway often lead to:
respiratory compromise.
All dressings used in the prehospital management of open wounds should be:
sterile
Which layer of the skin provides shock absorption and insulation?
subcutaneous
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 rule of palm is a method for measuring the extent of the burn that compares the size of the burn with:
the size of the palm and fingers of the patient's hand.
Which of the following BEST describes a partial thickness burn?
the skin is red and moist with blister formation
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
Which of the following statements concerning lacerations is FALSE?
then may be degloving injuries to the skin or tissues
What is an example of classifying a burn by agent and source?
thermal burn from excessively hot coffee
Which of the following is required in the management of all open soft-tissue injuries?
use 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
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
In caring for an amputated part, it is important to:
wrap the part in sterile gauze and keep it cool
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 moistened with sterile saline, put them in a plastic bag, and keep them cool
You are caring for a 23-year-old female who fell off 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, clean the surface by simply removing large pieces of foreign matter if any, control bleeding, and dress and bandage the wound
In treating a puncture wound of the eye, if you bandage both eyes, it is because:
you want to avoid sympathetic eye movement.
A bruise on the abdomen could indicate injury to which of the following?
Spleen, liver, or kidneys
