Ch. 25 Soft-Tissue Injuries

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

A. Vasoconstriction and decreased blood flow to the burned area

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: A. follow proper standard precautions. B. ensure the patient's airway is patent. C. perform a primary assessment. D. immediately control all bleeding.

A. follow proper standard precautions

Common signs and symptoms of radiation sickness include: A. hair loss and skin burns. B. hyperactive organ function. C. thickening of the skin. D. increased visual acuity.

A. hair loss and skin burns

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

A. identify the number and location of all wounds

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

A. intense pain

You are dispatched to the scene of a shooting. Upon arrival, you are directed by law enforcement to the patient, a 44-year-old male, who is unconscious. He is lying in an impressive pool of blood and you can hear gurgling from his mouth when he breathes. After your partner assumes C-spine control and opens the patient's airway, you should: A. suction the patient's oropharynx. B. perform a secondary assessment. C. assess respiratory rate and quality. D. locate the source of the bleeding.

A. suction the patient's oropharynx

High-voltage burn injuries occur MOST frequently in: A. utility workers. B. adults in the workplace. C. industrial plant workers. D. children in the home.

A. utility workers

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

B. 1 mL/kg per hour.

How much IV fluid (per bolus) should you administer to a 65-kg patient with extensive burns and severe shock? A. 1,435 mL B. 1,300 mL C. 1,410 mL D. 1,350 mL

B. 1,300 mL

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

B. 12-gauge shotgun

Which of the following factors has the MOST significant impact on determining the severity of a burn? A. The age of the patient B. Depth and extent of the burn C. Preexisting medical conditions D. Location of the burned areas

B. Depth and extent of the burn

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

B. External bleeding

A 22-year-old male has sustained full-thickness burns to approximately 55% of his BSA. You are appropriately managing his airway and are administering 100% oxygen. You note that the patient's heart rate is 140 beats/min and thready and his blood pressure is 78/58 mm Hg. You should: A. deliver several 500 mL boluses of normal saline solution. B. administer 20 mL/kg crystalloid boluses to maintain perfusion. C. administer IV fluids based on the Parkland formula. D. withhold IV fluid therapy until you have contacted medical control.

B. administer 20 mL/kg crystalloid boluses to maintain perfusion

An elderly male was removed from his burning house by firefighters. He has extensive full-thickness burns; is semiconscious; and has shallow, stridorous respirations. The firefighters have already stopped the burning process. After ensuring an open airway, you should: A. insert a multilumen airway device to protect the patient's airway. B. assist his ventilations with a bag-mask device and 100% oxygen. C. apply 100% oxygen via a nonrebreathing mask and keep him warm. D. estimate the severity of his burns and begin IV fluid replacement.

B. assist his ventilations with a bag-mask device and 100% oxygen

When caring for a patient with multiple abrasions, you should: A. clean the wounds with sterile water. B. be alert for underlying injuries. C. give a 500 mL crystalloid bolus. D. transport to a local trauma center.

B. be alert for underlying injuries

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: A. immediately flushing the area with sterile saline to stop the burning process. B. brushing the chemical from the patient's arm and then irrigating with water. C. removing the patient's clothing and immersing his arm in a container of water. D. removing the patient's clothing and flushing with copious amounts of water.

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

You respond to a domestic dispute, where a middle-aged male was stabbed in the chest by his wife. Your assessment reveals that the patient is pulseless and apneic. The knife is impaled in the center of his chest. You should: A. turn the patient onto his side, stabilize the knife, and begin CPR. B. carefully remove the knife, control the bleeding, and perform CPR. C. stabilize the knife with bulky dressing, initiate CPR, and transport. D. leave the knife in place, control the bleeding, and initiate CPR.

B. carefully remove the knife, control the bleeding, and perform CPR

When a person is exposed to cold temperatures, blood vessels in the skin: A. dilate and draw blood to the surface of the skin. B. constrict and divert blood away from the skin. C. dilate and divert blood to the core of the body. D. constrict and draw blood to the skin's surface.

B. constrict and divert blood away from the skin

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

B. control of active bleeding

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: A. crush injury. B. contusion. C. abrasion. D. hematoma.

B. contusion

Following an electrical burn, estimating the extent of the BSA involved is: A. not possible in the prehospital setting and can only be determined by a physician. B. difficult because the degree and depth may be greater internally than externally. C. easy because the external wound is often more dramatic than any internal injury. D. extremely difficult and should not be assessed in the field by the AEMT.

B. difficult because the degree and depth may be greater internally than externally

Upon arriving at the scene of a motorcycle crash, you find the patient, a young male, lying supine approximately 10 feet from his bike. An emergency medical responder is manually stabilizing the patient's head. You note an obvious open injury to the patient's left lower leg with severe bleeding. Your MOST appropriate initial action should be to: A. open the patient's airway and assess respiratory rate, regularity, and depth. B. direct your partner to control the bleeding as you assess the patient's airway. C. locate and control all obvious bleeding and then perform a primary assessment. D. have your partner assume control of the patient's head as you open the airway.

B. direct your partner to control the bleeding as you assess the patient's airway

An industrial-plant worker was splashed in the left eye with a strong acid chemical. The MOST appropriate initial care for this patient's injury is to: A. neutralize the substance with a strong alkaline solution. B. irrigate the eye laterally, away from the unaffected eye. C. cover the affected eye with a sterile dressing or eye patch. D. limit irrigation of the affected eye to a maximum of 5 minutes.

B. irrigate the eye laterally, away from the unaffected eye

During an explosion, a metal worker sustained a large laceration to the left side of his neck by flying debris. He is conscious, but restless; the wound is moderately bleeding. Appropriate care for this patient's injury includes: A. circumferentially wrapping the neck with gauze to secure a dressing in place. B. preventing air from entering the wound and applying a pressure dressing. C. controlling the bleeding by applying direct pressure to both carotid arteries. D. applying a pressure dressing to the wound and then apply a cervical collar.

B. preventing air from entering the wound and applying a pressure dressing

The skin sends messages to the brain to regulate various functions via: A. efferent nerves. B. sensory nerves. C. motor nerves. D. axonal nerves.

B. sensory nerves

Radiation is released into the atmosphere when: A. atoms lose their charge and increase their production of energy. B. unstable atoms emit excess energy in an attempt to stabilize. C. stable atoms become unstable and produce excess energy. D. it becomes ionized and its atoms become stable in their charge.

B. unstable atoms emit excess energy in an attempt to stabilize

When managing an adult patient with an inhalation injury, inspiratory stridor, and an altered mental status, you should: A. apply ice packs to the neck to reduce swelling. B. give humidified oxygen via a nonrebreathing mask. C. prepare for early definitive airway management. D. ventilate at a rate of 20 breaths per minute.

C. prepare for early definitive airway management

Compartment syndrome is caused by: A. severe increased intracranial pressure following blunt head trauma. B. excessive blood or fluid collection within the abdominal musculature. C. tissue compression and damage due to fluid trapped in a confined space. D. permanent nerve and tissue damage proximal to an injury site.

C. tissue compression and damage due to fluid trapped in a confined space

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

C. ventilatory insufficiency

A utility worker was trimming branches away from a high power line when he accidentally cut the power line. He is unresponsive, apneic, and pulseless. You should begin CPR and then: A. assess for an entrance and exit wound. B. establish two large-bore IV lines. C. apply full spinal motion restriction precautions. D. apply the AED as soon as possible.

D. apply the AED as soon as possible

All of the follow deformity of a short bonea closed soft tissue injury, EXCEPT: A. swelling beneath the skin. B. a history of blunt trauma. C. pain at the site of injury. D. deformity of a short bone.

D. deformity of a short bone

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? A. 36% B. 27% C. 30% D. 45%

C. 30%

A 60-year-old male has sustained partial- and full-thickness burns to his anterior chest, head, and both anterior arms. On the basis of the "Rule of Nines," what percentage of his body surface area (BSA) has been burned? A. 45% B. 18% C. 27% D. 36%

D. 36%

What layer of the skin contains cells that are replaced with new cells that are formed in the germinal layer? A. Subcutaneous layer B. Melanin layer C. Dermis D. Epidermis

D. Epidermis

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

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

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

C. erector pili

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? A. 900-1,000 mL B. 700-800 mL C. 1,000-1,100 mL D. 800-900 mL

D. 800-900 mL

All of the following signs are indicative of upper airway burns due to an inhalation injury, EXCEPT: A. carbonaceous sputum. B. dyspnea and hypoxia. C. an altered mental status. D. wheezing or rhonchi.

D. wheezing or rhonchi

Common prehospital treatment for patients with severe burns includes all of the following, EXCEPT: A. advanced airway care. B. tetanus prophylaxis. C. crystalloid fluid boluses. D. contamination prevention.

B. tetanus prophylaxis

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

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

Which of the following is the MOST acute and serious complication associated with a break in the integrity of the skin? A. Loss of fluids B. Hyperthermia C. Severe infection D. Vasodilation

A. Loss of fluids

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

A. a cardiac dysrhythmia

You and your partner are caring for a 30-year-old female who sustained extensive partial- and full-thickness burns when she was near a gas heater that exploded. Your primary assessment reveals that the patient is semiconscious with profoundly labored and stridorous respirations. Immediate management of this patient should include: A. assisting her breathing with a bag-mask device and oxygen. B. covering her with dry, sterile dressings and applying oxygen. C. insertion of a multilumen airway to protect her from aspiration. D. 100% oxygen via a nonrebreathing mask and rapid transport.

A. assisting her breathing with a bag-mask device and oxygen

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

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

The layer of skin that lies below the germinal layer and contains nerves, sebaceous glands, and blood vessels is called the: A. dermis. B. melanin layer. C. subcutaneous layer. D. epidermis.

A. dermis

During a lengthy transport of a 120-lb 29-year-old female with partial- and full-thickness burns to 45% of her BSA, medical control orders you to begin IV fluid replacement based on the Parkland formula. What volume of IV crystalloid should you administer per hour? A. 690 mL B. 620 mL C. 720 mL D. 780 mL

B. 620 mL

Which of the following types of burns is characterized by intense pain and destruction of a portion of the dermis? A. First-degree B. Partial-thickness C. Third-degree D. Full-thickness

B. Partial-thickness

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: A. apply ice to the injury to reduce bleeding. B. assist his ventilations with 100% oxygen. C. administer oxygen via nonrebreathing mask. D. start an IV and administer a 20 mL/kg bolus.

B. assist his ventilations with 100% oxygen

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

B. compartment syndrome

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: A. first-degree burn. B. critical burn. C. minor burn. D. moderate burn.

B. critical burn

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

B. receives more energy than it can absorb without injury

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

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

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

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

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

C. inhalation of chemicals and particulate matter

In addition to improving systemic perfusion following an electrical burn injury, you should administer IV crystalloid fluid boluses in order to: A. abruptly increase the blood pressure. B. concentrate myoglobin in the renal tubules. C. maintain adequate urine output. D. prevent the occurrence of dysrhythmias.

C. maintain adequate urine output

A thermal burn involving the epidermis that is characterized by redness and pain is classified as a: A. moderate burn. B. second-degree burn. C. superficial burn. D. full-thickness burn.

C. superficial burn

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

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

In which of the following circumstances should you remove an impaled object? A. Metal rod in the thigh with severe arterial hemorrhage B. Knife in the abdomen of a pulseless and apneic patient C. Ice pick in the chest of an unconscious breathing patient D. Metal shard in the cheek and inadequate respiratory effort

D. Metal shard in the cheek and inadequate respiratory effort

Which of the following has the MOST impact on the severity of radiation injury or type of health effect? A. Type of radiation and the patient's age B. The distance between the patient and the source C. The presence of any underlying medical conditions. D. The amount and duration of exposure

D. The amount and duration of exposure

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: A. rapidly extricate her from the car and transport. B. open her airway with the jaw-thrust maneuver. C. obtain vital signs to assess for signs of shock. D. apply 100% oxygen via a nonrebreathing mask.

D. apply 100% oxygen via a nonrebreathing mask

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

D. serious hidden injuries

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

D. the electricity flows from arm to arm

Which of the following statements regarding severe burns is correct? A. Significant hypovolemia may not occur for several hours following the burn injury. B. Immediately following the burn, fluid shifts to the injured area and creates edema. C. Sodium is shunted away from the burned area as the body attempts to compensate. D. Following the burn, there is an immediate shift of fluid out of the vascular space.

A. Significant hypovolemia may not occur for several hours following the burn injury

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? A. The patient may die several hours later due to pulmonary complications. B. Signs and symptoms of upper airway swelling are rapidly progressing. C. It is likely that this patient has not experienced a serious airway burn. D. You should encourage this patient to drive himself to the hospital.

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

A 59-year-old male has a partial amputation of his left arm, just proximal to the elbow. Bleeding has been controlled and you note that the arm is attached by only a few strands of tissue. You should: A. cover the arm with a bulky dressing and carefully splint it. B. splint the arm but do not cover it so you can assess for bleeding. C. carefully detach the arm and wrap it in a moist sterile dressing. D. immerse the arm, still attached, in a container of cool water.

A. cover the arm with a bulky dressing and carefully splint it

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

A. dermis

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

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

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

C. cover the wound with a sterile dressing

The three basic pathways by which radiation enters the body are: A. inhalation, absorption and direct exposure. B. ingestion, direct exposure, and injection. C. inhalation, ingestion, and direct exposure. D. absorption, inhalation, and injection.

C. inhalation, ingestion, and direct exposure

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

C. mucus membranes

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

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

In order for electricity to flow through the body and cause injury: A. there must be an insulator in between the patient and the electrical source. B. the source of the electricity must be high voltage, such as a high power line. C. there must be a complete circuit between the electrical source and the ground. D. a patient must be in direct contact with the electrical source for at least 30 seconds.

C. there must be a complete circuit between the electrical source and the ground

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: A. apply an AED and monitor the child. B. fully immobilize his spinal column. 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: A. rapidly estimate the extent of the patient's burns. B. perform a secondary assessment and start an IV. C. immerse the burned areas in sterile water. D. apply supplemental oxygen and monitor his airway.

D. apply supplemental oxygen and monitor his airway

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: A. performing a secondary assessment. B. providing assisted ventilation. C. maintaining body temperature. D. controlling the bleeding from his leg.

D. controlling the bleeding from his leg

Upon arriving at the scene of a motor-vehicle crash involving a telephone pole, you note that the driver appears unconscious and is bleeding heavily from the mouth. There is a power line across the hood and roof of the car. You should: A. carefully remove the power line with rubber gloves. B. remove the power lines with a non-conductive object. C. attempt to safely remove the patient from the car. D. ensure that the power line is not electrically active.

D. ensure that the power line is not electrically active

A 55-year-old male sustained partial-thickness burns to his face and neck when he opened the hot radiator cap on his car. He is conscious and alert, but complains of dyspnea and difficulty swallowing. His oxygen saturation is 96% on room air. You should be MOST concerned about the: A. possibility of blindness. B. degree of burns. C. risk of infection. D. status of his airway.

D. status of his airway

Death immediately following a burn is MOST commonly the result of: A. massive bacterial infection. B. severe hypovolemic shock. C. incineration of the patient. D. toxic chemical inhalation.

D. toxic chemical inhalation