Chapter 26 Soft-Tissue Trauma

Which of the following is NOT true concerning​ lacerations?

They may be degloving injuries to the skin or tissue.

The layer of skin that contains 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 skins largest organ of the body it is comprimised of three layers including the

eperdemis

Which of the following is a consideration in determining a​ burn's severity?

The type of agent that caused the burn Other illnesses or injuries the patient may have Body surface area​ (BSA) involved in the burn

The meatus​ is:

an orifice of the urethra.

your patient has burns to the entire right arm and the right anterrior chest what is thevl estimated surface area involved

13.5

Which of the following is NOT a type of​ avulsion?

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)?

Airway

Which of the following is NOT appropriate in caring for a patient with closed​ soft-tissue injuries and a significant mechanism of​ injury?

Allow the patient to have small sips of water.

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?

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.

In bandaging a hand​ wound, what important consideration is​ necessary?

Bandage the hand in the position of function.

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.

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.

How does the skin provide temperature​ regulation?

By altering the blood flow to the skin and by controlling perspiration

Which of the following is the outermost layer of the​ skin?

Epidermis

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

Which of the following is NOT an open tissue​ injury?

Contusion

A patient has​ partial-thickness burns over​ 18% of his​ body, including both feet. Which of the following classifications do 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

Which of the following BEST describes an​ avulsion?

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?

Full thickness

Which of the following is of concern with a puncture​ wound?

Hidden internal bleeding with minimal external bleeding Strong possibility of contamination An object that remains impaled in the body

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

Your patient has a large bump on the forehead from being hit by a baseball. What type of injury is​ this?

Hematoma

Which of the following statements is incorrect regarding an electrical​ injury?

Injury is usually limited to the area around the source and ground burns.

Which of the following statements is NOT true concerning the proper transport of an avulsed​ ear?

It should be 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 it.

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?

Maintain​ in-line cervical​ stabilization, and perform a rapid secondary assessment.

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 aggravated by the burn.

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?

None of the above

Which of the following injuries requires the use of an occlusive​ dressing?

Open wound to the abdomen from which a loop of intestine is protruding Open wound to the neck Open wound to the chest

Burns pose a greater risk to infants and children for which of the following​ reasons?

Pediatric patients have a greater risk of shock from 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?

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?

Puncture

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 and place it in a pan of water cooled by an ice pack.

Which of the following organs is most likely to bleed significantly if​ injured?

Spleen

You are dispatched to the local elementary school for an injured student. Upon arrival you find that two​ 7-year-olds got into a fight and one of them jabbed a pencil in the​ other's cheek. The pencil is still sticking out of the​ child's cheek. When you examine the​ patient, you cannot see the end of the pencil that went through the​ cheek, as it appears to be stuck in the palate. There is not significant​ bleeding, and the child is not having any difficulty breathing. The child is very upset and wants you to pull the pencil out. What should you​ do?

Stabilize the​ object, but do not try to remove it.

Which of the following is a desirable characteristic of dressings used in the prehospital management of most open​ wounds?

Sterile

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?

Stop the burning process

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.

Which of the following BEST describes a partial thickness​ burn?

The skin is red and moist with blister formation.

You have just applied a bandage over a dressing that was used to cover an open laceration to the forearm. You now reassess the PMS findings and discern that there is no longer a distal​ pulse, and the patient says that his hand is​ "tingling." What could be the reason for this​ finding?

The bandage was applied too tightly.

Which of the following statements about puncture wounds is​ correct?

The course or depth of the trajectory of the object that caused the puncture cannot be known with certainty.

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.

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?

The palm of the​ patient's hand equals about​ 1% of the​ body's surface area.

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.

Which of the following is required in the management of all open​ soft-tissue injuries?

Use of Standard Precautions by the EMT

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.

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, 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?

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.

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):

abrasion.

When a large flap of tissue is traumatically​ removed, this condition is​ called:

an avulsion.

in accorance with the rule of nines how does the head of an infant compare with the bead of adult

an infants head and neck account for twice the total body surface area of an adult

which of the following is used when an airtight seal is needed

an occlusive dressing

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 should​ FIRST:

apply additional dressing material over the top of the original dressing and bandage it in place.

Your patient suffered a severe electrical burn injury. In your emergency​ care, you should​ always:

assess for an entrance and an exit wound.

your patient has susstained a chemical burn to her hands from a dry chemical how is this treated in the field

brish off the powder before using water to flush

You are performing a secondary assessment on your​ 19-year-old trauma patient. What assessment finding MOST likely indicates a closed head​ injury?

bruising noted to the posterior aspect behind his right ear

soft tissue injuries of the skin are classified as

closed and open

For a young child with isolated genital​ injuries, you​ should:

consider the possibility of abuse and treat the child with sensitivity.

you are dispatched to the scnene of a comtruction site where a 3e hear old male has been impaled with a piece of rebar to his right anterrior chest near the clavecle the rebar is to long to allow transport of the patient, the patient is alert an seated on the ground. how should you manage this injury

contact medical control amd ensure someone stabilized the object while it is cut to desired length

An injury in which the epidermis remains​ intact, but blood vessels and cells in the dermis are​ injured, is called​ a(n):

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):

crush injury.

which of the following statements about closed soft tissue injuries is true

dispite the maintained integrity of the skin in closed injuries underlying tissue destruction can be significant

the sterile material tbat is placed directly on a wound i termed

dressing s

a collection of blood under the skin or in tissue that forms a mass is called

hematoma

burns over a large surface area pose an increased risk of

hypothermia

comtinues use of a wet dressing in a burn patient may cuase

hypothermia

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 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 ad present a 23 year old male with a blood soaked shirt tge patient states that the assalant slashed at him with a box opener you expose chest and note a jagged cut on has left anterior chest with steady darkred hemorrhaging based on this assesment finding thebwoumds is most likely which of tefollowing

laceration

soft tissue injuries are somtimes dramatic but rarley

life threatening

in treating open wounds to the neck or abdomen which type of dressing is prefered

occlusive dressing

if a patient in a motor vehicle crash sustained a fairly large bruise over the leftbupper quadrant of the abdoment you should be most concerned

possible rupture of the patients spleen

the skin serves which of the following functions

protection

Burns involving the airway often lead​ to:

respiratory compromise.

what is the primary risk for electrical injury patients

respiratory or cariac arrest

The MOST common type of trauma that the body sustains​ is:

soft tissue injuries.

which one of the following organs would likely cause severe inflammation akd infection if ruptured

stomach

The first step in burn management is​ to:

stop the burning process

Which layer of the skin provides shock absorption and​ insulation?

subcutaneous

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:

their body surface area is greater in relation to their total body size.

you arrive on scene to a residence where you find a 16 year old female who was shocked while pluging in an appliance in the garage he father states thatvhe heard the shock and saw her thrown to the ground the patient is awake and alert still lying on the ground. backed on the presentation how should you manage the patients injury

this patient should be fully immobilized

which of the following is a guidline for the treatment of chemical burns

when flushing with water minimize further wound contamination by making sure the fluid runs away from the injury not toward uninjured areas

In caring for an amputated​ part, it is important​ to:

wrap the part in sterile gauze and keep it cool.

in treating a puncture wound of the eye it is important to bandage both eyes becuase

you want to avoid sympathetic eye movement

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)?

​1%

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?

​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?

​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 and the anterior surface of her right arm. What is the estimated percentage of body surface​ burned?

​22.5%

Which of the following patients has the greatest likelihood of being cared for in a burn​ center?

​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

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