Chapter 31: Caring for Patients with Soft Tissue Injuries

You are transporting a 68-year-old male patient who cut his arm while working in his workshop. During your reassessment, you notice that the dressing and bandaging you put in place is partially soaked with blood. Which of the following should you do next: remove the saturated dressings and apply a large trauma dressing, apply a tourniquet and tighten until the bleeding is controlled, or apply another dressing over the original and bandage appropriately?

Apply another dressing over the original and bandage appropriately

Which of the following is released by the adrenal glands in response to developing hypovolemic shock: blood, saliva, or epinephrine?

Epinephrine

A 22 year old male presents with a suspected intrathoracic hemorrhage. His skin is cool, pale, and clammy, and his vital signs are HR = 108/min with a weak radial pulse, BP = 124/92mmHg, RR = 22/min with deep tidal volume. This presentation is most characteristic of what class of hemorrhage?

Class II

A blood loss of 30-40% of total volume is characteristic of what class of hemorrhage?

Class III

All of the following can be utilized as a pressure dressing except a (an): roller gauze, gauze pad, or air splint?

Gauze pad

Uncontrolled hemorrhage will result in which type of shock: obstructive, distributive, or hemorrhagic?

Hemorrhagic

Your 22-year-old patient is an auto mechanic who was working on an engine when a piece of metal punctured his hand. All of the following are considerations when treating this wound EXCEPT that: the object should be stabilized in place, there may be hidden internal bleeding, or if the object is still impaled, it should be removed?

If the object is still impaled, it should be removed

All of the following are factors that may result in increased bleeding except: immobilization, removal of dressings, or IV fluids?

Immobilization

You are treating a patient who has a laceration to the forearm. Which of the following is required in the management of all open soft-tissue injuries: providing high-flow oxygen to the patient or the use of body substance isolation?

The use of body substance isolation

Which of the following is an example of an open soft tissue injury: contusion, hematoma, or abrasion?

Abrasion

Which of the following wounds is characterized by the scraping away of the epidermis: laceration, contusion, or abrasion?

Abrasion

Your patient presents unconscious after being struck by a car. You note snoring respirations, slow and shallow breathing, a fractured pelvis, and a BP of 82/P. Of the following possible treatments, which is indicated: oxygen via nonrebreather mask, application of a tourniquet, or application of a PASG?

Application of a PASG

An arterial bleed is uncontrolled with direct pressure. You should: apply a pressure dressing, elevate the wound, or apply a tourniquet?

Apply a tourniquet

Which of the following medications will interfere with the clotting process: vitamins, beta-blockers, or aspirin?

Aspirin

You are providing standby for the bicycle motocross races. During a heated race, one of the riders loses control and wipes out down an embankment. He has deep abrasions to his hands, arms, and knees, which are contaminated with dirt and gravel. How would you manage this patient?

Assess for additional injuries, flush away large pieces of debris with sterile water or saline solution, place dressings on the abrasions, transport

Your patient was working at a warehouse when a large piece of steel fell across his right forearm. As the injury begins to swell, what may result from the blood vessels and muscles being compressed within the extremity?

Compartment syndrome

You are spending a quiet day off fishing with your grandfather. While preparing his bait, your grandfather gets a fishhook impaled in his hand between his thumb and index finger. Which of the following is your best option of managing this injury: apply a pressure dressing over the hook, pull it out from the same direction which it entered, or control any bleeding and stabilize the hook in place?

Control any bleeding and stabilize the hook in place

As you arrive at the scene of an industrial incident you are greeted by a security officer who states the patient has an open injury. All of the following are open tissue injuries EXCEPT: abrasion, avulsion, or contusion?

Contusion

Which of the following is an example of a closed soft tissue injury: contusion, avulsion, or puncture?

Contusion

Which of the following wounds is the result of capillary bleeding within the dermis: hematoma, laceration, or contusion?

Contusion

You are treating a patient who had two fingers amputated while working on a lawn mower. You have located the fingers; now, how would you treat them?

Cover with dressing moistened with sterile saline

Which of the following statements regarding dressing and bandaging is true: a bandage may be applied across a joint, sterile material is not preferable for a dressing, or jewelry should be removed from the body part to be bandaged?

Jewelry should be removed from the body part to be bandaged

You have determined that you need to apply a tourniquet to a wound located on the wrist. You should apply the tourniquet: directly over the wound, on the bicep, just proximal to the elbow, or just proximal to the injury?

Just proximal to the injury

Which of the following skin signs is most characteristic of hypovolemic shock: warm flushed and dry skin, pale cool and diaphoretic skin, or mottled warm and dry skin?

Pale, cool, and diaphoretic skin

Your patient presents with bright red blood spurting from a stab wound to her bicep. You should immediately: apply a tourniquet proximal to the wound, apply direct pressure to the wound, or put on gloves and eyes protection?

Put on gloves and eye protection

Which of the following statements best describes the function of the skin: skin prevents all external objects from coming into contact with vital organs or skin protects the body from pathogens and helps regulate temperature?

Skin protects the body from pathogens and helps regulate temperature

Your partner is performing a primary assessment of your patient and mentions to you that he can see fatty tissue. What structure of the skin is exposed?

Subcutaneous layer

You are dispatched to a construction site for a worker who was shot in the foot while using a pneumatic nail gun. In which of the following situations would you remove an impaling object: bleeding from the wound is minimal, the nail is less than two inches in length, or the object interferes with the airway?

The object interferes with the airway

A tourniquet should be tightened: as tight as possible without causing pain, until the bleeding stops, or until there is no distal pulse?

Until the bleeding stops

Your patient presents with a laceration. There is dirt in and around the wound. You should: wipe dirt away from the wound with sterile gauze, pick embedded dirt out from the wound, or irrigate the wound with tap water?

Wipe dirt away from the wound with sterile gauze

An immediate, possible complication of a penetrating neck wound is __________.

air embolism

A patient presents with a stab wound to the neck. You should __________.

apply a 4-sided occlusive dressing

Your primary exam reveals a sucking chest wound. You should __________.

apply an occlusive dressing

Bright red blood that spurts from a wound is most characteristic of __________.

arterial bleeding

A pressure dressing that is appropriately applied will __________.

control bleeding

A patient presents with an abdominal evisceration. You should __________.

cover the wound with moist, sterile gauze

You are part of the initial response to a neighborhood that just experienced a tornado. While searching for victims, you find a male patient trapped under part of his collapsed house. He has a large beam trapping his left leg. This patient is suffering from a( n ) __________.

crush injury

When treating a patient with an abdominal evisceration, placing her hips and knees in a flexed position will __________.

decrease the tension of the abdominal muscles

Your 6-year-old patient fell while riding his bicycle. He has a scraped knee. This injury has damaged the __________.

epidermis

From the surface to muscle tissue, the layers of the skin are ordered __________.

epidermis, dermis, subcutaneous

The medical term for "bleeding from the nose" is __________.

epistaxis

A contraindication for the application of the PASG is __________.

eviscerated abdominal organs

Proper care for an amputated hand includes __________.

flushing the hand with sterile water to clean it

You are treating a 12-year-old female patient who was accidentally struck in the arm with a baseball bat during a tournament. The skin on her arm is intact, but you notice swelling and discoloration to the upper arm. In treating this patient you should __________.

immobilize the arm

A patient with a soft tissue injury who is anxious and restless may experience __________.

increased bleeding

A patient presents unconscious with a self-inflicted laceration and arterial injury to his lower arm. He has lost a significant amount of blood, and a tourniquet has been applied and has stopped the bleeding. You should next __________.

initiate rapid transport

You are treating a patient who got his arm caught in a commercial clothes dryer. Although the arm is still attached, there is a large piece of tissue peeled from his arm. Management of this avulsion would include __________.

laying the flap back into position and controlling hemorrhaging

A patient presents with a nose bleed. You should __________.

lean him forward and pinch the nostrils together

Your patient presents with a screwdriver impaled in his thigh, through his pants. You should immediately __________.

manually stabilize the screwdriver

As an EMT, you will frequently encounter trauma patients with lacerations. Lacerations __________.

may be deep or shallow

An indication for the application for the PASG is __________.

pelvic fracture with hypotension

Your patient is bleeding from his left ear canal after being struck in the head. You should __________.

place a loose dressing around the ear

A patient presents with a knife impaled in his neck. You note profuse bleeding from the wound. You should __________.

provide direct pressure to the wound around the knife

Your patient presents unconscious in and respiratory failure with a metal rod impaled through her jaw. The rod is interfering with your ability to form an adequate seal with the BVM face mask. You should __________.

remove the object

Your patient has fallen off a roof and struck his head. You note blood from his ears and nose. The most likely cause of this bleeding is __________.

skull fracture

You are dispatched to an apartment complex for a victim of a domestic dispute. The police have secured the scene. Your patient is a 32-year-old man who was stabbed in the thigh with a fork. The fork is still embedded in his thigh. Regarding the fork, you should ________.

stabilize the impaled object with bulky dressings

When treating any open wound, it is most desirable that the dressing you use is __________.

sterile

You are treating an elderly victim of a violent attack. The patient states that he was struck multiple times in the head, chest, and abdomen. You notice multiple lacerations to the face, a laceration to the neck, and extensive contusions to the chest and abdomen. Your highest index of suspicion should be for __________.

the development of an air embolism

Human bites are of particular concern in the long term because __________.

there is a high risk of infection

Dark red blood that flows steadily from a wound is most characteristic of __________.

venous bleeding