EMT Chapter 29
You have arrived on the scene of a large structure fire. Emergency Medical Responders (EMRs) are by the side of a patient who is responsive to verbal stimuli and has significant burns to his body. They report that the patient fell down a flight of stairs while trying to escape and was trapped for several minutes. Their assessment findings include partial- and full-thickness burns to his right arm, right leg, and right side of the face. The EMRs also report that the patient's unburned skin is cool, clammy, and pale, with a delayed capillary refill. His pulse is 144 beats/min, respirations are 22 breaths/min, and blood pressure is 88/50 mmHg. Which instructions would be most appropriate?
"After reassessing the ABCs, let's do a secondary assessment and look for signs of injuries that are causing shock."
Which statement made by the EMT indicates an understanding of the prehospital calculation of body surface area (BSA) burned?
"Determining the BSA is an estimation and should never delay transport of the burn patient to the hospital."
A 51-year-old female patient tripped in the kitchen and fell against a deep fryer, splashing hot oil onto her right arm. Assessment reveals partial- and deeppartial-thickness burns to her arm. You estimate that the burn covers 4 to 5 percent of her body. Which statement, made by the patient, provides the most important information for determining the overall severity of the burn from a medical standpoint?
"I have had diabetes for several years"
Which statement shows that the EMT understands the palm method of estimating the BSA burned?
"I use the patient's palm to estimate the size of the burn area."
A male patient was injured when a steam valve opened, causing hot steam to contact his face. Which statement made by the patient would be of most concern to the EMT and require immediate assessment or treatment?
"It is sort of hard to breathe."
A 24-year-old man was shocked while working on his house's electrical system. Assessment reveals a minor burn to the fingers on his left hand. Aside from being slightly shaky, the patient states he feels fine and does not see the need to be treated further or transported to the hospital. Which statement would you make before allowing him to refuse additional care and transport?
"It would be best to let the emergency physician check you out. Electrical shocks can damage the heart."
Which statement made by an EMT shows that he understands the major cause of death in the prehospital setting for a burn patient?
"Most burn patients who die before getting to the hospital die of airway or bleeding problems, not the burn itself."
A female who had hot coffee thrown at her has a superficial burn to the right side of her face. After transferring the patient to the hospital emergency department for continued care, a new EMT asks you if the patient will have a permanent scar on her face. Which is your best reply?
"Since only the outer layer of skin was burned, there is little chance of scarring."
A patient has suffered a superficial burn to the chest, arms, and face after pouring gasoline on a smoldering campfire and accidently inhaling the plume of smoke and fire that erupted suddenly. He is now coughing. Which statement indicates that the EMT is properly caring for him?
"Throughout transport, I am going to listen to your lungs quite frequently."
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 his anterior torso and the anterior surface of his right arm. What is the estimated percentage of body surface burned?
22.5 percent
A patient has full-thickness burns to the fronts of both legs and the entire left arm. Using the rule of nines, the EMT should estimate what percentage of the patient's body has been burned?
27 percent
When triaging multiple burn patients, the EMT would recognize which patient as having the most critical burn?
A 22-year-old patient with a partial-thickness burn to the right hand
A partial thickness burn covering 8 percent of the body would be considered moderate for which patient?
A 25-year-old patient with sickle cell disease
For which patient would the palm method be best to estimate the body surface area affected by a burn?
A 49-year-old patient with a partial-thickness burn to the inner thigh
Your patient suffered a severe electrical burn injury. In your emergency care, you should always:
Assess for an entrance wound and an exit wound
Firefighters have pulled a middle-aged male from a burning bedroom. The patient is unresponsive and has obvious deformity of his left ankle. His respirations are rapid, stridorous, and shallow. Your partner inserts an oropharyngeal airway and begins ventilating the patient with a bag-valve mask appropriately. Which action would you perform next?
Assess the patient's carotid pulse
You have been called for a patient who had a large bag of lime powder tear as he was unloading it from a truck. On your arrival, the patient complains of burning to both legs. You note that, aside from the shorts he is wearing, lime dust has covered both legs. Your immediate action would be to:
Brush as much of the lime off his legs as possible.
Emergency medical care of a burn patient includes which treatment?
Brushing dry chemicals away and then flushing with water
Of the actions described, which indicates proper care of a patient who has experienced a partial-thickness burn to the hand?
Carefully removal rings prior to applying a dry sterile dressing.
An awake but confused patient with a history of diabetes accidentally spilled a pot of hot water on himself while cooking. He has a partial-thickness burn on his right anterior leg. Following an unremarkable primary assessment, which action seems most appropriate?
Check the patient's blood glucose level.
Which statement concerning a flash burn is accurate?
Clothing will typically protect the skin from a flaw burn
The primary care for a liquid chemical burn is to:
Continually flood the affected area and with a large amount of water.
A patient has experienced partial- and full-thickness thermal burns to the anterior chest, abdomen, and arms in an industrial accident. Which action would be appropriate in the care of this patient?
Cool the burns with water and cover the burns with a sterile, dry burn sheet
You are treating a 57-year-old female victim of partial-thickness thermal burns of the hands, arms, feet, legs, genitalia, and anterior torso. After you have brought her airway under control, administered high-flow oxygen via a nonrebreather mask, and cooled the burned area with saline, she is still complaining of being in severe pain. After using cool saline to stop the burning, which of the additional steps can you take to relieve some of her pain?
Cover the burn with a sterile burn sheet
An intoxicated 28-year-old female has suffered burns to both legs after passing out next to a space heater, which ignited her pants. Emergency Medical Responders have removed her clothing and cooled the burns. Which action is most appropriate in the continued care of this patient?
Cover the burns with a clean, white, dry sheet.
A patient was trapped in a burning apartment before being rescued by firefighters. As you approach him, you note that his legs and arms are burned. The patient is screaming in pain and coughing, but no longer actively burning. Given this information, which intervention would you perform first?
Decide whether to administer oxygen with a nasal cannula or nonrebreather mask
The layers of the skin are the:
Epidermis, the dermis, and the subcutaneous layer
A student in a science lab has had an unknown chemical splashed into her eye. After assessing the airway, breathing, and circulation, the EMT would immediately:
Flush the eye with copious amounts of tap water
You arrive at a chemical explosion in a factory and are completing your scene size-up. What types of burn mechanisms might have occurred?
Gas, Contact, Flame, and Flash
You have been called for a 44-year-old male who was burned on the right hand and arm after falling against the hot door of an industrial incinerator. When you arrive on the scene, a nurse employed by the company informs you that he sustained a partial-thickness burn. Based on this information, the EMT should expect which characteristics at the burn site?
Intense pain and blister formation
Which of the following is an accurate statement regarding the dermis?
It contains the sensory structures of the skin
What is an advantage of the Lund and Browder system of BSA estimation?
It uses an age-related chart for more accurate determination
The EMT student is caring for a patient who sustained thermal burns to the face. Which action made by the student necessitates intervention by the medical director?
Open the eyelids prior to dressing
You are transporting a patient who was shocked by an electrical current while repairing a residential electrical service panel. He has partial-thickness burns to the hand and foot where the electricity entered and exited his body, respectively. When reassessing this patient, which finding would be of most concern?
Palpation of an irregular heartbeat
A 21-year-old male sustained a severe burn to his left leg while working on an industrial furnace. Coworkers immediately doused his flaming pants and removed them. Your primary assessment reveals no threats to the airway, breathing, or circulation. While performing the secondary assessment on his leg, which finding would be most critical?
Partial-thickness burn completely encircling the lower leg
An industrial worker sustained partial- and full-thickness burns to his right hand after accidentally touching an electric furnace used to incinerate medical waste. Assessment reveals no threats to the airway, breathing, or circulation. Which action would the EMT perform next?
Pour cool saline water on the hand
Firefighters have just pulled a young woman from a house fire and have laid her on the lawn. The patient is conscious, oriented, and badly burned on the chest, abdomen, and legs. Her clothes are still smoldering. Which action should the EMT take immediately?
Pour water on the smoldering clothes
Treatment of the superficial burn may include:
Pouring cool saline over the injury
A patient has been pulled from a house fire. Assessment reveals him to be lethargic with stridorous respirations, minimal chest wall motion, and a rapid but strong radial pulse. Firefighters are dousing his body with water to cool him and ensure he is extinguished. Which action would the EMT perform immediately once the fire on the patient is adequately extinguished with water?
Provide positive pressure ventilation with a bag-valve mask.
Which burns would be considered minor in an adult patient in terms of burn severity?
Superficial burns over the front and back of both arms
Your 22-year-old male patient has sustained thermal burns involving the entire front of both legs. These burns are dry and "leather-like." How severe are these burns, and how should you care for them?
The burns are critical, since they are over 10 percent full thickness. Wrap them in a dry dressing.
An intoxicated patient has suffered a burn to his left lateral thigh after passing out with his leg touching the side of a kerosene heater. Close examination of the burn reveals tough leathery tissue in the center of the burn, with red skin with blisters surrounding it. Regarding the burn, what would the EMT agree to be true?
The central portion of the burn is full thickness and the outer portion partial thickness.
When applying the rule of nines to a 10-month-old child, the EMT should recognize which statement to be accurate?
The head of a child is considered to be 18% of the total body.
How is the circulatory system affected by severe burns?
Vascular damage with fluid shifting
A 44-year-old electrician has been shocked. He now responds to verbal stimuli with garbled speech. His airway is open and he is breathing poorly at a rate of 8 times per minute. His pulse is slow and irregular. Which action would the EMT perform next?
Ventilate with a bag-valve mask at 10 breaths/min
A male patient who works in a steel fabricating plant has suffered a flash burn to his right arm and hand. Which assessment finding would assist the EMT in determining that the burn is superficial and not partial thickness?
absence of blisters
A 51-year-old male was burned in the face after a steam valve was accidentally opened at his industrial job. His face is red and swollen, and he is screaming in pain. The patient also states that he is having a hard time seeing. What is the EMT's priority concern in caring for this patient?
airway compromise
A 27-year-old male fell down a full flight of stairs while escaping his burning apartment. Which assessment finding in this patient should demand your immediateattention?
burns on the face
You have been called for an intoxicated male who sustained a full-thickness burn to his leg after passing out against a kerosene heater. After ensuring that his airway, breathing, and circulation are intact, you cool the burn with water and then:
carefully wrap the burn with a dry sterile dressing
A patient has a burn that completely encircles his right forearm and hand. After performing the primary assessment, the EMT should:
check for motor, sensory, and a pulse in the right upper extremity.
The FIRST priority on any call in which a person was burned is:
completing a scene size up
You are assessing a patient who was burned when she dropped a hot iron on her bare foot. Her foot is red and has a small partial-thickness burn to the anterior portion of the foot. When completing the prehospital care report, which mechanism of injury would you document?
contact burn
You are caring for an adult male patient who has a critical burn to the hand after attempting to pick up a piece of hot metal after it was cut with a set of torches. What type of burn mechanism would this be?
contact burn
You are assessing an elderly male patient who was trapped in a burning trailer. Which finding would be most indicative that he has an inhalation injury?
coughing of black sputum
The EMT is caring for a patient who sustained burns to the abdomen. Which should the EMT do to prevent contamination of the wound?
cover with burn sheet
A patient has partial-thickness burns over 18 percent of his body, including both feet. Which classification does this patient fall under?
critical
When classifying a burn as either superficial, partial thickness, or full thickness, the EMT would need to determine the:
depth of the burn
The EMT is caring for a patient who sustained damage to the portion of the skin that contains the small capillary beds and sensory structures. Which skin layer would the EMT document as damaged?
dermis
A 20-year-old waitress spilled hot coffee and burned her right forearm. When assessing the burn, you note a full-thickness burn surrounded by partial-thickness burns. The patient complains of pain in the surrounding partial-thickness burn, but not in the center where the full-thickness burn is located. As an EMT, you recognize that the patient does not localize pain to the center of the burn because of:
destruction of pain receptors located in the dermis
Which assessment finding would best indicate that a patient has suffered a full-thickness burn to his leg?
dry skin with little pain
A patient is struck by lightning while running from her car to her house. What would be the primary burn cause?
electrical
The paramedic is caring for a patient who was hit by lightning and is unresponsive. Which type of burn should the paramedic document in the medical record?
electrical
What type of burn mechanism may NOT have significant superficial tissue injuries, but the burns may be located deeper in the tissue?
electrical burn
A fair-skinned patient was exposed to the sun and has a painful superficial burn to her upper back. As a knowledgeable EMT, you would recognize that which layer(s) of the skin has been injured?
epidermal
Which of the following is the outermost layer of skin?
epidermis
A patient is brought to the emergency department via ambulance after sustaining full-thickness burns to the leg from an accident. The paramedic notices leathery dead, soft tissue. Which term should be used in the documentation to describe this area?
eschar
What type of burn occurs when the patient comes into contact with fire or flames?
flame burn
This type of burn mechanism is the result of a flammable gas or liquid that ignites rapidly, and often the burn damage is to skin surfaces NOT covered by clothing:
flash burn
A male patient has just been burned with hot water and has blisters on his left arm. The EMT would recognize that:
fluid has collected between the layers of skin
The innermost layer of skin is known as the
hypodermis
Which layer of the skin contains the larger blood vessels?
hypodermis
A young female, after being rescued from a burning apartment, is found to have partial- and full-thickness burns from her chest down to her feet. As such, the EMT would recognize the potential for the onset of:
hypothermia
When an oral burn can cause swelling of the airway structures, what is the pulmonary result?
hypoxemia
If the patient sustains burns to the hands, the EMT should remove:
jewelry
When a person experiences a severe electrical shock caused by directly touching the electrical source, the entrance wound is often on the hand, and the exit wound:
may be difficult to find
What is the waste product in the blood from extensive burns that causes renal failure?
myoglobin
A patient was burned when he accidentally ignited gasoline while working on his car. When performing your assessment of the injury, which finding would indicate that the patient has suffered a partial-thickness burn?
painful skin on the abdomen that is moist and contains blisters
The paramedic is preparing to bandage the arm and hands of a patient who suffered burns. Which should be performed first?
remove all jewelry
Why would an EMT be concerned about a partial-thickness burn circumferentially to the chest?
restriction of breathing
The EMT is determining total body surface area involved due to severe full-thickness burns to a large portion of the body in an adolescent. Which method should the EMT use?
rule of nines
Which body system is generally NOT harmed by extensive burns?
skeletal
Burned toes should be separated with:
sterile gauze pads
You are called by the owner of a restaurant for a female patron who spilled hot tea onto her right thigh. Your assessment reveals the burn area to be soft, red, and painful. The skin is intact with no blister formation noted, although some edema is present. Based on these assessment findings, you would recognize this injury as belonging to which category of burn?
superficial
The release of myoglobin into the blood, caused by an electrical burn, can result in failure of:
the kidneys
What forms the physical barrier against the entrance of undesirable microorganisms, found in the environment, into the body?
the skin
A 3-year-old male patient pulled a pan of hot grease from an electric stove onto himself. He has burns to both arms and his chest. How would this burn be classified?
thermal
The EMT arrives at a house and discovers the patient has sustained burns from hot water. Which burn classification should the EMT expect to treat?
thermal
A patient sustains burns from boiling water that spilled from a pot. Which type of burn should the paramedic document in the record?
thermal burn
