Chapter26

Front 1

Which of the following is NOT considered soft tissue?

Back 1

CartilagePage Ref: 681Objective: 26.2

Front 2

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?

Back 2

Remove the ice from the wound, then elevate and splint the limb. Transport the patient high priority.CORRECT. EMT treatment for high-pressure injection wounds includes elevating and splinting the limb. Cold can cause vasoconstriction and lead to further tissue damage. This is an extremely significant injury and can lead to loss of limb if treatment is delayed or improper.

Front 3

Bleeding from soft-tissue injuries should initially be controlled with which one of the following techniques?

Back 3

Direct pressureCORRECT. Direct pressure is the initial way to control bleeding from a wound.

Front 4

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?

Back 4

Potential internal injuriesCORRECT. Due to the mechanism of injury (MOI), the potential of internal injuries is the greatest concern.

Front 5

A burn extending into the subcutaneous fat would be classified as which type of burn?

Back 5

Full thicknessCORRECT. Full thickness burns involve the entire epidermis and dermis layers and extend down to the subcutaneous layer of the skin.

Front 6

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?

Back 6

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.CORRECT. The correct method after assessing for additional injuries is to flush away large pieces of debris with a sterile dressing, place dressings on the abrasions, bandage, and then transport.

Front 7

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

Back 7

Pediatric patients have a greater risk of shock from the burn.Page Ref: 706Objective: 26.7

Front 8

You are assessing a 30-year-old male patient that had his arm caught in a piece of machinery. 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?

Back 8

High-pressure injectionCORRECT. The EMT should maintain a high index of suspicion for a high-pressure injection of substances like hydraulic fluid from the machinery.

Front 9

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?

Back 9

Apply a dry sterile dressing.CORRECT. Dry sterile dressing application is appropriate care in the prehospital environment.

Front 10

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

Back 10

CORRECT. The correct sequence is to apply additional dressings over the blood soaked dressings and apply more direct pressure to control bleeding, then bandaging in place.

Front 11

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?

Back 11

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.CORRECT. General guidelines for caring for open wounds are expose, control bleeding, and clean the surface area; then use a sterile dressing and bandage. You should not attempt to clean the wound itself. Bleeding control is the priority.

Front 12

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

Back 12

An object that remains impaled in the bodyHidden internal bleeding with minimal external bleedingStrong possibility of contaminationAll of theseCORRECT. A puncture wound has a strong possibility of contamination. In a puncture wound there may be hidden internal bleeding with minimal external bleeding. Another concern with a puncture wound is the object that remains impaled in the body.

Front 13

Which of the following is recommended when caring for an amputated part?

Back 13

Seal the part in a plastic bag and place it in a pan of water cooled by an ice pack.Page Ref: 698Objective: 26.6

Front 14

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?

Back 14

Wrap them in a sterile dressing, put them in a plastic bag, and keep them cool.CORRECT. You cannot make a decision regarding the ability to reattach any amputated parts. Therefore, you should make every effort to bring them with you. Direct contact with ice could cause them to freeze, which would not allow them to be reattached. You should keep the fingers clean and cool.

Front 15

Which of the following is NOT a major function of the skin?

Back 15

Regulates the pH balance of the bodyPage Ref: 681-683Objective: 26.2

Front 16

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?

Back 16

The palm of the patient's hand equals about 1% of the body's surface area.CORRECT. Because the burns on the patient are being measured, you should use his palm and not yours in the calculation. Either the rule of nines or the rule of palm works regardless of the age of the patient, although the areas are different on children for the rule of nines.

Front 17

Which of the following is a consideration in determining a burn's severity?Other illnesses or injuries the patient may haveBody surface area (BSA) involved in the burnThe type of agent that caused the burn

Back 17

All of theseCORRECT. Other illnesses or injuries, BSA involved, and the agent type are all considerations in determining a burn's severity.

Front 18

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)?

Back 18

1%CORRECT. The patient's palm equals approximately 1% of the BSA

Front 19

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

Back 19

Allow the patient to have small sips of water.CORRECT. With a significant MOI, the patient should receive nothing by mouth (NPO) as surgery may be warranted.

Front 20

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 is less than 2 inches in length.The patient's distal pulse, motor function, and sensation are intact.Bleeding from the wound is minimal.

Back 20

None of theseCORRECT. An impaled object should not be removed from the thigh.

Front 21

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?

Back 21

18%CORRECT. 18% is assigned to the infant and child's head and neck as compared to 9% for the adult's head and neck.

Front 22

Which of the following is NOT a type of avulsion?

Back 22

A finger is cut off with a butcher's saw.CORRECT. A finger being completely cut off with a butcher's saw would be an amputation.

Front 23

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?

Back 23

Take appropriate Standard Precautions, apply high-concentration oxygen by nonrebreather mask, and transport the patient ASAP, carefully monitoring the patient during transport.CORRECT. Always consider the mechanism of injury (MOI) when you examine a patient with a closed injury. In this case, the MOI was significant. You have to be careful and consider internal bleeding and shock until ruled out in the ED.

Front 24

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

Back 24

It should be in a dry sterile dressingPage Ref: 697-698Objective: 26.6

Front 25

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?

Back 25

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.Page Ref: 711-713Objective: 26.10

Front 26

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?

Back 26

Brush the powder off the patient's arm and hand, and then flush with copious amounts of water.CORRECT. After brushing the powder off the burned area is washed with copious amounts of water.

Front 27

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):

Back 27

abrasion.CORRECT. An abrasion is a wound where the epidermis is scraped away with minimal bleeding.

Front 28

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:

Back 28

their body surface area is greater in relation to their total body size.CORRECT. A child's body surface area is greater in relation to the total body size. This results in greater fluid and heat loss than would occur in an adult patient. Infants and children have a higher risk of shock, airway problems, and hypothermia from burns.

Front 29

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

Back 29

EpidermisCORRECT. The outermost layer of the skin is the epidermis.

Front 30

Which of the following is NOT true concerning lacerations?

Back 30

They may be degloving injuries to the skin or tissue.CORRECT. Degloving injuries are a type of avulsion where the tissue or skin is completely or partially pulled off.

Front 31

Which of the following BEST describes an avulsion?

Back 31

Flap of skin that is partially or completely torn away from the underlying tissueCORRECT. An avulsion is a flap of skin that is partially or completely torn away from the underlying tissue.

Front 32

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?

Back 32

Stabilize the object, but do not try to remove it.CORRECT. The object does not appear to be interfering with the airway, breathing, or circulation. Because you cannot see the end of the object that is in the mouth, and it is not interfering with airway, breathing, or circulation, it should be treated like other impaled objects, that is, stabilized and left in place

Front 33

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)?

Back 33

AirwayCORRECT. Airway issues are the highest priority in a burn patient.

Front 34

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

Back 34

Injury is usually limited to the area around the source and ground burns.CORRECT. An electrical burn can be quite extensive and involve many internal organs such as the heart, spleen, and lungs. If the source burn is on the left hand and the ground burn is on the feet, right hand, hip, knee, and so on, the path crosses the heart and other vital organs.

Front 35

Which of the following layers of the skin is the MOST important in insulating the body against heat loss?

Back 35

subcutaneous layerCORRECT. Shock absorption and insulation are major functions of the subcutaneous layer.

Front 36

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

Back 36

SterileCORRECT. Most open wounds are treated with dry, sterile dressings.

Front 37

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?

Back 37

Leave the hook in place and try not to disturb it.CORRECT. With an impaled object it is best to leave the object in place, stabilize it if necessary, and transport to the ED for removal.

Front 38

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?

Back 38

Application of antibiotic ointmentCORRECT. Application of an antibiotic ointment is not part of burn management in the prehospital environment, but may be later done at the ED.

Front 39

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?

Back 39

PunctureCORRECT. A puncture wound has a small opening in the skin and may be deep, caused by nails, ice picks, or pencils

Front 40

Which of the following is NOT an open tissue injury?

Back 40

ContusionCORRECT. A contusion is a bruise which is a closed tissue injury.

Front 41

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?

Back 41

Apply a pressure dressing to control bleeding, stabilize the foot by splinting, apply oxygen, and transport as a priority patient.CORRECT. To control bleeding apply direct pressure, manually stabilize the foot, splint in a position of function, apply O2, and transport. EMTs should never complete an amputation. Control bleeding and splint to minimize further damage.

Front 42

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?

Back 42

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.CORRECT. After brushing away the substance the patient's skin should be washed with copious amounts of water.

Front 43

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?

Back 43

Care for the burn and do a complete patient assessment, including cervical spine precautions.CORRECT. Patient assessment should not be neglected in order to give complete burn care. When caring for a burn patient, it is important to think beyond the burn. Did this person fall? Do you have to be concerned with his medical history (e.g., does he have a history of heart problems that might be exacerbated by the burns)?

Front 44

Which of the following is of concern in a patient who received burns to his hand when he grabbed a live electrical wire?

Back 44

The extent of tissue damage may be much greater than it appears on the surface.CORRECT. The extent of tissue damage may be much greater than it appears on the surface (where contact with the live wire was made).

Front 45

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):

Back 45

crush injury.CORRECT. Force can be transmitted from the body's exterior to its internal structures, even when the skin remains intact and the only indication of injury is a simple bruise. This force can cause the internal organs to be crushed or ruptured, causing internal bleeding. This is called a crush injury.

Front 46

When managing an electrical burn, the EMT should:

Back 46

check for a source and ground burn injuryPage Ref: 711-713Objective: 26.10

Front 47

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

Back 47

contusion.Page Ref: 683-684Objective: 26.3

Front 48

Which of the following is a description of the rule of nines for an adult?

Back 48

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.CORRECT. 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, with the remaining 1% assigned to the genital region.

Front 49

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?

Back 49

18%CORRECT. The front of one leg is 9% and the back is 9%. Taking half of the leg (from the knee down to the foot) would yield 4.5% on each front and 4.5% on each back leg (since the burns are circumferential). 9% on each leg would equate to 18% for both legs.

Front 50

Which of the following injuries requires the use of an occlusive dressing?Open wound to the neckOpen wound to the abdomen from which a loop of intestine is protrudingOpen wound to the chest

Back 50

All of theseCORRECT. Open neck wounds, abdominal eviscerations, and chest wound require the use of occlusive dressing so that air from the atmosphere is not entrained into the body through the open wound.

Front 51

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?

Back 51

Medical conditions may be aggravated by the burn.Page Ref: 705Objective: 26.7

Front 52

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

Back 52

Use of Standard Precautions by the EMTCORRECT. All open soft-tissue injuries should alert the EMT to use Standard Precautions such as gloves.

Front 53

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

Back 53

30-year-old woman who has deep partial thickness burns on her hand and arm as a result of spilling hot cooking oil on herselfCORRECT. A partial thickness burn of the arm and hand caused by a chemical (hot oil) will require treatment at a burn center due to the hand involvement as well as the hot liquid contacting the skin.

Front 54

Which of the following BEST describes a partial thickness burn?

Back 54

The skin is red and moist with blister formation.CORRECT. In a partial thickness burn the skin is red and moist with blister formation.

Front 55

The meatus is:

Back 55

an orifice of the urethra. Page Ref: 699Objective: 26.2

Front 56

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?

Back 56

16-year-old male whose shirt caught on fire, resulting in circumferential burns of his chestCORRECT. A patient with circumferential burns to the chest is at great risk for respiratory failure due to possible ineffectiveness of chest expansion during breathing secondary to edema of the tissues.