14 - Bleeding / Soft Tissue Injuries

Question 1

Name the five blood vessels.

Answer 1

Arteries
Arterioles
Venules
Veins
Capillaries

Question 2

The skin has two principal layers, name them.

Answer 2

Epidermis
Dermis

Question 3

List three functions of the skin.

Answer 3

1. Protects the body by keeping pathogens out and fluids in
2. Helps regulate body temperature
3. The nerves in the skin report to the brain on the environment and on many sensations (964)

Question 4

The body will not tolerate an acute blood loss of greater than:

Answer 4

20%

Question 5

The body has mechanisms in place to help control bleeding, list tw0 of these mechanisms:

Answer 5

1. Vasoconstriction
2. Coagulation (blood clotting)
   (939)

Question 6

What are three types of soft tissue injuries?

Answer 6

Closed soft-tissue injury
Open soft tissue injury
Burns

Question 7

In a hot environment the vessels in the skin: In the cold environment the vessels in the skin:

Answer 7

HOT: Vessels expand to allow the body to sweat and cool down

COLD: Vessels constrict to preserve heat

Question 8

Define these terms:
1. Melena
2. Hematemesis
3. Hemoptysis

Answer 8

Melena: Dark, sticky, stool
Hematemesis: Vomiting blood
Hemoptysis: Coughing blood

Question 9

List three different methods to control external bleeding other than a tourniquet.

Answer 9

Direct pressure

Hemostatic dressing

Wound packing

Pressure dressings and / or splints

(944)

Question 10

The brain and spinal cord can be injured after how many minutes without perfusion?

Answer 10

4 to 6 minutes
(937)

Question 11

You are treating a 26 year old patient who has partial thickness burns on the anterior portion of both arms and the anterior portion of his right leg. What percentage of his body is burned?

Treatment:

Answer 11

4.5 + 4.5 + 9 = 18%

1. remove burned clothing and jewelry
2. Cover burns with dry sterile non adherent dressings
3. High flow O2
4. Treat for shock (SOBER) / hypothermia
5. Rapid transport to burn center ER

Question 12

A patient fell off her bike, landing on her left arm. There is a large amount of swelling in her forearm, and there is no pulse distal to the injury. The patient states the pain is a 15/10 on the pain scale and increases with movement. The S/S are most likely due to what condition?

Answer 12

Compartment syndrome

Question 13

A 30-year-old patient is bleeding from a laceration to the lower leg. You are unable to control the bleeding with direct pressure and the patient is now showing signs of AMS. Your next action should be:

Answer 13

Apply a tourniquet above the wound and use a hemostatic dressing to cover

Treat for shock (SOBER)

Rapid transport to ER

Question 14

In addition to external bleeding, the MOST significant risk of an open soft tissue injury is:

Answer 14

Infection

Question 15

What are the two most important factors in determining the severity of a burn?

Answer 15

Depth

Extent

Exposure time

(982)

Question 16

When assessing the respiratory system of a burn patient you should look specifically for what?

Answer 16

Soot in the mouth
Soot in the nose
Singed hairs in the nose
Stridor

Question 17

You are treating a 37-year-old patient who has partial-thickness burns on the anterior portion of both arms and the anterior portion of his chest. What percentage of his body is burned? What is the best treatment for his injuries?

Answer 17

4.5 + 4.5 + 18 = 27%

Call for ALS
Remove jewelry and clothing
Apply sterile dry dressings to burns
Treatment for shock (SOBER)
Rapid transport to burn trauma center (ER)

Question 18

Which burn involves the outer layer of the skin and a portion of the dermal layer?

Answer 18

Partial thickness burn
(Second Degree)

Question 19

List three areas of the body where burns are considered critical burns.

Answer 19

Eyes
Upper airway
Hands
Feet
Genitalia

Question 20

Dressings and bandages have three primary functions, list them.

Answer 20

Protect wound from further damage
Stop or control bleeding
Prevent contamination

Question 21

What is the function of collagen in the healing process of a soft tissue injury?

Answer 21

Collagen is a tough, fibrous protein found in scar tissue, hair, bones and other connective tissues.

Provides the structural integrity necessary for the regrowth of tissues. (965)

Question 22

What is the most common symptom of internal bleeding?

Answer 22

Pain

(940)

Question 23

You are responding to a factory for a patient who has his arm stuck in a paper press. The power has been secured and the patient is conscious, he has been stuck in a machine for 5 hours. You recognize this situation as what condition?

In the scenario above list all treatment / management considerations for this patient?

Answer 23

1. Crushing syndrome
2. Request ALS support, IV fluid before moving, tourniquet (if needed), O2 via NRB, keep patient warm, rapid transport to trauma center
   (966)

Question 24

List two late signs of hypovolemic shock.

Answer 24

Decreasing blood pressure (<90)
Weak, rapid (thready) pulse
Dull eyes
Cold, moist clammy skin
Thirst
Tachycardia

(941)

Question 25

List three precautions that should be followed when applying a tourniquet to a patient.

Answer 25

Not applied over clothing
Not applied over joint
Not applied on the injury

If bleeding is not controlled with the first tourniquet, apply a second one adjacent to the first. (950)

Question 26

List early signs of hypovolemic shock:

Answer 26

Change in mental status: anxiety, restlessness or combative (First sign)
Pale skin
Faintness
Dizziness on standing (941)

Question 27

A patient was the victim of an assault; the scene is secure. The patient was struck with a pipe several times on the torso and left arm. The left forearm is rigid, swollen, and there is no radial pulse. The patient states the pain is a 10/10 on the pain scale and increases with movement. There S/S are most likely due to what condition?

Answer 27

Compartment syndrome
(966)

Question 28

A soft tissue injury affects the superficial layer of skin is referred to as a(n):

Answer 28

Abrasion

(ALAP)

(966)

Question 29

The victim of a house fire was pulled from the structure by firefighters and brought to the ambulance. List three signs that would indicate burns to their respiratory system?

Answer 29

1. Soot in mouth
2. Soot in nose
3. Singed nasal hairs
4. Stridor for burned lungs

Question 30

An open would in the abdominal cavity may expose internal organs, this type of injury is called a/an:

Treatment:

Answer 30

Evisceration

Do not touch organs
Cover wound with sterile moist gauze with saline solution, secure with occlusive dressing, keep warm, rapid transport to trauma center

(977)

Question 31

During your assessment of an altered 40-year old who was involved in a vehicle accident you find the following S/S: tachycardia, cold, moist skin, slightly dilated pupils that are slow to respond and the pulse is weak and rapid. What is the treatment for this patient?

Answer 31

Treat for shock (SOBER)

Rapid transport to trauma ER

Question 32

You are treating a 26 year old patient who has partial thickness burns on the anterior portion of both arms and the anterior portion of his right leg. What percentage of his body is burned?

Answer 32

4.5 + 4.5 + 9 = 18%

Treatment:
Remove burned clothing and jewelry
Cover burns with dry sterile non adherent dressings
High flow O2
Treat for shock (SOBER) / hypothermia
Rapid transport to burn center ER

Question 33

After applying a dressing to an arterial bleed, you notice that the dressing becomes saturated with blood. What should you do next?

Answer 33

Apply another dressing on top of the current dressing and continue to apply direct pressure

If bleeding continues apply a tourniquet