38 Bleeding and Soft Tissue Trauma

Question 1

Which layer of the skin acts as a protective barrier against bacterial infection and helps maintain fluid balance?
A.
Dermis
C.
Stratum corneum
B.
Epidermis
D.
Stratum granulosum

Answer 1

A

Question 2

The outermost layer of the epidermis, composed of about 20 layers of dead skin cells, is the stratum \_\_\_\_\_.
A.
Spinosum
C.
Lucidum
B.
Granulosum
D.
Corneum

Answer 2

D

Question 3

The body’s response to surface trauma includes vasoconstriction, coagulation, and the growth of tissue to close and seal the wound. What is the broad term for this initial response called?
A.
Hemostasis
C.
Epithelialization
B.
Coagulopathy
D.
Neovascularization

Answer 3

A

Question 4

What characteristic best represents vasoconstriction secondary to injury?
A.
Slow but effective long-term response to trauma
B.
Rapid but temporary response to trauma
C.
Temporary measure that begins once a clot is formed
D.
Effective long-term measure to slow bleeding from injured vessels

Answer 4

B

Question 5

What is the role of thrombin in clot formation?
A.
Activate the platelets, causing them to adhere to one another
B.
Stimulate the release of prothrombin activators
C.
Cause the conversion of platelets to prothrombin
D.
Convert fibrogen into fibrin threads to help form a blood clot

Answer 5

D

Question 6

After an injury, how is blood flow to the injured area affected?
A.
Decreases to promote hemostasis
B.
Increases, causing further damage to already injured tissue
C.
Increases to meet the increased metabolic demands of injured tissue
D.
Decreases, causing hypoxic damage to the injured tissue

Answer 6

C

Question 7

During the healing process of an open wound, what structures prepare the wound for healing by clearing foreign bodies and dead tissues?
A.
Platelets
C.
Macrophages
B.
Erythrocytes
D.
Epithelial cells

Answer 7

C

Question 8

What is one difference between a hematoma and a contusion?
A.
A hematoma results in bruising, but contusions do not.
B.
A hematoma is an open injury; a contusion is a closed injury.
C.
A hematoma is a more severe injury and may result in greater blood loss than a contusion.
D.
A hematoma occurs when organs are damaged; a contusion occurs when muscle tissue is damaged.

Answer 8

C

Question 9

Abrasions are typically:
A.
Minor injuries with a low risk for infection
B.
Painful injuries with a high risk for infection
C.
Injuries that are closed with sutures and that have a high risk for infection
D.
Injuries that are sealed with an occlusive dressing and have a low risk for infection

Answer 9

B

Question 10

A 37-year-old female was “shot” with a high-pressure nozzle of dry-cleaning fluid. Which statement is correct regarding this injury?
A.
Definitive care to resolve this situation can be rendered in the field.
B.
Definitive care is typically amputation of the affected limb.
C.
There is a high risk of compartment syndrome after this type of trauma.
D.
Immediate subcutaneous administration of 0.01 mg/kg epinephrine (1:1000) at or near the trauma site increases the odds of saving the affected limb.

Answer 10

C

Question 11

How is compartment syndrome best defined?
A.
Disseminated intravascular coagulopathy (DIC)
B.
Fluid shunting following the complete transection of a major artery or vein
C.
Tissue pressure rising above perfusion pressure, resulting in ischemia to the muscle
D.
Blood leaking into the interstitial tissues, which results in a relative hypovolemia

Answer 11

C

Question 12

What mnemonic is used to recall the signs and symptoms of a major crush injury?
A.
The 5 Ps
C.
AEIOU-TIPS
B.
OPQRST
D.
DCAP-BLS

Answer 12

A

Question 13

Which is a typical finding in a patient with compartment syndrome?
A.
Pain seemingly out of proportion to the injury
B.
Spasticity of the involved muscle groups
C.
No pain associated with passive stretching
D.
Lack of tenderness to palpation

Answer 13

A

Question 14

With what is compartment syndrome most commonly associated?
A.
Tibia fracture
C.
Forearm fracture
B.
Femur fracture
D.
Humerus fracture

Answer 14

A

Question 15

What is the early physiological response to hemorrhage, including vasoconstriction, formation of a platelet plug, and coagulation, called?
A.
Status tissue coagulation
C.
Hemostasis
B.
Hemoptysis
D.
Peripheral vascular orthostasis

Answer 15

C

Question 16

What are black, “tarry” stools called?
A.
Hematochezia
C.
Melena
B.
Hematemesis
D.
Hemoptysis

Answer 16

C

Question 17

Serious internal hemorrhage generally occurs in the chest cavity, abdominal cavity, pelvic cavity, and what other area?
A.
Thoracic cavity
C.
Gastrointestinal space
B.
Peritoneal cavity
D.
Retroperitoneal cavity

Answer 17

D

Question 18

A 3-year-old has a bruise to his right eye. The day-care provider is concerned that this child may have been abused. She states that, although the child “bonked” his right eye on a chair 2 days earlier, he did not have the bruise yesterday, and his father was unable to produce “a suitable explanation” of the current presentation. Which statement is true regarding this child’s contusion and subsequent bruising?
A.
Bruising always occurs within 1 to 2 hours of the original injury.
B.
Bruising always occurs within 24 hours of the original injury.
C.
Bruising may be delayed by as much as 48 hours after an injury.
D.
Bruising would result only if underlying skeletal structures have been fractured.

Answer 18

C

Question 19

A 38-year-old female has fallen onto a pitchfork. The tines of the pitchfork have left a 9-inch-long, full-thickness wound to her right leg. The wound runs laterally from just below the knee to mid-thigh.

On close inspection, paramedics discover that the wound appears to have smooth edges and no tissue flaps. With what is the description of this wound consistent?
A.
Avulsion
C.
Hematoma
B.
Puncture
D.
Incision or laceration

Answer 19

D

Question 20

A 38-year-old female has fallen onto a pitchfork. The tines of the pitchfork have left a 9-inch-long, full-thickness wound to her right leg. The wound runs laterally from just below the knee to mid-thigh.

A large vessel appears to have been severed because the wound has dark-red blood flowing from it. What is the initial treatment for this injury?
A.
A venous tourniquet
B.
An arterial tourniquet
C.
Direct pressure over the wound
D.
Pressure to the proximal artery supplying the wound

Answer 20

C

Question 21

A 38-year-old female has fallen onto a pitchfork. The tines of the pitchfork have left a 9-inch-long, full-thickness wound to her right leg. The wound runs laterally from just below the knee to mid-thigh.

To further reduce bleeding, what should the paramedic implement next?
A.
Apply a splint to the extremity.
B.
Massage the wound with a proximal-to-distal motion.
C.
Elevate the wound above the level of the patient’s heart.
D.
Apply a sterile dressing moistened with cold saline solution.

Answer 21

A

Question 22

A 38-year-old female has fallen onto a pitchfork. The tines of the pitchfork have left a 9-inch-long, full-thickness wound to her right leg. The wound runs laterally from just below the knee to mid-thigh.

During the subsequent healing process, where should the paramedic anticipate hypertrophic scar formation?
A.
Distal end of the injury
C.
Proximal end of the injury
B.
Knee joint
D.
Point closest to the severed vessel

Answer 22

B

Question 23

Which of the following treatments should not be used for severe hyperkalemia secondary to crush injuries?
A.
Calcium chloride
C.
Insulin and dextrose
B.
Mannitol
D.
Potassium chloride

Answer 23

D

Question 24

Paramedics are dispatched to the site of a building collapse. On your arrival, first-responder personnel state that a 56-year-old female is trapped on the first floor of a three-story warehouse complex. According to the first-responders, there are “tons of building material compressing her stomach and legs.” Extrication is going to be a long and arduous process.

Which statement is true regarding this patient’s situation?
A.
Hydration with IV fluids should be avoided at all costs because it may contribute to uncontrollable hemorrhage.
B.
Once released from entrapment, this patient may rapidly deteriorate because of the release of myoglobin from damaged cells.
C.
Oxygen should be delivered judiciously via a nasal cannula because a patient like this typically depends on a hypoxic drive for respiratory stimulus.
D.
Long-term survival is closely tied to the speed at which you are able to lower the patient’s core body temperature, thus decreasing metabolism.

Answer 24

B

Question 25

Paramedics are dispatched to the site of a building collapse. On your arrival, first-responder personnel state that a 56-year-old female is trapped on the first floor of a three-story warehouse complex. According to the first-responders, there are “tons of building material compressing her stomach and legs.” Extrication is going to be a long and arduous process.

In contacting medical direction for advice on treating this patient, paramedics can anticipate that medical direction may order what treatment? A. Administer intravenous sodium bicarbonate B. Apply venous tourniquets and surgically extricate (amputate) the patient from entrapment C. Administer intravenous fluid boluses of 20 mL/kg of chilled normal saline or lactated Ringer’s solution D. Transport the patient, once freed, in the Trendelenburg’s position to slow the return of metabolic waste products to the core

Answer 25

A

Question 26

Paramedics are dispatched to the site of a building collapse. On your arrival, first-responder personnel state that a 56-year-old female is trapped on the first floor of a three-story warehouse complex. According to the first-responders, there are “tons of building material compressing her stomach and legs.” Extrication is going to be a long and arduous process.

This rare, often catastrophic, event known as crush syndrome is typically characterized by what findings?
A.
An abnormally high metabolism that requires continual administration of intravenous glucose
B.
A stable presentation for hours or even days as long as the compressive force remains constant
C.
An unstable presentation that immediately stabilizes as soon as the patient is freed from entrapment
D.
Profound hypotension during entrapment that rapidly progresses to a hypertensive crisis once the patient is freed from entrapment

Answer 26

B

Question 27

A 43-year-old male injured his forearm while removing a tire. The patient is conscious and alert and tells you that he cut his left forearm with a pry bar. On inspection, paramedics observe a 2-inch-long, partial-thickness avulsion. Bleeding is moderate with approximately 20 mL of blood loss.

After applying direct pressure, how long should paramedics anticipate that a clot will form at the end of any severed vessels?
A.
After approximately 4 to 6 minutes
B.
After 20 to 30 minutes
C.
Within 1 to 2 hours
D.
Only after application of pressure at the brachial artery

Answer 27

A

Question 28

A 43-year-old male injured his forearm while removing a tire. The patient is conscious and alert and tells you that he cut his left forearm with a pry bar. On inspection, paramedics observe a 2-inch-long, partial-thickness avulsion. Bleeding is moderate with approximately 20 mL of blood loss.

En route to the hospital, paramedics observe that the wound continues to bleed, despite the best efforts of paramedics. If a tourniquet is unavailable, what artery should paramedics place pressure on?
A.
Subclavian artery
C.
Cephalic artery
B.
Brachial artery
D.
Radial artery

Answer 28

B

Question 29

A 43-year-old male injured his forearm while removing a tire. The patient is conscious and alert and tells you that he cut his left forearm with a pry bar. On inspection, paramedics observe a 2-inch-long, partial-thickness avulsion. Bleeding is moderate with approximately 20 mL of blood loss.

Should it become necessary to augment bleeding control by using a blood pressure cuff as a tourniquet, what should inflation of the cuff be aimed at?
A.
Never exceed a pressure greater than 50 mm Hg.
B.
Achieve a pressure slightly greater than arterial pressure.
C.
Achieve a pressure equal to one-half of the mean arterial pressure.
D.
Achieve a pressure equal to or slightly less than the diastolic blood pressure.

Answer 29

B

Question 30

What is the passage of red blood from the rectum called?
A.
Melena
C.
Sigmoidal anemia
B.
Hematochezia
D.
Hemoptysis

Answer 30

B

Question 31

If mechanisms of hemostasis fail, what is the result?
A.
Apnea
C.
Increased intracranial pressure
B.
Chest pain
D.
Hypotension

Answer 31

D

Question 32

A patient reports a kick to his lower leg from a horse 24 hours before. He called 911 because of tingling in his lower leg. His calf is ecchymotic and tender to the touch. He can walk but reports severe pain when paramedics flex or extend his foot. He does not wish transport to the hospital. What should paramedics tell this patient?
A.
Elevate the leg, apply ice, and contact his private physician if the pain continues.
B.
Make an appointment with his private physician to obtain a tetanus shot.
C.
Immediate ambulance transport to the ED is advisable.
D.
There is little risk of severe injury because he is able to walk.

Answer 32

C

Question 33

Paramedics have treated a small abrasion on a patient. What additional step should the paramedics undertake?
A.
Splint the extremity.
B.
Provide wound management care instructions.
C.
Give the patient supplies to redress the wound.
D.
Contact medical control for advice.

Answer 33

B

Question 34

What is a keloid?
A.
Wound that does not heal without surgical repair
B.
Excessive accumulation of scar tissue extending beyond the original wound borders
C.
Wound contaminated with organic material, requiring antibiotic therapy
D.
Excessive accumulation of scar tissue contained within the original wound borders

Answer 34

B

Question 35

Without proper care and follow-up, trauma patients with open wounds may contract a serious infection. What is a potentially fatal bacterial infection of the central nervous system called?
A.
HIV
C.
Pertussis
B.
Tetanus
D.
Diphtheria

Answer 35

B

Question 36

A 27-year-old woman fears that the laceration to her hand that had been sutured the day before is becoming infected. The woman’s hand is swollen and red. What should the paramedic advise her?
A.
These are normal findings in the first 3 days but should subside as the wound heals.
B.
Her hand is likely to be infected, and she should go to the emergency department immediately.
C.
She has probably contracted tetanus.
D.
She should call her doctor and request antibiotics.

Answer 36

A

Question 37

An elderly woman was bitten by a large dog. She reports hearing a “crack” when the dog bit her. Paramedics observe several small puncture wounds to her ankle with slow venous bleeding that is easily controlled with a gauze dressing. She walks with little difficulty. What advice should paramedics give her?
A.
Go to the ED if warmth, swelling, or purulent drainage develops.
B.
Go to the ED immediately for physician evaluation of the wounds.
C.
Make an appointment to see her PMD to obtain a tetanus booster.
D.
Dogs have clean mouths so there is little risk of infection.

Answer 37

B

Question 38

A 23-year-old male impaled himself on a metal gatepost while attempting to break into a residence. On arrival, paramedics observe that the patient is standing on a bench seat and has a -inch square rod impaled in his back just inferior to the right scapula. The rod exits the patient’s body just superior to the right clavicle and protrudes approximately 4 inches. The total length of the rod makes it impossible for the patient to fit into the ambulance with the rod intact.

To facilitate the transportation of this patient, how should paramedics proceed?
A.
Cut the rod near the entry wound and stabilize it in place.
B.
Cut the rod at the entry wound and pass it through in the original direction of travel.
C.
Cut the rod at the entry wound and pass it through in the reverse direction of travel.
D.
Do not cut the rod; lift the patient off of the rod, and control bleeding with direct pressure.

Answer 38

A

Question 39

A 23-year-old male impaled himself on a metal gatepost while attempting to break into a residence. On arrival, paramedics observe that the patient is standing on a bench seat and has a -inch square rod impaled in his back just inferior to the right scapula. The rod exits the patient’s body just superior to the right clavicle and protrudes approximately 4 inches. The total length of the rod makes it impossible for the patient to fit into the ambulance with the rod intact.

When dressing and bandaging a penetrating chest or abdominal wound, what type of dressing should be applied first at the wound site?
A.
Sterile bulky dressing
C.
Sterile nonocclusive dressing
B.
Sterile occlusive dressing
D.
Sterile, saline-moistened dressing

Answer 39

B

Question 40

A 34-year-old male has been injured by a combine. On arriving at the scene, paramedics observe that the patient has freed himself from entanglement. His left arm is still in the machine (completely amputated), and his right arm is torn and twisted (partial amputation).

Once the combine has been secured, paramedics retrieve the amputated left arm from the machine. How should the paramedic proceed?
A.
Place the arm in a biohazard bag for proper disposal.
B.
Place the arm in a bag of ice and transport it with the patient.
C.
Wrap the arm in moistened gauze, place it in a bag, and keep it cool during transport.
D.
Place the arm back into its anatomical position, wrap it with moistened gauze, immobilize the entire extremity, and transport.

Answer 40

C

Question 41

A 34-year-old male has been injured by a combine. On arriving at the scene, paramedics observe that the patient has freed himself from entanglement. His left arm is still in the machine (completely amputated), and his right arm is torn and twisted (partial amputation).

While inspecting the right arm, paramedics observe large flaps of tissue hanging from open, gaping wounds. What does proper treatment include?
A.
Cleaning the wound with rubbing alcohol
B.
Gently folding the tissue back into its anatomical position
C.
Placing an occlusive dressing between the tissue and its anatomical position, then wrapping with sterile gauze
D.
Leaving the wound exactly as found and controlling bleeding primarily by indirect pressure

Answer 41

B

Question 42

A 34-year-old male has been injured by a combine. On arriving at the scene, paramedics observe that the patient has freed himself from entanglement. His left arm is still in the machine (completely amputated), and his right arm is torn and twisted (partial amputation).

At this point, what should paramedics implement?
A.
Maintain direct pressure.
B.
Replace the original dressing with an occlusive dressing and continue direct pressure.
C.
Release direct pressure, locate the nearest proximal artery, and perform indirect pressure.
D.
Maintain direct pressure and apply a venous tourniquet.

Answer 42

A

Question 43

A 34-year-old male has been injured by a combine. On arriving at the scene, paramedics observe that the patient has freed himself from entanglement. His left arm is still in the machine (completely amputated), and his right arm is torn and twisted (partial amputation).

During the management of this patient, paramedics decide to apply pressure-point control. How should the paramedics proceed?
A.
Pressure-point control is not recommended.
B.
Alternated with direct pressure at the bleeding site
C.
Released every 2 to 4 minutes to allow for distal circulation
D.
Performed until the patient can be fitted with an appropriate tourniquet

Answer 43

A