Chapter 30 | Soft-Tissue Trauma Flashcards
• Understanding closed wounds and emergency care for closed wounds • Understanding open wounds and emergency care for open wounds • Understanding burns and emergency care for burns • Understanding electrical injuries and emergency care for electrical injuries • How to dress and bandage wounds
List:
soft tissues of body
8 points
- skin
- fatty tissues
- muscles
- blood vessels
- glands
- nerves
- fibrous tissues
- membranes
Define:
contusion
bruise with pain, swelling, and/or discoloration at sight
Define:
hematoma
like a contusion with more tissue damage which involves larger blood vessels
Define:
dressing
any material applied to wound to control bleeding and prevent contamination
Define:
bandage
any material used to hold dressing in place
Define:
abrasion
open wound where your skin is scraped off
(i.e. carpet burn or road rash)
Define:
laceration
open wound that is wider than it is deep
Define:
puncture
open wound that is deeper than it is wide
Define:
avulsion
flappiness of skin
Define:
closed crush injury
excessive force transmitted from body’s exterior to its internal structures
often crushing or rupturing internal organs
Describe:
primary treatment for closed wounds
elevation and immobilization (using a splint) of affected limb or area
try to manage the bleeding
List:
primary treatments for open wounds
5 points
- direct pressure
- hemostatic agents
- elevation
- wound packing
- tourniquet use on extremeties
any way to control/stop the bleeding
Describe:
primary treatment for abrasions and lacerations
hold direct pressure to control bleeding
Fill in the blank:
You [SHOULD/SHOULDN’T] open the edges of a laceration to see inside or further clean the wound.
You should never ever open the edges of a laceration to see inside or further clean the wound.
Fill in the blank:
To treat puncture wound with an object that is still impaled, you [SHOULD/SHOULDN’T] remove the impaled object.
you should not remove the impaled object.
Define:
degloving
skin removal like taking off a glove
Describe:
primary consideration when treating an avulsion
after cleaning wound, fold skin back in place if possible (to prevent hypoperfusion to tissue)
control bleeding and dress with bulky dressings
Define:
amputation
traumatic severing of a body part (usually an extremity)
List:
components of treatment for amputations
3 points
apply pressure dressing over stump
bleeding will probably be excessive, so you may want to consider a tourniquet
properly store/transport aputated appendage with patient
Explain:
how to store an amputated body part
wrap amputated part in moist sterile dressing and place in plastic bag
put bag in pan/bag with water and cold packs
Define:
evisceration
protrusion of organs (like intestines) through an open wound
Fill in the blank,
In treating an evisceration, [DO/DON’T] touch or try to replace the exposed organ.
do not touch or try to replace the exposed organ.
List:
primary considerations when treating an evisceration
3 points
- do not touch organs (lest risk suffocating them)
- cover exposed organs and wound with moist sterile dressing
- flex the knees (to decrease tension on abdomen)
List:
primary consideration when treating for impaled objects
stabilize and do not remove impaled object
Fill in the blank:
For an impaled object in the cheek, take care that object does not enter oral cavity, causing [BLANK].
take care that object does not enter oral cavity, causing an airway obstruction.
Fill in the blank:
For an impaled object in the cheek, take care that object does not [BLANK], causing an airway obstruction.
take care that object does not enter the oral cavity, causing an airway obstruction.
Fill in the blank:
For an impaled object in the cheek, profuse bleeding into mouth and throat can cause [BLANK].
(besides an airway obstruction 🙄)
profuse bleeding into mouth and throat can cause nausea and vomiting.
Fill in the blank:
For an impaled object in the cheek, [BLANK] can cause nausea and vomiting.
profuse bleeding into mouth and throat can cause nausea and vomiting.
Fill in the blank:
For an impaled object in the cheek, external wound care [WILL/WON’T] stop the flow of blood into the mouth.
external wound care will not stop the flow of blood into the mouth.
Fill in the blank:
If you find the perforation in the cheek and can see both ends of the impaled object, you [SHOULD/SHOULDN’T] remove the object.
you should remove the object.
usually never remove an object, but seeing both ends through cheek is basically only exception
Fill in the blank:
If respiratory structures are affected by burns, [BLANK] may occur, causing a life-threatening obstruction.
swelling may occur, causing a life-threatening obstruction.
Fill in the blank:
[DO/DON’T] let burn distract from spinal damage or fractures.
Do not let burn distract from spinal damage or fractures.
Fill in the blank:
For patients with abrasions or lacerations on their limbs, always be sure to check [BLANK].
For patients with abrasions or lacerations on their limbs, always be sure to check PMS.
pulse, motor, sensory
Fill in the blank:
Soft tissue injuries often appear [WORSE/BETTER] than they are.
Soft tissue injuries often appear worse than they are.
List:
types of closed wounds
3 points
- contusion
- hematoma
- closed crush injury
Answer:
In the treatment of an open wound, at what point would you bandage dressings in place?
after bleeding is controlled
Fill in the blank:
Crush injuries can also be open if [BLANK].
Crush injuries can also be open if bones are fractured (as result of heavy force) and those bone ends break the skin.
Fill in the blank:
Blast injuries may cause [OPEN/CLOSED] wounds.
Blast injuries may cause both open and closed wounds.
Answer:
In treating a patient with an impaled object in their eye, why would you cover their other (uninjured) eye?
eyes work together and injured eye will move with impaled object in it
this could severely impact wound when attempting to stablilize impaled object
List:
primary treatments for impaled object in eye
3 points (plus 1 bonus)
- stabilize object in place
- cover the other (uninjured) eye
- secure double-eye bandages in place
(also reassure the patient)
Fill in the blank:
Burns [COULD/COULDN’T] involve more than just skin-level structures.
Burns could involve more than just skin-level structures.
List:
considerations during assessment of burn injuries
3 points
- agent and source
- depth
- severity
List:
possible depth classifications of burns
(you should know the number)
- 1ˢᵗ degree: superficial
- 2ⁿᵈ degree: partial
- 3ʳᵈ degree: full
Define:
1ˢᵗ degree burn
burn which involves only the epidermis
(presents as reddening with minor swelling)
Describe:
appearance of 1ˢᵗ degree burn
reddening with minor swelling
(superficial burn)
Define:
2ⁿᵈ degree burn
burn in which epidermis is burned through and dermis is damaged
Describe:
appearance of 2ⁿᵈ degree burn
blisters and mottling
(partial thickness burn)
Define:
3ʳᵈ degree burn
burn in which all layers of skin are burned
(full thickness burn)
Describe:
appearance of 3ʳᵈ degree burn
blackened areas surrounded by dry/white patches
Define:
rule of nines
memorization device used to remember that most body segments cover approximately 9% of total body surface area
(chest, upper back, arms, abdomen, upper leg, lower leg)
Explain:
palmar method of determining burn severity
palm of hand is equivalent to approximately 1% of total body surface area
(calculate accordingly)
Fill in the blank:
A “minor” burn area in a young adult [CAN/CAN’T] be fatal to a geriatric adult.
A “minor” burn area in a young adult can be fatal to a geriatric adult.
Fill in the blank:
Infants and children have a much [GREATER/LOWER] relationship of body surface area to total body size, resulting in [GREATER/LOWER] fluid and heat loss from burned skin.
Infants and children have a much greater relationship of body surface area to total body size, resulting in greater fluid and heat loss from burned skin.
more surface area for less mass — so skin’s job of insulation is harder
Fill in the blank:
Infants and children have a much greater relationship of body surface area to total body size, resulting in greater [BLANK] from burned skin.
Infants and children have a much greater relationship of body surface area to total body size, resulting in greater fluid and heat loss from burned skin.
True or false:
Thermal burns are caused by flame, radiation, excessive heat from fire, steam, hot liquids, and hot objects.
true
True or false:
Thermal burns are caused by various acids,
bases, and caustic substances.
false
True or false:
Chemical burns are caused by various acids, bases, and caustic substances.
true
True or false:
Chemical burns are caused by flame, radiation, excessive heat from fire, steam, hot liquids, and hot objects.
false
Fill in the blank:
In treating thermal burns, you [SHOULD/SHOULDN’T] use dry, sterile dressings.
In treating thermal burns, you should use dry, sterile dressings.
Fill in the blank:
In treating thermal burns, you [SHOULD/SHOULDN’T] consider applying an ointment, spray, or butter.
In treating thermal burns, you should never consider applying an ointment, spray, or butter.
nothing excess on site of burn
FIll in the blank:
In treating thermal burns, you [SHOULD/SHOULDN’T] break open blisters.
In treating thermal burns, you should not break open blisters.
blister keeps fluid on tissue for protection and healing
Fill in the blank:
In treating chemical burns, you [SHOULD/SHOULDN’T] keep the site dry.
you should not keep the site dry.
chemical burns require flushing with copious amounts of water
Fill in the blank:
In treating chemical burns, you [SHOULD/SHOULDN’T] wash the site with copious amounts of flowing water.
you should wash the site with copious amounts of flowing water.
Fill in the blank:
In treating dry chemical burns, you should [BLANK] before you flush the site with water.
In treating dry chemical burns, you should brush away powder before you flush the site with water.
True or false:
Electrical injuries may cause severe damage through body by disrupting nerve pathways.
true
True or false:
Electrical injuries may cause entry/exit burns at point of contact.
true
True or false:
Electrical injuries may cause respiratory or cardiac arrest.
true
True or false:
It is possible for bones to fracture from electrical injuries.
true
bones may fracture from violent muscle contractions
True or false:
Bones cannot fracture as a result of electrical injuries.
false
bones may fracture from violent muscle contractions
Fill in the blank:
A hematoma is similar to a contusion, except that hematomas [BLANK].
A hematoma is similar to a contusion except that hematomas involve a larger amount of tissue damage.
(including damage to larger blood vessels with greater blood loss)
Fill in the blank:
A hematoma is similar to a [BLANK], except that hematomas involve a larger amount of tissue damage.
A hematoma is similar to a contusion except that hematomas involve a larger amount of tissue damage.
Fill in the blank:
A [BLANK] is similar to a contusion, except that contusions involve a smaller amount of tissue damage.
A hematoma is similar to a contusion except that contusions involve a smaller amount of tissue damage.
Choose:
Which of the following is the most reliable identifier for crush injuries?
A. Finding of bleeding from the nose or ears
B. Swelling or deformity
C. Mechanism of injury
D. Palpation of the wound
C
crush injuries may be difficult or impossible to identify during assessment (so you must rely on the MOI)
patients with a significant MOI should be considered to have internal bleeding and shock until they are ruled out in the emergency department
Choose:
Your 24-year-old patient was riding an ATV through the woods and impaled herself on a dead tree branch. The one-inch diameter branch went in through her mouth and out her right cheek before breaking from the tree. You can see both ends of the penetrating branch. On your arrival, the patient is bleeding heavily into her mouth and is struggling to breathe unless she is leaning forward.
To gain control of the patient’s bleeding and thereby her airway, you should:
A. sacrifice spinal immobilization and transport the patient in a sitting position, leaning forward.
B. insert a nasopharyngeal airway.
C. pack the patient’s mouth full of gauze and tell her to breathe through her nose.
D. attempt to remove the object.
D
you may remove an object that is impaled in the cheek if you find perforation and you can see both ends of the object
pull it out in the direction it entered the cheek (or leave in place if not possible)
Choose:
To stabilize an object impaled in an eye, you should:
A. place a roll of 3-inch gauze bandage or folded 4x4s on either side of the object, along the vertical axis of the head, in a manner that will stabilize the object.
B. place a paper cup over the impaled object and secure in place with a self-adherent roller bandage.
C. snap off as much of the object as you can and then seal the eye with an occlusive dressing before bandaging it with a self-adherent roller bandage.
D. wrap a roll of 3-inch gauze bandage around the entirety of the patient’s head along the horizontal axis, covering the eyes.
A
Choose:
The emotional and psychological damage from burn injuries:
A. usually occurs only with the most severe injuries.
B. begins at the emergency scene.
C. typically is not long-lasting.
D. is not a concern for EMTs.
B
in addition to phyical burn damage, patients often suffer emotional and psychological problems that begin at emergency scene and may last lifetime
Choose:
Singed nasal hairs in a burned patient are an ominous sign because:
A. the smell can be overpowering.
B. they are very painful.
C. they could indicate airway damage.
D. they make it difficult to administer oxygen.
C
True or false:
A first-degree burn is the most serious and the deepest.
false
first-degree burn is the lighest and most superficial
True or false:
A second-degree burn is the most serious and the deepest.
false
second-degree burns are in between first- and third-degree burns
True or false:
A third-degree burn is the most serious and the deepest.
true
True or false:
A second-degree burn is characterized by red, dry, smooth skin.
false
1st degree has those symptoms; 2nd degree has blisters and peeling skin
True or false:
A superficial burn is also called a second-degree burn.
false
superficial burn would be first-degree burn
True or false:
A full-thickness burn is also known as a third-degree burn.
true
True or false:
A full-thickness burn is also known as a first-degree burn.
false
full thickness burn would be third-degree burn
True or false:
For a partial-thickness burn, the formation of blisters is common.
true
True or false:
Partial-thickness burns are not very painful, because of the nerve ending damage.
false
the skin is not fully cooked through
True or false:
A partial-thickness burn involves only the epidermis.
false
burns through epidermis and damages dermis
True or false:
The damaged skin of a partial-thickness burn is called eschar.
false
eschar is dead tissue found in a full-thickness burn
True or false:
The damaged skin of a full-thickness burn is called [BLANK].
The damaged skin of a full-thickness burn is called eschar.
Choose:
Your patient was involved in a serious industrial accident, and sustained critical electrical burns to both his hands when he accidentally grabbed a live wire. Despite the severity of his burns, the patient says he doesn’t feel that bad.
This patient will need to:
A. have his wounds flushed with hot, sterilized water immediately.
B. be administered bag-valve-mask ventilations.
C. be transported as soon as possible.
D. have his wounds wrapped loosely in sterile bandages with no dressings.
C
transport ASAP
some problems with electrical injuries have a slow onset — but heart problems may develop in any case of electrical shock
there also may be more serious hidden problems if there are burns
other treatments are inappropriate, and this patient should be administered high-concentration oxygen but should not be administered bag-valve-mask ventilations (because there are no signs of inadequate breathing)
Choose:
After treating an actively bleeding head laceration with a sterile dressing and bandage, you notice that the dressing has become blood-soaked and that blood is seeping through the bandage.
You should:
A. remove the blood-soaked dressing and replace it with new, sterile dressing.
B. reapply pressure and place additional sterile dressings over the blood-soaked dressing.
C. apply direct pressure to the patient’s neck with both hands.
D. remove the bandage and reposition the dressing, being sure to rewrap it tightly.
B
do not remove dressings
Once a dressing has been applied to a wound, it must remain in place. Bleeding may restart and tissues at the wound site may be injured if the dressing is removed. If the bleeding continues, reapply pressure, apply additional hemostatic agent, and put new dressings over the blood-soaked one.
Choose:
A patient who was injured by lightning is awake on your arrival but is not able to hear what you are saying. He can talk, and is frightened because he does not know what happened. The patient was in a picnic area at a park and was thrown several feet to the ground when the lightning struck near him.
Which of the following steps has the highest priority in this patient’s assessment and treatment?
A. Care for spine injuries, head injuries, and severe fractures.
B. Transport as soon as possible.
C. Evaluate the electrical burns.
D. Apply sterile dressings to the burn sites.
A
Choose:
You are called to the scene of a patient who was burned by an electrical shock while installing a washing machine. On your arrival, the patient is lying beside the washing machine on which he was working.
What is your first consideration for this patient?
A. Place an AED on the patient.
B. Assume the source of electricity is still active.
C. Establish baseline vital signs on the patient.
D. Establish an airway, because he may have suffered burns to the mouth.
B
Choose:
You are caring for a 15-year-old female who has sustained a laceration to her lower arm. It is spurting bright red blood uncontrollably.
What personal protective equipment would be most preferred in managing this wound?
A. Gloves and a gown
B. Gloves and a face shield
C. Gown and mask
D. Gloves only
B
Choose:
For a young child with isolated genital injuries, you should:
A. consider the possibility of abuse, and treat the child with sensitivity.
B. withhold care until law enforcement arrives.
C. avoid questioning the child about the cause of the injuries, so as not to embarrass the child.
D. challenge the parents directly about the possibility of child abuse.
A
Choose:
You are called to the scene of a metal fabrication plant, where you are presented with a 30-year-old male patient complaining of bilateral severe eye pain. Upon examination, you notice both eyes are red and irritated. Patient states that one of the dyes he was working with splashed into his eyes.
How would you manage this patient’s injury?
A. Cover both eyes with a moist, sterile dressing.
B. Irrigate both eyes with copious amounts of water for at least 20 minutes or until you arrive at the medical facility.
C. Cover both eyes with dry, sterile dressing and transport immediately to the nearest appropriate facility.
D. Neutralize the acid immediately with vinegar or baking soda.
B
Choose:
You are performing a secondary assessment on your 19-year-old trauma patient with a severely bruised trunk and signs of damage to the ribs and sternum. He is coughing up frothy red blood and having difficulty breathing.
What injury do these signs point to?
A. Injury to abdominal organs
B. A punctured lung
C. Damage to the cervical spine
D. Damage to the brain
B
Choose:
How does the skin provide temperature regulation?
A. By increasing or decreasing the metabolism within the skin structures
B. By altering the blood flow to the skin and by controlling perspiration
C. By opening temperature pores in the skin
D. By thickening or thinning the layers of the skin
B
True or false:
The rule of nines assigns:
- 9 percent to the head and neck, each upper extremity, the chest, the abdomen, the upper back, and the lower back and buttocks
- 8 percent to the front of each lower extremity
- 10 percent for the back of each lower extremity
- 1 percent to the genital region
false
The rule of nines assigns:
- 9 percent to the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks
- 18 percent to each lower extremity
- 1 percent to the genital region
True or false:
The rule of nines assigns:
- 9 percent to the head and neck, as well as each upper extremity
- 10 percent to the chest, the abdomen, and the upper back
- 8 percent to the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity
- 1 percent to the genital region
false
The rule of nines assigns:
- 9 percent to the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks
- 18 percent to each lower extremity
- 1 percent to the genital region
True or false:
The rule of nines assigns:
- 9 percent to the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks
- 18 percent to each lower extremity
- 1 percent to the genital region
true
True or false:
The rule of nines assigns:
- 9 percent to the head and neck
- 6 percent to each upper extremity
- 12 percent to the chest and abdomen
- 9 percent to the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity
- 1 percent to the genital region
false
The rule of nines assigns:
- 9 percent to the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks
- 18 percent to each lower extremity
- 1 percent to the genital region
Choose:
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?
A. Call the parents and see what they want you to do.
B. Remove the object and put a bandage on the outside of the cheek.
C. Let the child carefully pull the object out.
D. Stabilize the object, but do not try to remove it.
D
you can only remove impaled object from cheek if you can see both ends
greatest concern is puncture of palate — but airway seems patent for now
Choose:
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?
A. The palm of the patient’s hand equals 9% of the body’s surface area.
B. The palm of your hand represents 1% of the body’s surface area.
C. The palm of the patient’s hand equals about 1% of the body’s surface area.
D. You can only use the rule of palm for children, so you would use the rule of nines instead.
C
Choose:
Which of the following treatments in a burn patient is most likely to cause further injury as opposed to treating the initial burn?
A. Ice packs on the burned area
B. Clean, dry, sterile dressings
C. Aggressive IV fluid administration
D. Antibiotic creams over the burn area
A
Burn injuries are treated in the field with clean dressings and IV fluids. In the hospital setting, this may include antibiotic creams.
Ice packs are potentially harmful as burned areas have damaged nerves and capillaries which makes protecting the skin from extreme cold and detecting excessive cold difficult. This can potentially result in a second “cold burn” or frostbite in the thermally/chemically burned area.
Antibiotic creams should not be used in the EMS setting as they make an assessment of the burn difficult and may not be applicable for certain types of burns, but they are unlikely to directly harm the patient.
Choose:
The “rule of 9s” is used as a memory aid in assessing what?
A. Percentage of body burned
B. Type of burn injury
C. Degree of burn injury
D. Survival potential
A
Choose:
Which of the following best fits into the category of a “superficial burn?”
A. A baker who experienced blistering after touching a hot pan
B. A beach goer with erythematous and painful skin
C. An elderly patient with erythema and blisters after spilling boiling water
D. A house fire victim with black charring of the skin
B
The depth of a burn is what most people associate with its “degree.” A superficial burn (or “first degree burn”) is defined by pain, erythema, and the absence of “bullae” (or blisters).
A sunburn is the classic example of a superficial burn, although a serious sunburn can sometimes be 2nd degree if severe enough for blisters to erupt.
Define:
erythema
superficial reddening of the skin (usually in patches) as a result of injury/irritation causing dilatation of the blood capillaries
Choose:
Your patient is a 50-year-old male with a gunshot wound to the abdomen. Which of the following does not have a bearing on the MOI analysis?
A. The type of fire arm used
B. The distance the shooter was from the patient
C. The type of ammunition used
D. Whether the shooter was right or left handed
D
Choose:
You are called by law enforcement to a local bar for an assault. On arrival, you find an adult male face down with a stab wound to his mid back about 4 inches left of his spine. He is conscious and alert but is increasingly dyspneic. There is bubbling around the wound, leading you to suspect a sucking chest wound.
If so, what should be your first concern?
A. To control his airway
B. To apply wet gauze to the wound
C. To apply O2 and transport rapidly
D. To prevent air/debris from entering the wound
D
The first concern with a sucking chest wound is to prevent the further entry of air or debris into the wound. This is accomplished by applying an occlusive dressing and sealing 3 sides of the bandage to prevent air from entering the wound. Apply this dressing quickly then progress with the remainder of your ABC’s.
