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Emergency Medical Technician > Soft-Tissue Injuries > Flashcards

Soft-Tissue Injuries Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

Injuries that result from sudden or extreme changes in air pressure

A

Barotrauma

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2
Q

Death resulting from soft-tissue injury is often related to ___

A

Hemorrhage or infection

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3
Q

First line of defense against external forces and infection

A

Skin

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4
Q

Two principle layers of skin

A
  1. Epidermis
  2. Dermis
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5
Q

Tough external layer that forms a watertight covering for the body

A

Epidermis

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6
Q

Where new skin cells form at the base of the epidermis

A

Germinal layer

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7
Q

Deeper cells in the germinal layer contain ___

A

Pigment granules

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8
Q

Inner layer of the skin

A

Dermis

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9
Q

Lies below the germinal cells of the epidermis

A

Dermis

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10
Q

Contains the structures that give the skin its characteristic appearance: hair follicles, sweat glands, and sebaceous glands

A

Dermis

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11
Q

Produce sebum

A

Sebaceous glands

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12
Q

The oily material that waterproofs the skin and keeps it supple

A

Sebum

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13
Q

Sebum travels to the skin’s surface along the ___

A

Shaft of adjacent hair follicles

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14
Q

Small organs that produce hair

A

Hair follicles

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15
Q

Similar to skin, these membranes provide a protective barrier against bacterial invasion

A

Mucous membranes

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16
Q

Mucous membranes differ from skin in that they ___

A

Secrete a watery substance that lubricates the openings

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17
Q

Three types of soft-tissue injuries

A
  1. Closed injuries
  2. Open injuries
  3. Burns
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18
Q

Soft-tissue damage occurs beneath the skin or mucous membrane but the surface remains intact

A

Closed injuries

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19
Q

There is a break in the surface of the skin or mucous membrane, exposing deeper tissues to potential contamination

A

Open injuries

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20
Q

Soft-tissue damage occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation

A

Burns

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21
Q

Second stage of wound healing

A

Inflammation

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22
Q

Migrate to the wound area to combat pathogens that have invaded the exposed tissue

A

White blood cells

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23
Q

A type of white blood cell that destroys bacteria and other pathogens from the wound site

A

Lymphocytes

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24
Q

Release histamine as part of the body’s early response in the early stages of inflammation

A

Mast cells

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25
Q

Dilates blood vessels, increasing blood flow to the injured area and resulting in a reddened warm area immediately around the site

A

Histamine

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26
Q

Histamine makes capillaries more ___

A

Permeable

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27
Q

Inflammation ultimately leads to the ___

A

Removal of foreign material, damaged cellular parts, and invading microorganisms from the wound site

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28
Q

The third stage of wound healing

A

New skin grows in

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29
Q

The fourth stage of wound healing

A

New blood vessels form

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30
Q

Tough, fibrous protein found in scar tissue, hair, bones, and other connective tissues

A

Collagen

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31
Q

Last stage of wound healing

A

Collagen provides stability to the damaged tissue and joins wound borders

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32
Q

Closed soft-tissue injuries are characterized by ___

A

A history of blunt trauma, pain at the site of injury, swelling beneath the skin, and discoloration

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33
Q

Bruise

A

Contusion

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34
Q

An injury that causes bleeding beneath the skin but does not break the skin

A

Contusion

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35
Q

Occurs when a significant force is applied to the body

A

Crushing injury

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36
Q

Crush syndrome can develop if an area of the body is trapped for longer than ___ and ___

A
  1. 4 hours
  2. Arterial blood flow is compromised
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37
Q

The extent of a crushing injury depends on ___

A

How much force is applied and for how long

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38
Q

Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods

A

Crush syndrome

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39
Q

If a patient has been trapped with a crushing object for a prolonged period, ALS providers should ___

A

Administer IV fluid before freeing the patient

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40
Q

Crush syndrome can lead to ___

A

Cardiac arrest and renal failure

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41
Q

Develops what edema and swelling result in increased pressure within a closed soft-tissue compartment

A

Compartment syndrome

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42
Q

The presence of infections organisms or foreign bodies

A

Contamination

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43
Q

Four types of soft-tissue wounds

A
  1. Abrasions
  2. Lacerations
  3. Avulsions
  4. Penetrating wounds
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44
Q

A wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface

A

Abrasion

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45
Q

A jagged cut in the skin caused by a sharp object or blunt force that tears the tissue

A

Laceration

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46
Q

A sharp, smooth cut

A

Incision

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47
Q

Lacerations and incisions may appear ___ or ___

A
  1. Linear (regular)
  2. Stellate (irregular)
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48
Q

An injury that separates various layers of soft tissue so that they become either completely detached or hang as a flap

A

Avulsion

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49
Q

An avulsion is usually between the ___

A

Subcutaneous layer and fascia

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50
Q

What to do if an avulsion is hanging like a flap

A

Replace the flap in its original position as long as it is not visibly contaminated with dirt and/or other foreign materials

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51
Q

What to do if an avulsion has completely separated

A

Wrap the separated tissue in sterile gauze and take it with you to the ED

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52
Q

An injury in which part of the body is completely severed

A

Amputation

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53
Q

An injury resulting from a piercing object

A

Penetrating wound

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54
Q

Objects that penetrate the skin but remain in place

A

Impaled objects

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55
Q

Treat all penetrating wounds of the neck, chest, back, and upper abdomen with an ___

A

Occlusive dressing

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56
Q

Anytime you observe bruising, swelling, or deformity, or the patient reports pain, the possibility of a ___ should be considered

A

Closed injury

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57
Q

Types of patients that need immediate transportation

A
  1. Poor initial general impression
  2. Altered level of consciousness
  3. Dyspnea
  4. Abnormal vital signs
  5. Shock
  6. Severe pain
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58
Q

Using ___ may provide some background on isolated extremity injuries

A

OPQRST

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59
Q

Extremities that are painful, swollen, or deformed should be ___

A

Splinted

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60
Q

If done correctly, splinting can assist with ___

A

Pain management and bleeding control

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61
Q

Small contusions generally do not require special emergency medical care, but you should ___

A

Note their presence when trying to determine the true extent of the patient’s injuries

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62
Q

Treat a closed soft-tissue injury by applying the mnemonic ___

A

RICES

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63
Q

RICES

A

Rest
Ice
Compression
Elevation
Splinting

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64
Q

All open wounds are assumed to be ___

A

Contaminated

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65
Q

To prevent an open wound from drying, you may ___

A

Apply sterile dressings moistened with sterile saline solution and then cover the moist dressing with a dry, sterile dressing

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66
Q

Organs protrude though the wound

A

Evisceration

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67
Q

How to care for evisceration

A

Cover the wound with sterile gauze moistened with sterile saline solution and secure it with an occlusive dressing

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68
Q

The only exceptions to the rule of not removing an impaled object

A

It is through the mouth or cheek and actively obstructs breathing or it is in the chest and directly interferes with performing CPR on a patient who is already in cardiac arrest

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69
Q

If enough air is sucked into a blood vessel, it can block the flow of blood into the lungs and cause cardiac arrest

A

Air embolism

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70
Q

To control bleeding and prevent the possibility of an air embolism with a neck injury ___

A
  1. Cover the wound with an occlusive dressing.
  2. Apply manual pressure (don’t compress both carotid vessels at the same time).
  3. Secure a pressure dressing over the wound by wrapping roller gauze loosely around the neck and then firmly through the opposite axilla
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71
Q

Removal of damaged tissue

A

Debridement

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72
Q

Small animal bites may require ___

A
  1. Debridement
  2. Antibiotics
  3. Tetanus prophylaxis
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73
Q

How to treat small animal bites

A

Place a dry, sterile dressing over the wound, and promptly transport to the ED

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74
Q

Emergency treatment of human bites

A
  1. Apply a dry, sterile dressing
  2. Promptly immobilize the area with a splint or bandage
  3. Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy
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75
Q

A severe burn injury presents several simultaneous life threats, including ___

A
  1. Hypovolemic shock
  2. Sepsis
  3. Hypothermia
  4. Respiratory failure
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76
Q

Occurs when the body receives more radiant energy than it can absorb

A

Burn

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77
Q

Thermal burns can occur when the skin is exposed to temps higher than ___

A

111°F

78
Q

In general, the severity of a thermal injury directly correlates with ___

A

Temperature, concentration, or amount of heat energy possessed by the object and the duration of exposure

79
Q

Burns to the airway are of great importance because the ___

A

Loose mucosa in the hypopharynx can swell and result in complete airway obstruction

80
Q

Circumferential burns of an extremity can ___

A

Compromise breathing

81
Q

Circumferential burns of an extremity can lead to ___, resulting in ___

A
  1. Compartment syndrome
  2. Neurovascular compromise and irreversible damage if not appropriately treated
82
Q

TBSA

A

Total body surface area

83
Q

Burns of ___ will likely require IV fluid resuscitation

A

20% of TBSA or more

84
Q

Burns of ___ may be fatal without treatment

A

30% of TBSA or more

85
Q

Burns of ___ in older adults may be fatal without treatment

A

Less than 15% of TBSA

86
Q

Inhalation burn injury can ___ the risk of death from a burn injury

A

Double

87
Q

Five factors to determine the severity of a burn

A
  1. Depth of the burn
  2. Extent of the burn
  3. Any critical areas involved or circumferential burns
  4. Preexisting medical conditions or other injuries
  5. Younger than 5 or older than 55
88
Q

Critical burn areas

A
  1. Face
  2. Upper airway
  3. Hands
  4. Feet
  5. Genitalia
89
Q

Recommend transfer to a designated burn center for any patient with an acute burn with any of the following ___

A
  1. Partial-thickness burns of 20% TBSA or greater in patients 10 to 50 years old
  2. Partial-thickness burns of 10% TBSA or greater in children younger than 10 or adults older than 50
  3. Full-thickness burns of 5% TBSA or greater
  4. Partial or full-thickness burns to the hands, feet, genitalia, face, or major joints
  5. High-voltage electrical injuries
  6. Significant chemical burns
  7. Concomitant traumatic injury
  8. Inhalation injury
  9. Significant ongoing medical problems
  10. Special social/emotional or long-term rehabilitative support
90
Q

Severe burn in an adult classification criteria

A
  1. Full-thickness burns involving the hands, feet, face, genitalia, airway, or circumferential burns
  2. Full-thickness burns covering more than 5% TBSA in any patient
  3. Partial-thickness burns covering more than 20% TBSA (10 to 50 y/o) and 10% TBSA (younger than 10 and older than 50)
  4. Burns with concomitant traumatic injuries
  5. Burns to patients younger than 5 or older than 50 that would otherwise be classified as moderate
91
Q

Moderate burn in an adult classification criteria

A
  1. Full-thickness burns involving 2% to 10% TBSA (excluding hands, feet, face, genitalia, and upper airway)
  2. Partial-thickness burns covering 15% to 30% TBSA
  3. Superficial burns covering more than 50% TBSA
92
Q

Minor burn in an adult classification criteria

A
  1. Full-thickness burns covering less than 2% TBSA
  2. Partial-thickness burns covering less than 15% TBSA
  3. Superficial burns covering less than 50% TBSA
93
Q

When you are treating older adults, pediatric patients, or special needs patients with burns, it is important to be alert for the possibility of ___

A

Abuse

94
Q

Signs of abuse include ___

A
  1. Evidence of multiple injuries in various stages of healing
  2. Injuries that do not seem to correspond to the history provided by caregivers
  3. Burns associated with a suspicious history
95
Q

Burns that appear in a pattern are suspicious for ___

A

Intentional injuries

96
Q

Burns are first classified according to their ___

A

Depth

97
Q

Three types of burns

A
  1. Superficial (first degree)
  2. Partial-thickness (second degree)
  3. Full-thickness (third degree)
98
Q

Involves only the top layer of skin, the epidermis. The skin turns red but does not blister or burn through this top layer

A

Superficial burn

99
Q

Involve the epidermis and some portion of the dermis. Do not destroy the entire thickness of skin, nor is the subcutaneous tissue injured. Typically the skin is moist, mottled, and white to red. Blisters are present

A

Partial-thickness burn

100
Q

Extend through all skin layers and may involve the subcutaneous layers, muscle, bone, or internal organs

A

Full-thickness burn

101
Q

The burned area is dry and leathery and may appear white, dark brown, or even charred. Some may feel hard to the touch

A

Full-thickness burn

102
Q

Significant airway burns may be associated with ___

A

Singed hair in the nostrils, soot around the nose and mouth, hoarseness, and hypoxia

103
Q

Rule of palm

A

The area of the patient’s palm and fingers equals 1% of TBSA

104
Q

Rule of nines

A

Divides the body into sections, each of which is about 9% of TBSA

105
Q

When you calculate the extent of burn injury, include only ___

A

Partial-thickness and full-thickness burns

106
Q

Burns in infants and children of a similar size and severity to an adult is more serious because ___

A

They have more surface area relative to total body mass, which means greater fluid and heat loss. Children also do not tolerate burns as well as an adult does and are more likely to go into shock, experience hypothermia, and have airway difficulties

107
Q

Severe burn in a child or infant classification criteria

A
  1. Any full-thickness burn
  2. Partial-thickness burns covering more than 20% TBSA
108
Q

Moderate burn in a child or infant classification criteria

A

Partial-thickness burns covering 10% to 20% TBSA

109
Q

Minor burn in a child or infant classification criteria

A

Partial-thickness burns covering less than 10% TBSA

110
Q

Specific questions to ask a patient with a burn for the SAMPLE history

A
  1. Are you having any difficulty breathing?
  2. Are you having any difficulty swallowing?
  3. Are you having any pain?
111
Q

First responsibility in caring for a patient with a burn

A

Stop the burning process and prevent additional injury

112
Q

Do not keep the burned part submersed in water for more than ___

A

10 Minutes

113
Q

Large burn

A

Greater than 10% BSA

114
Q

Cover larger burns with ___

A

A dry, sterile, nonadherent dressing

115
Q

Caused by heat

A

Thermal burn

116
Q

Types of thermal burns

A
  1. Flame
  2. Scald
  3. Contact
  4. Steam
  5. Flash
117
Q

Upper airway damage is often associated with the inhalation of ___

A

Superheated gases

118
Q

Lower airway damage is often associated with the inhalation of ___

A

Chemicals and particulate matter

119
Q

Apply ___ to help reduce some minor edema in a patient with an inhalation burn

A

Cool mist, aerosol therapy, or humidified oxygen

120
Q

The less efficient the combustion process, the more ___ the gases

A

Toxic

121
Q

___ intoxication should be considered whenever a group of people in the same place all report a headache or nausea

A

Carbon monoxide

122
Q

Carbon monoxide binds to the receptor sites on hemoglobin at least ___ times more easily than oxygen does

A

250

123
Q

Most people have ___ carbon monoxide attached to their hemoglobin

A

2%

124
Q

Heavy smokers may have ___ carbon monoxide attached to their hemoglobin

A

4% to 8%

125
Q

Carbon monoxide levels in the blood at levels of ___ or higher may be fatal

A

50%

126
Q

Patients with severe carbon monoxide intoxication usually have an oxygen saturation level that is ___

A

Normal

127
Q

Patients who have potentially inhaled toxic gases should receive ___ regardless of ___

A
  1. A high concentration of supplemental oxygen
  2. Pulse oximetry readings
128
Q

Gaseous form of cyanide

A

Hydrogen cyanide

129
Q

Hydrogen cyanide color and smell

A
  1. Colorless
  2. Bitter almonds
130
Q

Signs and symptoms of hydrogen cyanide poisoning

A
  1. Involve the CNS, respiratory, and cardiovascular systems of the body
  2. Faintness
  3. Anxiety
  4. Abnormal vital signs
  5. Headache
  6. Seizures
  7. Paralysis
  8. Coma
131
Q

Prehospital diagnosis of hydrogen cyanide poisoning is difficult because ___

A

Laboratory studies are necessary

132
Q

In situations in which you have patients who have sustained inhalation injuries, you must first ___

A

Ensure your own safety and the safety of your coworkers

133
Q

Prehospital treatment of a patient with suspected hydrogen cyanide poisoning may include ___

A

Decontamination and supportive care according to signs and symptoms

134
Q

Most chemical burns are caused by ___

A

Strong acids or strong alkalis

135
Q

If the chemical burn exposure occurs at an industrial site, ___

A

An expert should be on site and able to provide you with information on the chemical

136
Q

Emergency care of a chemical burn is ___

A

Basically the same as a thermal burn

137
Q

The severity of a chemical burn in dependent on ___

A
  1. Type of chemical
  2. Strength
  3. Duration of exposure
  4. Area of the body exposed
138
Q

To stop the burning process from a chemical, ___

A

Remove any chemical from the patient

139
Q

Why always brush the dry chemical off before flushing with water?

A

May be activated with contact with water

140
Q

Remove a chemical burn patient’s clothing, because there may be ___

A

Small amounts of chemicals in the creases

141
Q

For liquid chemicals, immediately ___

A

Flush the burned area with large amounts of water

142
Q

When flushing a liquid chemical off of a patient, take care to ___

A

Not contaminate uninjured areas or make the patient hypothermic. Never direct a forceful stream of water from a hose at the patient

143
Q

Continue flooding the chemical burn area with gallons of water for ___

A

15 to 20 minutes after the patient says the burning has stopped

144
Q

When flushing the chemical from the eyes ___

A

Hold the eyelid open, without applying pressure over the globe of the eye. Flush from the inside corners to the outside to prevent cross contamination.

145
Q

If only one eye has chemicals in it ___

A

Turn the head to that side and flush

146
Q

If both eyes have chemicals in it ___

A

Consider hooking up a nasal cannula to a bag of saline and flush both eyes simultaneously. Place the prongs on the bridge of the nose to flush from the inside corners of the eyes to the outside corners

147
Q

Any substance that prevents the flow of electricity

A

Insulator

148
Q

Any substance that allows a current to flow through it

A

Conductor

149
Q

A burn injury appears where the electricity ___

A

Enters and exits

150
Q

Two dangers specifically associated with electrical burns

A
  1. May be large amount of deep tissue injury. Force of the electrical energy can also cause fractures or joint dislocations
  2. May go into cardiac or respiratory arrest
151
Q

If neither CPR nor defibrillation is indicated in an electrical burn patient, ___

A

Gove supplemental oxygen and monitor closely for respiratory or cardiac arrest

152
Q

Treatment of electrical burn soft tissue injuries includes ___

A

Placing dry, sterile dressings on a burn wounds, splinting suspected fractures. Provide prompt transport

153
Q

Taser injuries are generally treated at ___

A

Impaled objects, the electrodes are removed by a physician

154
Q

Taser barb length

A

About .5”

155
Q

Taser barb wounds are easily treated unless they ___

A

Penetrate the eye

156
Q

Characterized by extreme agitation, reduced pain sensitivity, hallucinations, persistent struggling, and elevated temperature

A

Excited delirium

157
Q

Excited delirium is commonly associated with ___

A

Illegal drug ingestion

158
Q

Excited delirium warrants ___

A

Assisted ALS response

159
Q

Be certain you have access to ___ when you respond to calls for patients who have been exposed to Taser shots

A

An AED

160
Q

Three types of ionizing radiation

A
  1. Alpha
  2. Beta
  3. Gamma
161
Q

___ particles have little penetrating energy and are easily stopped by the skin

A

Alpha

162
Q

___ particles have greater penetrating power and can travel much farther in air than alpha particles. Can penetrate skin but can be blocked by simple protective clothing designed for this purpose

A

Beta

163
Q

The threat from gamma radiation is ___

A

Directly proportional to its wavelength

164
Q

This type of radiation is very penetrating and easily passes through the body and solid materials

A

Gamma

165
Q

Radiation is measured in units of ___

A

Radiation absorbed dose (rad) or radiation equivalent in man (rem): 100 rad = 1 gray (Gy)

166
Q

Small amounts of everyday background radiation are measured in ___

A

Rad

167
Q

The amount of radiation released in a major incident may be measured in ___

A

Gray

168
Q

The average human exposure from back ground radiation

A

0.31 rem per year

169
Q

Mild radiation sickness can be expected with exposures of ___

A

1 to 2 Gy (100 to 200 rad)

170
Q

Moderate radiation sickness can be expected with exposures of ___

A

2 to 5 Gy

171
Q

Severe radiation sickness can be expected with exposures of ___

A

4 to 6 Gy

172
Q

Exposure to more than ___ may result in death within 2 to 4 weeks (radiation)

A

10 Gy

173
Q

Most ionizing radiation accidents involve ___

A

Gamma radiation or x-rays

174
Q

Once a radiation explosion victim is decontaminated by the HAZMAT team, begin ___

A

Treating the XABCs and treat the patient for any burns or trauma

175
Q

Consider providing basic care to the radiation patient before decontamination if ___

A

You are wearing protective clothing

176
Q

How to minimize exposure to radiation

A
  1. Limit duration of exposure
  2. Increase distance from source
  3. Place shielding between yourself and the source
177
Q

To treat a contact radiation burn ___

A

Decontaminate as if it were a chemical burn, then treat it as a burn

178
Q

Three primary functions of dressings and bandages

A
  1. Control bleeding
  2. Protect the wound from further damage
  3. Prevent further contamination and infection
179
Q

Appropriate for smaller wounds

A

Gauze pads

180
Q

Adhesive-type dressings are useful for ___

A

Minor wounds

181
Q

Made of petroleum jelly-based gauze, aluminum foil, or plastic, prevents air and liquids from entering the wound

A

Occlusive dressing

182
Q

These dressings are used to cover sucking chest wounds, abdominal eviscerations, penetrating back wounds, and neck injuries

A

Occlusive dressing

183
Q

To keep dressings in place during transport, you can use ___

A

Soft roller bandages, rolls of gauze, triangular bandages, or adhesive tape

184
Q

Holds small dressing in place and helps to secure larger dressings

A

Adhesive tape

185
Q

Some patients are ___ to adhesive tape

A

Allergic

186
Q

If a patient is allergic to adhesive tape, use ___ instead

A

Paper or plastic tape

187
Q

Easiest bandage to use

A

Self-adherent, soft-roller bandages

188
Q

Do not use ___ to secure dressings. It may become a ___ if the injury swells

A
  1. Elastic bandages
  2. Secure dressings
189
Q

Always check a limb distal to a bandage for ___

A

Signs of impaired circulation and sensation

190
Q

___ are useful in stabilizing broken extremities, and can be used with dressings to help control bleeding from soft-tissue injuries

A

Air splints and vacuum splints

191
Q

If a wound continues to bleed despite the use of direct pressure, quickly use a ___

A

Tourniquet

192
Q

A tourniquet is most effective as a life-saving measure if ___

A

Applied prior to the onset of shock from blood loss

Emergency Medical Technician (100 decks)

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