Chapter 27: Soft Tissue Injuries
According to the rule of nines, burns to the front of both arms and the chest cover 18% of body surface area. For abdominal evisceration, the exposed organs should be covered with moist, sterile gauze and an occlusive dressing without attempting to replace them. This prevents contamination and drying until surgical care.
A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA.
Select one:
A. 45%
B. 27%
C. 18%
D. 36%
C. 18%
Explanation (scroll down and click on the picture for visual)
One side of Right Arm = 4.5%
One side of Left Arm = 4.5%
Upper Chest Area = 9%
Total = 18%
Key Terms
A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA.
Select one:
A. 45%
B. 27%
C. 18%
D. 36%
C. 18%
Explanation (scroll down and click on the picture for visual)
A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound?
Select one:
A. Carefully replace the exposed bowel into the abdomen and transport.
B. Cover it with moist, sterile gauze and secure with an occlusive dressing.
C. Irrigate it with sterile water and cover it with a dry dressing.
D. Cover the exposed bowel and keep his legs in a straight position.
B. Cover it with moist, sterile gauze and secure with an occlusive dressing.
A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He has a large hematoma in the center of his forehead and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should:
Select one:
A. administer high-flow oxygen.
B. apply ice to the hematoma.
C. perform a neurologic exam.
D. palpate his radial pulses.
A. Administer high-flow oxygen.
Explanation:
The patient shows signs of a concussion or possible traumat...
A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should:
Select one:
A. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing.
B. replace the avulsed flap to its original position and cover it with a sterile dressing.
C. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.
D. carefully probe the wound to determine if the bleeding is venous or arterial.
B. Replace the avulsed flap to its original position and cover it with a sterile dressing.
A burn that is characterized by redness and pain is classified as a:
Select one:
A. partial-thickness burn.
B. second-degree burn.
C. full-thickness burn.
D. superficial burn.
D. Superficial burn
Superficial burns involve only the top layer of sk...
A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n):
Select one:
A. crush injury.
B. contusion.
C. hematoma.
D. abrasion.
B. contusion.
A contusion, or bruise, is an injury that causes bleeding beneath the ski...
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| Term | Definition |
|---|---|
A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA. Select one: A. 45% B. 27% C. 18% D. 36% | C. 18% Explanation (scroll down and click on the picture for visual) One side of Right Arm = 4.5% One side of Left Arm = 4.5% Upper Chest Area = 9% Total = 18% |
A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound? Select one: A. Carefully replace the exposed bowel into the abdomen and transport. B. Cover it with moist, sterile gauze and secure with an occlusive dressing. C. Irrigate it with sterile water and cover it with a dry dressing. D. Cover the exposed bowel and keep his legs in a straight position. | B. Cover it with moist, sterile gauze and secure with an occlusive dressing. Explanation: Do not attempt to push the organs back inside or use a dry dressing—both can cause tissue damage and infection. |
A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He has a large hematoma in the center of his forehead and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should: Select one: A. administer high-flow oxygen. B. apply ice to the hematoma. C. perform a neurologic exam. D. palpate his radial pulses. | A. Administer high-flow oxygen. Explanation: Other options (ice application, neuro exam, pulse check) come after life threats are addressed. |
A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should: Select one: A. carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing. B. replace the avulsed flap to its original position and cover it with a sterile dressing. C. thoroughly irrigate the wound with sterile water and cover it with a sterile dressing. D. carefully probe the wound to determine if the bleeding is venous or arterial. | B. Replace the avulsed flap to its original position and cover it with a sterile dressing. If the avulsed tissue is still attached by a small piece of skin, its circulation may be at risk. If it’s clean and not contaminated, gently replace the flap in its original position and cover it with a sterile dressing. A. Incorrect – Carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing: Removing viable tissue can delay healing and cause more damage if the flap still has blood supply. C. Incorrect – Thoroughly irrigate the wound with sterile water and cover it with a sterile dressing: Irrigation is helpful for cleaning, but this option omits replacing the flap, which is essential for an incomplete avulsion. D. Incorrect – Carefully probe the wound to determine if the bleeding is venous or arterial: Probing causes more tissue damage and is unnecessary; focus on controlling bleeding and protecting the wound instead. |
A burn that is characterized by redness and pain is classified as a: Select one: A. partial-thickness burn. B. second-degree burn. C. full-thickness burn. D. superficial burn. | D. Superficial burn Superficial burns involve only the top layer of skin, the epidermis. The skin becomes red and painful but does not blister or burn through this layer. Sunburn is a common example.
A. Incorrect – Partial-thickness burn: B. Incorrect – Second-degree burn: C. Incorrect – Full-thickness burn: |
A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n): Select one: A. crush injury. B. contusion. C. hematoma. D. abrasion. | B. contusion. A contusion, or bruise, is an injury that causes bleeding beneath the skin but does not break the skin. Contusions result from blunt forces striking the body. The epidermis remains intact, but cells within the dermis are changed, and small blood vessels are usually torn. The depth of the injury varies, depending on the amount of energy absorbed. As fluid and blood to leak into the damaged area, the patient may have swelling and pain. A. Incorrect - crush injury. A crushing injury occurs when significant forces applied to the body. The extent of the damage depends on how much force is applied and how long it is applied. C. Incorrect - hematoma. A hematoma is blood that has collected within the damaged tissue or in a body cavity. The hematoma occurs whenever a large blood vessel is damaged and bleeds rapidly. It is usually associated with extensive tissue damage. A hematoma can result from soft tissue injury, fracture, or any injury to a large blood vessel. D. Incorrect - abrasion. An abrasion is 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. |
An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should: Select one: A. advise the child that he will need rabies shots. B. ask the child’s father to try to locate the dog. C. report the incident to the appropriate authorities. D. administer oxygen via a nonrebreathing mask. | C. report the incident to the appropriate authorities. Explanation (pg. 923) “In many locations, reporting animal bites to public health officials is mandatory. Based on your protocols you may need to have law enforcement respond to the scene or to the hospital.” A. Incorrect - advise the child that he will need rabies shots. The child is not the legal decision-maker and it will only serve to upset them. B. ask the child’s father to try to locate the dog. You must assume that the animal may turn and attack. The animal needs to be secured by law enforcement or animal control. (pg. 923) D. administer oxygen via a nonrebreathing mask. As the bite was to the left hand, an acute infection that can only be treated by a series of vaccinations is indicated. No difficulty breathing has been indicated. (pg. 922-923) |
As you approach a young male who was involved in an industrial accident, you note that his eyes are closed and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with minimal bleeding, and a closed deformity to his right leg. You should: Select one: A. open his airway and assess his breathing status. B. perform an immediate head-to-toe assessment. C. assess his pulse for rate, regularity, and quality. D. apply high-flow oxygen and assess his injuries. | A. Open his airway and assess his breathing status. Follow the MARCH algorithm:
B: Head-to-toe comes later. |
Burns to pediatric patients are generally considered more serious than burns to adults because: Select one: A. most burns in children are the result of child abuse. B. pediatric patients have a proportionately larger volume of blood. C. pediatric patients are more prone to hyperthermia. D. pediatric patients have more surface area relative to total body mass. | D. pediatric patients have more surface area relative to total body mass. Explanation (pg. 927) “Burns to children are generally considered more serious than burns to adults. The reason is infants and children have more surface area relative to body mass, which means greater fluid and heat loss. In addition, children do not tolerate burns as well as adults do. Children are also more likely to go into shock, have hypothermia develop, and experience airway difficulties because of the unique differences associated with their ages and anatomy. Many burns in infants and children result from child abuse. The classic burn resulting from deliberate immersion involves the hands and wrists, as well as the feet, lower legs, and buttocks. Similarly burns around the genitals and multiple cigarette burns should be viewed as possible abuse. Report all suspected cases of abuse to the proper authorities, especially those where significant delaying evaluation and treatment is evident. A. Incorrect - most burns in children are the result of child abuse. This is a serious concern, that needs to be taken into account. Priority goes to the life-threatening conditions first. B. Incorrect - pediatric patients have a proportionately larger volume of blood.* 1. Despite a smaller stature, burned children have a greater body surface area per mass than adults. 2. Cardiac function, mean blood volume, and normal hemoglobin levels are age-dependent in children; hence, children have a higher blood transfusion/unit volume ratio. C. Incorrect - pediatric patients are more prone to hyperthermia.* This is secondary to the burn area. |
During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a: Select one: A. handgun. B. .22-caliber pistol. C. .357 magnum. D. shotgun. | D. shotgun. Explanation Shotgun ammunition scatters multiple fragments as part of its exit from the gun barrel, while the other options do not fragment as they leave the barrel. The other options would have a single entry without fragmented punctures around it. |
In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is: Select one: A. a spinal fracture. B. an ischemic stroke. C. nerve fiber damage. D. an air embolism. | D. an air embolism. Explanation: For air to enter a closed system (i.e. vascular system), a connection must occur between the gas, the vessel, and a pressure gradient, that enables the flow of air into the vessel. An open neck injury presents this opportunity. Venous gas embolism can go to the lungs and block pulmonary blood flow. This can create pulmonary hypertension & right-heart failure quickly. A gas embolism that enters the heart can cause an “air lock” in the right side of the heart: the heart valves do not work properly, and the heart cannot eject the gas. Cardiac out then falls rapidly. This is fatal. A gas embolism that enters the arterial system or reaches the left side of the heart can be pumped into the arterial circulation, and then cause an infarction (i.e. blood flow blockage, lack of oxygen delivery, tissue death) in the vital organs, including the heart and brain. A. Incorrect - a spinal fracture. Spinal fracture with a neck injury is a consideration, but severe bleeding and an open neck injury indicate a gas embolism is likely. B. Incorrect - an ischemic stroke. Ischemic strokes occur in arteries where blood only. A gas embolism can enter either the venous or arterial system. Uniquely saying it can cause an ischemic stroke leaves a venous blockage out and thus is less complete of an answer as “air embolism.” C. Incorrect - nerve fiber damage. Nerve fiber damage with a neck injury is a consideration, but severe bleeding and an open neck injury indicate a gas embolism is likely. |
In which of the following patients should you remove an impaled object? Select one: A. A pulseless and apneic patient with a knife impaled in the back B. A semiconscious patient with an ice pick impaled in the chest C. An apneic patient with a shard of glass impaled in the abdomen D. A conscious and alert patient with a fishhook impaled in the eye | A. A pulseless and apneic patient with a knife impaled in the back Explanation “The only exceptions to the rule of not removing an impaled object are the objects in the cheek or mouth that obstruct breathing and objects in the chest that directly interfere with performing CPR on a patient who is already in cardiac arrest.” (pg 920) Being pulseless and apneic, the patient is already in cardiac arrest and the position of the knife would make it impossible to perform CPR. B. Incorrect - A semiconscious patient with an ice pick impaled in the chest This patient is not in cardiac arrest as they are semiconscious. Also, depending on the location of the ice pick, it may or may not interfere with CPR. With the provided information, removal is not indicated. C. Incorrect - An apneic patient with a shard of glass impaled in the abdomen This patient has a shard of glass in their abdomen and will not compromise CPR. Also, this patient is apneic, and it is possible to be apneic with cardiac activity, albeit not for long, thus it is not indicated that they are in cardiac arrest. D. Incorrect - A conscious and alert patient with a fishhook impaled in the eye The fishhook does not impair CPR, and there is a high probability that definitive care is required to remove the hook to salvaged function in the eye. |
The sebaceous glands produce sebum, a material that: Select one: A. waterproofs the skin and keeps it supple. B. facilitates shedding of the epidermis. C. discharges sweat onto the skin’s surface. D. pulls the hair erect when you are cold. | A. waterproofs the skin and keeps it supple. Explanation: “The sebaceous glands lie next to the hair follicles and secrete sebum along the hair follicle to the skin surface. In addition to providing waterproofing for the skin, sebum keeps the skin soft so it does not crack.” (pg. 212) B. facilitates shedding of the epidermis. The stratum corneum consists of a series of layers of specialized skin cells that are continuously shedding as new cells move superficially to replace older cells. (pg 212; 906) C. Incorrect - discharges sweat onto the skin’s surface. Sweat’s main purpose is to cool the body to aid in thermoregulation (pg 212; 906) Apocrine sweat glands are believed to be adrenergic (part of the sympathetic nervous system), while eccrine sweat glands Eccrine glands are innervated by the sympathetic nervous system, primarily by cholinergic fibers whose discharge is altered primarily by changes in deep body temperature (core temperature), but by adrenergic fibers as well. D. Incorrect - pulls the hair erect when you are cold. The Erector Pillae muscle is what pulls a hair follicle erect. (pg 213; 906) |
When caring for a patient whose arm is covered with a dry chemical, you should: Select one: A. brush away the chemical before flushing with water. B. quickly irrigate the arm with large amounts of water. C. use forceful streams of water to remove the chemical. D. deactivate the chemical with a 5% vinegar solution. | A. brush away the chemical before flushing with water. Explanation To stop the burning process, remove any chemical from the patient. A dry chemical that is activated with water may damage the skin more when it is wet than when it is dry. Therefore, always brush off dry chemicals from the skin and clothing before flushing the patient with water. (pg 934) For liquid chemicals, immediately flush the area with large amounts of water. B. Incorrect - quickly irrigate the arm with large amounts of water. From the above statement, water may activate the chemical causing more damage. C. use forceful streams of water to remove the chemical. From the above statement, water may activate the chemical causing more damage. Also, forceful streams of water can contaminate uninjured areas and may mechanically injure the burned skin. D. deactivate the chemical with a 5% vinegar solution. Treatment of chemical burns can be specific to the chemical agent. (pg 934) Vinegar is a weak aid but may increase the damage of the chemical agent. The emergency care for chemical burns is basically the same as a thermal burn. |
Which of the following areas of the body has the thinnest skin? Select one: A. Soles of the feet B. Back C. Scalp D. Ears | D. Ears Explanation “Skin varies in thickness, depending on a person’s age and the area the skin covers. The skin of the very young or the very old is thinner than the skin of a young adult. The skin covering the scalp, the back, and the soles of the feet is quite thick, while the skin of the eyelids, lips, and ears is very thin. Thin skin is more easily damaged.” (pg. 906) A. Incorrect - Soles of the feet “The skin covering the scalp, the back, and the soles of the feet is quite thick, while the skin of the eyelids, lips, and ears is very thin.” (pg. 906) B. Incorrect - Back “The skin covering the scalp, the back, and the soles of the feet is quite thick, while the skin of the eyelids, lips, and ears is very thin.” (pg. 906) C. Incorrect - Scalp “The skin covering the scalp, the back, and the soles of the feet is quite thick, while the skin of the eyelids, lips, and ears is very thin.” (pg. 906) |
Which of the following is a severe burn in a 65-year-old patient? Select one: A. Superficial burn to 30% of the BSA B. Second-degree burn covering 10% of the BSA C. Full-thickness burn to 1% of the BSA D. Partial-thickness burn to 20% of the BSA | D. Partial-thickness burns to 20% of the BSA Explanation Burns that would be considered “moderate” on a young adult are classified as “Severe” on patients younger than 5 years or older than 55 years. (pg 925; Table 26-1) These include: (moderate in young adults, severe in over 55 years old)
A. Superficial burn to 30% of the BSA This superficial burn is under 50% BSA and does not meet the 50% BSA threshold. B. Incorrect - Second-degree burn covering 10% of the BSA This is a partial-thickness under 15% BSA and does not meet the 15% to 30% threshold. C. Incorrect - Full-thickness burn to 1% of the BSA This is a full-thickness under 2% BSA and does not meet the 2% to 10% threshold. |
Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss? Select one: A. Avulsion B. Incision C. Laceration D. Abrasion | D. Abrasion Explanation An abrasion is 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. An abrasion usually does not penetrate completely through the dermis, but blood may ooze from the injured capillaries in the dermis. Also known as road rash, road burn, and rug burn, abrasions can be extremely painful because the nerve endings are located in this area. (pg. 909) A. Incorrect - Avulsion An avulsion is an injury that separates various layers of soft tissue (usually between the subcutaneous layer & fascia) so they become either completely detached or hang by a flap. Often there is significant bleeding. (pg 909) B. Incorrect - Incision A sharp, smooth cut. The depth and severity of the injury can vary. (pg 909) C. Incorrect - Laceration A jagged cut in the skin caused by a sharp object or blunt force that tears the skin. The depth and severity of the injury can vary. (pg 909) |
Which of the following processes occurs during the inflammation phase of the healing process? Select one: A. The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound. B. The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. C. White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow. D. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling. | D. The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling. Explanation: Histamine is not only the major mediator of the acute inflammatory and immediate hypersensitivity responses but has also been demonstrated to affect chronic inflammation and regulate several essential events in the immune response. A. Incorrect - The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound. This is the process of coagulation, not inflammation. (pg 883) B. Incorrect - The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection. Constricting blood vessels reduces inflammation. The vessels’ permeability drops so they do not leak and blood moves faster through them lessening the time it has to leave the vessel. C. Incorrect - White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow. White blood cells flood areas of injury along with red blood cells. |
Which of the following statements regarding crush syndrome is correct? Select one: A. With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity. B. Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body. C. Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours. D. Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal. | C. Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours. Explanation: Other options are incorrect because:
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You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should: Select one: A. carefully manipulate her arm until the symptoms subside. B. remove the gauze bandage and replace it with an elastic one. C. assess distal circulation and readjust the bandage as needed. D. remove the bandage and dressing and apply another one. | C. assess distal circulation and readjust the bandage as needed. Explanation Numbness and tingling in the hand can be an indicator that the bandage is too tight and cutting off circulation to the distal aspect of the extremity. Checking the capillary refill and pulse bilaterally can be a step in verifying perfusion differences. The bandage can be loosened to allow for perfusion but not removed as it could dislodge the coagulated blood and start bleeding again. A. Incorrect - carefully manipulate her arm until the symptoms subside. Moving the extremity can increase blood flow to the area, increasing bleeding that was previously controlled. B. Incorrect - remove the gauze bandage and replace it with an elastic one. The gauze bandage will work and simply needs to be loosened, without taking off the pressure on the dressing. Taking the bandage all the way off removed the pressure on the wound that is controlling bleeding. D. Incorrect - remove the bandage and dressing and apply another one. Removing the bandage completely risks the wound opening again, and bleeding control being repeated. The hospital staff will remove the bandage. This circumstance only requires that pressure bandage to be loosened sufficiently for perfusion to occur (as it is not a tourniquet). |