EMT ch28 Bleeding and Soft Tissue Trauma: Study HW Guide With Complete Solutions

EMT ch28 Bleeding and Soft Tissue Trauma: Study HW Guide With Complete Solutions Your patient was slashed with a knife and has a flap of skin hanging from his arm. This is known as​ a/n: A. laceration. B. avulsion. C. abrasion. D. puncture. avulsion pg 789 An avulsion is a loose flap of skin and underlying soft tissue that has been torn loose or pulled completely off. A laceration is a break in the skin of varying​ depth, which may be linear​ (regular) or stellate​ (irregular). An abrasion generally is caused by​ scraping, rubbing, or shearing away of the​ epidermis, the outermost layer of the skin. A puncture injury generally is the result of a​ sharp, pointed object being pushed or driven into soft tissue. The entry wound may appear very small and cause little bleeding.​ However, such injuries may be deep and damaging and may cause severe internal bleeding. A​ 43-year-old male has a circular shaped entrance wound to his stomach after being stabbed with a screwdriver. This is known as​ a/n: A. laceration. B. avulsion. C. puncture. D. abrasion. puncture pg790 A puncture injury generally is the result of a​ sharp, pointed object being pushed or driven into soft tissue. The entry wound may appear very small and cause little bleeding.​ However, such injuries may be deep and damaging and may cause severe internal bleeding. An avulsion is a loose flap of skin and underlying soft tissue that has been torn loose or pulled completely off. A laceration is a break in the skin of varying​ depth, which may be linear​ (regular) or stellate​ (irregular). An abrasion generally is caused by​ scraping, rubbing, or shearing away of the​ epidermis, the outermost layer of the skin. You should cover an open chest wound with​ a/n: A. moist dressing. B. dry dressing. C. sterile dressing. D. occlusive dressing. occlusive dressing pg 793 Use an occlusive dressing to prevent air from entering the chest cavity through the wound. An occlusive dressing​ (one that can form an airtight​ seal), such as Vaseline​ gauze, household plastic​ wrap, or the plastic bag from a dressing or oxygen​ mask, should be secured with tape on three sides.​ Sterile, dry, and moist dressings are not appropriate if they allow air to pass. Which item should NEVER be removed in the​ field? A. A knife that is lodged in your​ patient's chest B. A pencil that is stuck in your​ patient's cheek C. A pen that is stuck in your​ patient's hard palate D. A screwdriver that is impaled through your​ patient's trachea A knife that is lodged in your​ patient's chest pg790 An impaled object​ (an object that is still embedded in a​ wound) should never be removed in the field unless it is impaled through the cheek or the neck where it is obstructing airflow through the trachea. Soft tissue injuries are sometimes dramatic but​ rarely: A. serious. B. life threatening. C. preventable. D. painful. life threatening Soft tissue injuries may be painful and are often dramatic but are rarely life threatening unless they involve organs or major vessels. Soft tissue injuries are classified as open or closed The skin is the largest organ of the body. It is composed of three​ layers, including​ the: A. superior dermis. B. epidermis. C. subdermis. D. sebaceous layer. epidermis The skin is composed of three​ layers: the​ epidermis, the​ dermis, and a subcutaneous layer. It protects the body from the​ environment, bacteria, and other​ organisms, and it helps to regulate the​ body's temperature. Why is a list of medications important to​ gather, if​ available, during your rapid trauma​ assessment? A. To determine the impact of IV fluid replacement on circulating drug concentrations B. To assess the impact of​ volume-supporting medications on the patient C. To determine whether there are any medications that may affect coagulation D. To assess the possibility of false high readings on the pulse oximeter To determine whether there are any medications that may affect coagulation Medications may affect coagulation. Coumadin​ (warfarin) and other anticoagulant​ drugs, aspirin,​ ibuprofen, and other nonsteroidal​ anti-inflammatory drugs​ (NSAIDs) will interfere with the clotting process. It is important to recognize that the patient you are treating may be suffering from blood loss into the​ chest, abdomen, or pelvis that will continue unabated​ until: A. normal blood pressure is restored with the use of whole blood or packed red blood cells. B. additional clotting factor is administered. C. the pressure equalizes in the compartment. D. it clots or is surgically repaired it clots or is surgically repaired The goal of all emergency medical care for internal bleeding is to recognize its presence​ quickly, maintain the​ body's perfusion, treat for​ shock, and provide rapid transport to an appropriate medical facility. Resistance to continuing blood loss does not develop in body cavities such as the​ chest, abdomen, and pelvis. Blood loss continues unabated until it is halted by the normal clotting​ process, a significant drop in blood​ pressure, or surgical intervention. Your​ 35-year-old female patient has accidentally cut her forearm with a kitchen knife. Because the blood is bright red and​ spurting, you consider the bleeding to be from​ a/an: A. artery. B. capillary. C. venule. D. vein. Artery Bright​ red, spurting blood from a wound usually indicates a severed or damaged artery. The blood is bright red because it is rich in oxygen. Spurting generally coincides with the pulse or contraction of the heart. Arterial bleeding can be more difficult to control than any other type of bleeding because of the higher pressure in the arteries. External venous hemorrhage can almost always​ be, and is preferred to​ be, controlled​ by: A. firmly bandaging a dressing in place. B. using pressure points. C. splinting the limb and applying a cold pack. D. applying direct digital pressure to the appropriate proximal pressure point. firmly bandaging a dressing in place The first method for controlling bleeding is direct pressure. This is usually accomplished by placing a sterile gauze pad or dressing over the injury site and applying fingertip pressure directly to the point of bleeding. Firmly bandaging a dressing in place quickly slows the blood flow and assists the natural clotting mechanisms. How much blood loss can femur fractures account​ for? A. 3 L B. 500 mL C. 750 mL D. ​1,500 mL 1500mL Up to​ 1,500 mL of blood can be lost around each femur. This can be considered a serious​ bleed, as it can place the patient into shock. Slow oozing blood that is dark in color is MOST likely what​ type? A. Significant B. Capillary C. Arterial D. Venous Capilary Slowly oozing blood that is a dark or intermediate color of red usually indicates damaged capillaries. In most​ cases, capillary bleeding is easily controlled. This type of bleeding often clots spontaneously.​ However, if a large body surface is​ involved, bleeding may be​ profuse, and the threat of infection may be great. Dark red blood that flows steadily from a wound usually indicates a severed or damaged vein. Bright​ red, spurting blood from a wound usually indicates a severed or damaged artery. The method of bleeding control that is the FIRST and MOST successful method you will try​ is: A. the application of cold. B. direct pressure. C. the use of a pressure point. D. a tourniquet. direct pressure The first method for controlling bleeding is direct pressure. This is usually accomplished by placing a sterile gauze pad or dressing over the injury site and applying fingertip pressure directly to the point of bleeding. If bleeding is not controlled with direct​ pressure, the next step is to apply a tourniquet. Many commercial tourniquets are now available Which set of​ steps, in​ order, is BEST for controlling​ bleeding? A. ​Elevation, pressure​ points, and direct pressure B. ​Tourniquets, direct​ pressure, and pressure points C. Pressure​ points, direct​ pressure, and elevation D. Direct​ pressure, pressure​ dressing, and tourniquet Direct​ pressure, pressure​ dressing, and tourniquet If an injury continues to bleed despite direct​ pressure, the EMT can attempt to remove the dressing and apply direct pressure to the wound or a pressure dressing if the wound is large and the bleeding diffuse. If the wound continues to bleed after this direct​ pressure, the next step is a tourniquet. If your patient has a possible bone injury with severe bleeding in both lower​ extremities, medical direction may give you permission to​ use: A. an air splint. B. a tourniquet. C. the PASG. D. pressure points in the groin. the PASG The PASG can be use as a device for controlling​ bleeding, since it can provide circumferential pressure to the lower extremities. This can be especially useful if the patient concurrently has a​ lower-extremity fracture. As​ always, however, medical direction would be necessary for any intervention the EMT wishes to employ. You are treating a​ 43-year-old female who was hunting with a pistol. When she sat down in the​ outhouse, her gun went​ off, and the bullet created a large hole in her right​ thigh, which is now severely spurting blood. What is the MOST appropriate method of bleeding control for this injury if direct pressure​ fails? A. Direct pressure and elevation B. Looking for a pressure point to apply C. Application of ice on the wound D. Application of a tourniquet Application of a tourniquet If bleeding is not controlled with direct​ pressure, the next step is to apply a tourniquet. Many commercial tourniquets are now available. In performing your initial assessment and focused history and physical examination on a patient with an external​ bleed, which statement is NOT​ true? A. Severe bleeding should be treated as soon as it is found. B. You should take a complete family medical history. C. Body substance isolation precautions should be taken if there is any external bleeding. D. You should obtain a SAMPLE history. You should take a complete family medical history. When dealing with a​ patient, you will make no clinical decisions based on information learned about the family. Treatment will be based only on things you have learned or assessed from the patient. A blood vessel that is cut along its length​ will: A. cause hypoperfusion within two to three minutes. B. immediately seal itself with reticular fibers. C. retract and clot off. D. bleed uncontrollably. bleed uncontrollably pg 774 A cut along the length of the vessel will cause the vessel to open wider when it contracts. This will cause the vessel to bleed more severely. A vessel that has been cut​ across, or perpendicular to the length of the​ vessel, will have a tendency to retract and clot off. If you find a major bleed during your initial assessment of the​ patient, you​ should: A. complete your initial​ assessment, then control the bleeding with a pressure bandage. B. immediately apply direct pressure to the site with your gloved hand. C. immediately hold the injury above heart level and compress the appropriate pressure point. D. apply a blood pressure cuff above the site and inflate it until the bleeding stops. immediately apply direct pressure to the site with your gloved hand. pg775 If you note significant bleeding as you approach the​ patient, the first immediate action should be to control the bleeding with direct pressure. As that is being​ done, you or your partner should continue with the primary assessment. Do not skip the assessment of the​ airway, breathing, and circulation because you are distracted by a​ dramatic, bloody patient. Control the​ bleeding, and proceed with the assessment You are treating a​ 32-year-old male who struck a large tree with his car. On your​ arrival, law enforcement tells you that the patient was wandering around the accident scene. You locate the patient sitting on the ground next to his​ car, conscious and alert. He is unable to speak because of an avulsion of his left​ cheek, leaving a​ full-thickness section that was severed and is heavily​ bleeding, just below his zygomatic​ arch, flipped down onto his lower jaw. You also note that he is missing several of his now exposed teeth. Your partner immediately begins control of the​ patient's cervical​ spine, and you note that his respirations are 16 and easy and his radial pulse is 92. After the airway has been​ secured, what is your NEXT​ priority? A. Immobilizing the spine B. Applying​ high-flow oxygen C. Controlling the bleeding D. Locating the missing teeth contoling the bleeding pg: 777-778 Ensure that the patient has a patent airway. Assess the breathing rate and tidal volume to determine whether breathing is adequate. Assess for adequate oxygenation. If the breathing is adequate and the patient is exhibiting signs and symptoms of poor​ perfusion, administer supplemental oxygen via a nonrebreather mask at 15 lpm to maintain an SpO2 reading of 94 percent or more. Assess the central and peripheral​ pulses, skin, and capillary refill. External bleeding has a tendency to be very dramatic. Control the​ bleeding, but continue with the primary assessment. Do not skip the assessment of the​ airway, breathing, and circulation because you are distracted by a​ dramatic, bloody patient. Control the​ bleeding, and proceed with the assessment. Bleeding from the​ nose, ears, or mouth is a cause for concern. Keep in mind​ that: A. treatment for nosebleeds consists of having the patient pinch the fleshy part of the nostrils together and lean backward. B. attempting to stop bleeding from the ears if the patient has a head injury could increase pressure inside the skull. C. if your patient has a head​ injury, you should attempt to stop the flow of​ blood, since the bleeding will decrease blood flow to the brain. D. hyperglycemia can increase intracranial​ pressure, resulting in the bleeding. attempting to stop bleeding from the ears if the patient has a head injury could increase pressure inside the skull. pg 778-779 Any time you observe bleeding from a​ patient's ears or nose associated with​ trauma, suspect a possible skull fracture. If the patient has experienced a head​ injury, you should not attempt to stop the flow of​ blood; that could create pressure inside the​ skull, causing even more damage.​ Instead, place a loose dressing around the area to collect the drainage and limit exposure to sources of infection. Why would blood loss from the ear of a patient with a head injury be of special​ concern? A. Ears do not have blood vessels and therefore cannot​ bleed; this means that the blood is coming from the brain. B. It tells you that the patient has also suffered a temporal skull fracture. C. It may be indicative of a basilar skull fracture. D. It means that the ear canal itself is injured. It may be indicative of a basilar skull fracture. pg 865 basilar skull fracture's Any time you observe bleeding from a​ patient's ears or nose associated with​ trauma, suspect a possible skull fracture. If the patient has experienced a head​ injury, you should not attempt to stop the flow of​ blood; that could create pressure inside the​ skull, causing even more damage.​ Instead, place a loose dressing around the area to collect the drainage and limit exposure to sources of infection. Your​ 24-year-old male patient was riding an ATV through the woods and impaled himself on a dead tree branch. The​ 1-inch-diameter branch went in through his mouth and out his right cheek before breaking from the tree. On your​ arrival, the patient is bleeding heavily into his mouth and is struggling to breathe unless he is leaning forward. To gain control of his bleeding and thereby his​ airway, you​ should: A. insert a nasopharyngeal airway. B. sacrifice spinal immobilization and transport him​ sitting, leaning forward. C. pack his mouth full of gauze and tell your patient to breathe through his nose. D. remove the object. remove the object pg 775, 794 (impaled objects) An impaled object should never be removed in the field unless it is impaled through the cheek or the neck where it is obstructing airflow through the trachea. Be prepared to apply direct pressure to the wound both from inside the cheek and externally. Your​ 11-year-old patient was riding his bike without a helmet when he wrecked and hit the back of his head. You now see bleeding from his nose. Why is this of special​ concern, given his mechanism of​ injury? A. This is most likely a child abuse case. B. It means that a contrecoup injury has occurred. C. It may indicate that a skull fracture has occurred. D. It means that he is probably lying about what happened. It may indicate that a skull fracture has occurred. 778-779 Any time you observe bleeding from a​ patient's ears or nose associated with​ trauma, suspect a possible skull fracture. If the patient has experienced a head​ injury, you should not attempt to stop the flow of​ blood; that could create pressure inside the​ skull, causing even more damage.​ Instead, place a loose dressing around the area to collect the drainage and limit exposure to sources of infection. Internal bleeding may result from a variety of causes. If you suspect that your patient has internal​ bleeding, remember​ that: A. your suspicion of internal bleeding may be based only on the mechanism of injury. B. the two most common causes of internal bleeding are ruptured aortic aneurysm and bleeding stomach ulcers. C. internal bleeding is usually very obvious and should be identified quickly. D. head injury is more likely to cause unexplained shock than internal bleeding. Your suspicion of internal bleeding may be based only on the mechanism of injury pg: 779-780 Assessment based approach: Internal Bleeding During your scene​ size-up, look for and evaluate potential mechanisms of injury. Your suspicion of internal bleeding may be based on the mechanism of injury you identify. For​ example, if the emergency involves a​ fall, motorcycle or automobile​ collision, pedestrian​ impact, or​ blast, you should suspect blunt trauma and internal bleeding. Remember that penetrating injuries can result in both external and internal bleeding.