Emergency Care, 13e (Limmer et al.)
Chapter 26 Soft-Tissue Trauma
1) Which of the following is the outermost layer of the skin?
A) Dermis
B) Epidermis
C) Adipose tissue
D) Fascia
Objective: 26.1
2) 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 your hand represents 1% of the body’s surface area.
B) The palm of the patient’s hand equals about 1% of the body’s surface area.
C) The palm of the patient’s hand equals 9% 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.
Objective: 26.1
1
3) Which of the following is a description of the rule of nines for an adult?
A) The rule of nines assigns 9% to the head and neck, each upper extremity, the chest, the
abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the
back of each lower extremity, then 1% to the genital region.
B) The rule of nines assigns 9% to the head and neck, as well as each upper extremity; 10% to
the chest, the abdomen, and the upper back; 8% to the lower back and buttocks, the front of each
lower extremity, and the back of each lower extremity, then 1% to the genital region.
C) The rule of nines assigns 9% to the head and neck, each upper extremity, the chest, the
abdomen, the upper back, and the lower back and buttocks; 8% to the front of each lower
extremity; and 10% for the back of each lower extremity, then 1% to the genital region.
D) The rule of nines assigns 9% to the head and neck; 6% to each upper extremity; 12% to the
chest and abdomen; 9% to the upper back, the lower back and buttocks, the front of each lower
extremity, and the back of each lower extremity, then 1% to the genital region.
Objective: 26.1
4) Which of the following is NOT a major function of the skin?
A) Excretion of wastes
B) Protection from the environment
C) Temperature regulation
D) Regulates the pH balance of the body
Objective: 26.2
2
5) Which of the following layers of the skin is the MOST important in insulating the body
against heat loss?
A) Parietal layer
B) Subcutaneous layer
C) Epidermis
D) Subdural layer
Objective: 26.2
6) Which of the following is NOT considered soft tissue?
A) The skin
B) Muscles
C) Membranes
D) Cartilage
Objective: 26.2
7) The meatus is:
A) an orifice of the urethra.
B) in a male, the area between the scrotum and the anus.
C) the tube that carries urine from the kidney to the bladder.
D) the canal through which urine is discharged from the bladder to the exterior of the body.
Objective: 26.2
3
8) An injury in which the epidermis remains intact, but blood vessels and cells in the dermis are
injured, is called a(n):
A) contusion.
B) abrasion.
C) concussion.
D) avulsion.
Objective: 26.3
9) An injury caused by heavy pressure to the tissues, such as when an extremity is trapped under
a fallen tree, that results in damage to muscle cells and the accumulation of waste products in the
tissue is called a(n):
A) crush injury.
B) evisceration.
C) contusion.
D) abrasion.
Objective: 26.3
4
10) You are dispatched to the local high school for a “person struck with a baseball.” You arrive
on the scene and find a 16-year-old male sitting on the bench. Apparently he was the pitcher and
was struck in the abdominal area by a line drive ball that was hit very hard. He states that nothing
is hurting except he has some mild pain in the area where he was struck. He is upset that the
ambulance was called and wants to go back into the game and continue pitching. Your exam
reveals nothing remarkable except mild pain when you palpate the injured area. Vital signs are
normal. What is the next step?
A) Have the coach apply cold to the area and let the pitcher back in the game if he does not get
worse in the next 15 minutes.
B) Have the patient walk to the ambulance and take him to the ED. No other care needs to be
provided, as there is really no significant sign of any injury.
C) Take appropriate Standard Precautions, apply high-concentration oxygen by nonrebreather
mask, and transport the patient ASAP, carefully monitoring the patient during transport.
D) Tell the coach the patient is okay and he can go back into the ball game.
Objective: 26.3
5
11) Your patient is a 55-year-old male who was found in the parking lot behind a tavern. He
states that he was assaulted and robbed by three individuals. He is complaining of being “hit in
the face and kicked and punched in his ribs and stomach.” Your examination reveals contusions
and swelling around both eyes, bleeding from the nose, a laceration of his upper lip, and multiple
contusions of the chest, abdomen, and flanks. Which of the following should cause the greatest
concern regarding the prehospital care of this patient?
A) The presence of any defensive wounds the patient may have sustained
B) The swelling around his eyes, which may be reduced by applying a cold pack
C) Potential internal injuries
D) Getting a description of the assailants
Objective: 26.4
12) Which of the following is NOT appropriate in caring for a patient with closed soft-tissue
injuries and a significant mechanism of injury?
A) Treat for shock if you think there are internal injuries even if the patient’s vital signs are
normal.
B) Anticipate vomiting.
C) Splint any swollen, deformed extremities.
D) Allow the patient to have small sips of water.
Objective: 26.4
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13) Which of the following is NOT true concerning lacerations?
A) They may indicate deeper underlying tissue damage.
B) They may be caused by penetrating trauma.
C) They may be caused by blunt trauma.
D) They may be degloving injuries to the skin or tissue.
Objective: 26.5
14) Which of the following is of concern with a puncture wound?
A) An object that remains impaled in the body
B) Hidden internal bleeding with minimal external bleeding
C) Strong possibility of contamination
D) All of the above
Objective: 26.5
15) Which of the following is NOT an open tissue injury?
A) Abrasion
B) Contusion
C) Avulsion
D) Evisceration
Objective: 26.5
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16) Which type of wound has a small opening into the skin, but may be quite deep, and is often
caused by instruments such as nails, ice picks, or pencils?
A) Avulsion
B) Laceration
C) Puncture
D) Incision
Objective: 26.5
17) A wound in which the epidermis is scraped away with minimal bleeding, such as commonly
occurs when a child falls on his knees on a sidewalk, is called a(n):
A) abrasion.
B) contusion.
C) avulsion.
D) evisceration.
Objective: 26.5
18) Bleeding from soft-tissue injuries should initially be controlled with which one of the
following techniques?
A) Application of an ice pack or chemical cold pack
B) Direct pressure
C) Elevation of the injured part
D) Running cold water over the wound
Objective: 26.5
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19) Which of the following is required in the management of all open soft-tissue injuries?
A) Provision of high-concentration oxygen
B) Use of Standard Precautions by the EMT
C) Cervical spine precautions
D) Application of a disinfectant solution
Objective: 26.5
20) Which of the following BEST describes an avulsion?
A) An injury caused by a sharp, pointed object
B) Flap of skin that is partially or completely torn away from the underlying tissue
C) Epidermis that is scraped away by a rough surface
D) Accumulation of blood beneath the skin, resulting in swelling
Objective: 26.5
21) Which of the following is NOT a type of avulsion?
A) The skin is partially torn away from the foot.
B) A finger is cut off with a butcher’s saw.
C) An ear is partially torn away from the head.
D) The skin is stripped off the hand, like removing a glove.
Objective: 26.5
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22) You are assessing a 30-year-old male patient that had his arm caught in a piece of machinery.
By the time you arrive he has been freed. The patient tells you that he does not understand why
you were called, but as you inspect the injured limb you notice a small puncture wound. You
should have a high index of suspicion of which of the following injuries?
A) Puncture
B) Crush injury
C) Chemical burn
D) High-pressure injection
Objective: 26.5
23) Your patient is a 14-year-old male who crashed his bicycle, landing prone and sliding along a
gravel trail. He has deep abrasions to his hands, arms, chest, and knees. The patient has small
pieces of gravel, twigs, and dirt embedded in the abrasions. Which of the following is the best
way to manage this situation after taking cervical spine immobilization?
A) Use your fingers to pick embedded debris from the wound, bandage with moist saline
dressings in place, and transport.
B) Do not attempt to remove any debris, apply pressure dressings over the embedded material if
necessary, apply high-concentration oxygen, and transport.
C) Use a tongue depressor to scrape large pieces of debris out of the wounds, place the patient on
high-concentration oxygen, and transport.
D) Assess for additional injuries, flush away large pieces of debris with a sterile dressing, place
dressings on the abrasions, bandage them in place, and transport.
Objective: 26.6
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