Ch. 28 Knowledge

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What are the major functions of the skin?
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Excretion of wastes, Protection from the environment, and Temperature regulation
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What is the outermost layer of the skin?
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Epidermis
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What layer of the skin is the most important in insulating the body against heat loss?
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Subcutaneous layer
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What is required in the management of all open soft-tissue injuries?
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Use of Standard Precautions by the EMT
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An injury in which the epidermis remains intact, but blood vessels and cells in the dermis are injured, is called a:
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contusion.
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What type of wound has a smal l opening into the skin, but may be quite deep, and is often caused by instruments such as nails, ice picks, or pencils?
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punctures
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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 an:
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abrasion
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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:
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crush injury
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What BEST describes an avulsion?
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A flap of skin that is partially or completely torn away from the underlying tissue
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Bleeding from soft-tissue injuries should initially be controlled with what technique?
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direct pressure
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What injuries require the use of an occlusive dressing?
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An open wound to the neck, an open wound to the abdomen from which a loop of intestine is protruding, and an open wound to the chest.
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What is recommended when caring for an amputated part?
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Seal the part in a plastic bag and place it in a pan of water cooled by an ice pack.
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A burn extending into the subcutaneous fat would be classified as which type of burn?
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Full thickness
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What BEST describes a partial thickness burn?
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The skin is red and moist with blister formation.
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Your patient is a 25-year-old man who picked up an iron skillet with a very hot handle. He has a reddened area with blisters across the palm of his hand. What must be avoided in the prehospital management of this wound?
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Application of antibiotic ointment
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Your patient is a 35-year-old female who spilled a cup of hot coffee on herself. She has an area about twice the size of the palm of her hand on her right thigh that is red and painful, but without blisters. When caring for this injury in the prehospital setting, what is appropriate?
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Apply a dry, sterile dressing.
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What is a desirable characteristic of dressings used in the prehospital management of most open wounds?
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Sterile
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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. What should cause the greatest concern regarding the prehospital care of this patient?
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Potential internal injuries.
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What is appropriate in caring for a patient with closed soft-tissue injuries and a significant mechanism of injury?
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Treat for shock if you think there are internal injuries even if the patient’s vital signs are normal, anticipate vomiting, and splint any swollen, deformed extremities.
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What is true concerning lacerations?
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They may indicate deeper underlying tissue damage, penetrating trauma and blunt trauma.
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What is of concern with a puncture wound?
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An object that remains impaled in the body, hidden internal bleeding with minimal external bleeding, and the strong possibility of contamination.
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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. What is the best way to manage this situation after taking cervical spine immobilization?
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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.
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Your patient is a 32-year-old man with a fish hook that has perforated his hand between the thumb and index finger. What is the best way to manage the situation in the prehospital setting?
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Leave the hook in place and try not to disturb it.
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What is a consideration in determining a burn’s severity?
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Other illnesses or injuries the patient may have, body surface area involved in the burn, and the type of agent that caused the burn.
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Your patient is a 40-year-old man who was burned when he spil led gasoline on his pants as he was standing near the pilot light of his hot water heater. He has partial thickness burns from his feet to just above his knees, and circumferentially around both legs. Using the rule of nines, which percentage of the body is burned?
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18 percent
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What is of concern in a patient who received burns to his hand when he grabbed a live electrical wire?
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The extent of tissue damage may be much greater than it appears on the surface.
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Your patient is a 40-year-old male who has been exposed to a dry chemical powder and is complaining of severe pain on both of his hands, the site of the contact. He is working in an illegal chemical manufacturing plant and there is no decontamination shower on site. What would be the BEST way to manage this situation?
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Brush away as much of the powder as possible and then have the patient hold his hands under running water from a faucet or regular garden hose.
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While assessing a 78-year-old male patient who escaped an apartment fire with partial thickness burns to both arms, what else must the EMT be aware of?
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Medical conditions may be aggravated by the burn.
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Burns pose a greater risk to infants and children for what reason?
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Pediatric patients have a greater risk of shock from the burn.
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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 suspension of what injury?
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high-pressure injury
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While assessing a patient with partial thickness burns to his chest and neck, what should be your highest priority (even if there are no symptoms presently)?
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Airway
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You assess a 35-year-old female patient with a chemical burn to her right forearm and hand. As you assess the burn, you notice a white powder on the burn. What should be your next step?
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Brush the powder off the patient’s arm and hand, and then flush with copious amounts of water.
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When using the rule of palm to estimate the approximate body surface area burned, the patient’s palm equals about what percentage of the body’s surface area?
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1 percent
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According to the Rule of Nines for infants and young children, the patient’s head and neck account for what percentage of the total body surface area?
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18 percent

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