A Level I trauma alert gunshot wound to the head is paged out by EMS and they are at the back door of the ambulance bay with a 32-year-old man.
Per EMS report, the man was shot in a drive-by shooting. The patient is being ventilated by bag-valve mask. He has a Glasgow Coma Scale score of 7. He has an obvious gunshot wound to his left temple and the crown of his head, with brain matter exposed. Upon your assessment you also notice some stippling. He is tachycardic and hypertensive, with bilateral breath sounds and good distal pulses. What is meant by stippling?
The invagination of tissue into the wound
Stippling refers the existence of cavitation
Stippling refers to the exit wound
Flame, gases, smoke, unburnt powder, metal scrapings, grease from the barrel can be embedded in the skin
The Correct Answer is D
Rationale:
A. This describes tissue being drawn inward, which is not the definition of stippling. Stippling is related to surface skin findings from a firearm discharge, not tissue movement into the wound.
B. Cavitation refers to the temporary cavity created by the bullet as it passes through tissue, causing internal damage. This is a separate ballistic concept and not related to stippling.
C. An exit wound is where the bullet leaves the body and is typically larger and more irregular than the entrance wound. Stippling is associated with the entrance wound, not the exit wound.
D. Stippling (also called powder tattooing) occurs when unburnt gunpowder and other residues from the firearm are driven into the skin. This indicates a close-range or intermediate-range gunshot wound, and the pattern can help estimate the distance between the firearm and the victim at the time of injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. This describes tissue being drawn inward, which is not the definition of stippling. Stippling is related to surface skin findings from a firearm discharge, not tissue movement into the wound.
B. Cavitation refers to the temporary cavity created by the bullet as it passes through tissue, causing internal damage. This is a separate ballistic concept and not related to stippling.
C. An exit wound is where the bullet leaves the body and is typically larger and more irregular than the entrance wound. Stippling is associated with the entrance wound, not the exit wound.
D. Stippling (also called powder tattooing) occurs when unburnt gunpowder and other residues from the firearm are driven into the skin. This indicates a close-range or intermediate-range gunshot wound, and the pattern can help estimate the distance between the firearm and the victim at the time of injury.
Correct Answer is ["C","D"]
Explanation
Rationale:
A. The patient is experiencing hypertension (BP 189/100) and bradycardia (HR 56), which are classic signs of autonomic dysreflexia, not hypotension or tachycardia. Therefore, looking for tachycardia and low BP would not identify the cause.
B. While imaging is important for fracture management, the acute presentation of severe hypertension and bradycardia in a patient with a T6 or above spinal cord injury is most often due to autonomic dysreflexia triggered by a noxious stimulus below the injury. Imaging is not the immediate priority in this scenario.
C. A detailed assessment is needed to identify any triggers of autonomic dysreflexia, such as bladder distention, constipation, or infection. Vital signs, temperature, and symptom assessment (e.g., headache, flushing, sweating, nasal congestion) are essential to guide immediate interventions.
D. Most cases of autonomic dysreflexia are triggered by bladder distention, bowel impaction, or skin irritation (pressure ulcers, tight clothing, or injury). Rapid identification and removal of the trigger is critical to lower blood pressure and prevent complications such as stroke, seizures, or retinal hemorrhage.
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