ATLS- MSK injuries

Question 1

Why should an ED doc not worry about completely reducing an open fracture back into the skin?

Answer 1

Will require surgical debridement

Question 2

How do anterior and posterior shoulder dislocations classically appear?

Answer 2

Anterior = Squared off
Posterior = Locked in internal rotation

Question 3

How do posterior elbow dislocations appear?

Answer 3

Olecranon prominent posteriorly

Question 4

How do anterior and posterior hip dislocations appear on exam?

Answer 4

Anterior = flexed, abducted and externally rotated
Posterior = Flexed adducted and internally rotated

Question 5

When is the only time an x-ray is not indicated prior to reduction of a broken bone?

Answer 5

In the presence of vascular compromise or impending skin breakdown

Question 6

What are the two major extremity injuries that are potentially life threatening?

Answer 6

Major arterial hemorrhage

crush syndrome

Question 7

What are the stabilizing measures used to stop hemorrhage?

Answer 7

Tourniquet use and direct pressure

Question 8

What is the recommended rate of urinary output to prevent renal failure with rhabdo?

Answer 8

100 mL/hr

Question 9

Should you ever explore an open wound?

Answer 9

No

Question 10

True or false: if a fracture and a wound exist on the same limb, it is considered an open wound until proven otherwise

Answer 10

True

Question 11

What is the only way to determine if a wound is an open fracture?

Answer 11

Surgically explore it in the OR

Question 12

What two antimicrobial interventions should all patients with open wounds receive?

Answer 12

Abx and tetatnus

Question 13

How long can muscle tolerate a lack of arterial flow for?

Answer 13

6 hours

Question 14

How many attempts should be made at relocating a dislocated joint when arterial insufficiency is present?

Answer 14

Once. If unsuccessful, then splint and emergently call a surgeon

Question 15

Is a patient with multiple injuries who requires intensive resuscitation and emergency surgery a candidate for replantation?

Answer 15

No

Question 16

What is the appropriate way to save an amputated finger?

Answer 16

Wrap with isotonic solution in sterile gauze and PCN, and put in ice, but do not freeze

Question 17

When in the course of disease does the lack of a pulse present itself with compartment syndrome?

Answer 17

Late

Question 18

Tissues pressures greater than how many mmHg suggest compartment syndrome?

Answer 18

30-45 mmHg

Question 19

What is the role of compartment pressures in the diagnosis of compartment syndrome?

Answer 19

Aid, but it is a clinical diagnosis

Question 20

If compartment syndrome is suspected, and all of the occlusive dressings are removed, how much time does the pressure have to fall before an emergent fasciotomy is needed?

Answer 20

30-60 minutes

Question 21

How can you test motor and sensory function for the following nerve: ulnar

What injury is this usually compromised in?

Answer 21

Index and little finger abduction
Sensation to little finger

elbow injury

Question 22

How can you test motor and sensory function for the following nerve: distal median nerve

What injury is this usually compromised in?

Answer 22

Thenar contraction with opposition
index finger sensation

Wrist fracture or dislocation

Question 23

How can you test motor and sensory function for the following nerve: median/anterior interosseous n

What injury is this usually compromised in?

Answer 23

Index tip flexion
No sensation

Supracondylar fracture of humerus

Question 24

How can you test motor and sensory function for the following nerve: musculocutaneous

What injury is this usually compromised in?

Answer 24

Elbow flexion
Radial forearm sensation

Anterior shoulder dislocation

Question 25

How can you test motor and sensory function for the following nerve: radial What injury is this usually compromised in?

Answer 25

Thumb, finger metacarpophalangeal extension First dorsal web space sensation Distal humeral shaft fracture/anterior shoulder dislocation

Question 26

How can you test motor and sensory function for the following nerve: axillary What injury is this usually compromised in?

Answer 26

Deltoid motor function Lateral shoulder sensation Anterior shoulder dislocation

Question 27

If a laceration extends below what level does it require surgical debridement?

Answer 27

Fasical level

Question 28

What is the general management of joint injuries?

Answer 28

Immobilize the joint and reassess the vascular and neuro status. Call the surgeon

Question 29

True or false: Imaging and immobilization follow the rule of above and below the site of injury

Answer 29

True

Question 30

How are femur fractures without lower leg fractures handled?

Answer 30

Traction splint

Question 31

How should the knee be positioned to be immobilized?

Answer 31

In about 10 degrees of flexion

Question 32

How should the hand be position to be immobilized?

Answer 32

in anatomic functional position, with wrist slightly dorsiflexed and fingers gently flexed at 45 degrees at the MCP

Question 33

How should the wrist and forearm be positioned to be immobilized?

Answer 33

flat

Question 34

How should the elbow be positioned to be immobilized?

Answer 34

flexion

Question 35

What is the best way to ensure that you do not miss an injury?

Answer 35

Frequent reassessment and thorough secondary survey

Question 36

How can you test motor and sensory function for the following nerve: femoral nerve What injury is this usually compromised in?

Answer 36

Knee extension Anterior knee sensation Pubic rami fractures

Question 37

How can you test motor and sensory function for the following nerve: obturator What injury is this usually compromised in?

Answer 37

Hip adduction Medial thigh sensation Obturator ring fractures

Question 38

How can you test motor and sensory function for the following nerve: Posterior tibial What injury is this usually compromised in?

Answer 38

toe flexion Sole of foot sensation knee dislocation

Question 39

How can you test motor and sensory function for the following nerve: superficial peroneal What injury is this usually compromised in?

Answer 39

Ankle eversion Lateral dorsum of the foot sensation Fibular neck fracture/knee dislocation

Question 40

How can you test motor and sensory function for the following nerve: Deep peroneal What injury is this usually compromised in?

Answer 40

Ankle/toe dorsiflexion Dorsal first to second web space sensation fibular neck fractures

Question 41

How can you test motor and sensory function for the following nerve: sciatic nerve What injury is this usually compromised in?

Answer 41

Plantar dorsiflexion Foot sensation Posterior hip dislocation

Question 42

How can you test motor and sensory function for the following nerve: superior gluteal nerve What injury is this usually compromised in?

Answer 42

Hip abduction Upper buttocks acetabular fractures

Question 43

How can you test motor and sensory function for the following nerve: inferior gluteal What injury is this usually compromised in?

Answer 43

Gluteus maximus hip extension Lower buttocks sensation acetabular fx