Chapter 32 | Musculoskeletal Trauma COPY

Question 1

True or false:

All injuries can be confirmed as a fracture in the field.

Answer 1

false

not all fractures can be identified in field

Question 2

True or false:

Not all injuries can be confirmed as a fracture in the field.

Answer 2

true

Question 3

True or false,

For a patient with a deformed extremity, you should realign the limb back in place.

Answer 3

true

assists in restoring circulation to extremity and to fit into splint

Question 4

True or false:

For a patient with a deformed extremity, you should not realign the limb back in place.

Answer 4

false

assists in restoring circulation to extremity and to fit into splint

Question 5

True or false:

The increased pain from realigning a deformed extremity is only temporary.

Answer 5

true

Question 6

True or false:

The increased pain from realigning a deformed extremity lasts after the procedure.

Answer 6

false

pain should only be temporary

Question 7

Choose:

Most injuries to the upper extremities are caused by:

A. assault or abuse.

B. athletic injuries.

C. forces applied to an outstretched arm.

D. penetrating trauma.

Answer 7

C

Question 8

Choose:

You are summoned to the aid of a​ 45-year-old male who was hunting and fell from a tree stand. When you​ arrive, he is experiencing severe pain in his lower right thigh. On​ examination, you find that an area about three inches above his right knee has an open wound about one inch in diameter that is bleeding minimally. There are no exposed​ bones, but you palpate crepitus and see swelling that makes you suspect bone fracture.

You would you classify this as a(n):

A. open extremity injury.

B. sprain.

C. closed extremity injury.

D. dislocation.

Answer 8

A

This would be classified as an open extremity​ injury, which is an extremity injury in which the skin has been broken or torn through from the inside by an injured bone or from the outside by something that has caused a penetrating wound with associated injury to the bone.

Question 9

Choose:

Your patient fractured her right wrist in a motor vehicle collision. You notice swelling, redness, and tenderness distal to the site. The patient is wearing a ring and a bracelet. The ring slides off her finger easily but the bracelet is tight against the swelling.

You should:

A. slide off the ring and cut off the bracelet.

B. leave both the ring and bracelet in place.

C. cut off the bracelet but leave the ring in place.

D. slide off the ring but leave the bracelet in place.

Answer 9

A

jewelry can easily constrict and injure underlying tissue

Question 10

Choose:

Why should you not let a grotesque but relatively minor extremity injury sidetrack you or the patient when assessing a patient with musculoskeletal injuries?

A. The pain or terrible appearance of an extremity injury may distract the patient and you from awareness of other injuries or symptoms.

B. It’s important to remember where you are in the assessment process to make sure you follow the steps correctly.

C. You will treat any musculoskeletal injury the same way, and so it’s wrong to assign importance to injuries based on appearance.

D. The more apparently gruesome an injury is, the less likely it is to actually be serious.

Answer 10

A

In cases of severe extremity​ trauma, injuries can be very obvious.​ However, when treating trauma​ patients, your priority must be to rapidly identify and treat​ life-threatening conditions first. Do not let a grotesque but relatively minor extremity injury sidetrack you or the patient. The pain or terrible appearance of an extremity injury may distract the patient from awareness of other injuries or​ symptoms, such as abdominal pain from internal bleeding. Be sure to assess the patient fully and ask appropriate questions to avoid missing other injuries.

Question 11

Choose:

As you care for a patient with a possible lower leg injury, you should assess the distal pulse, motor function, and sensation:

A. only before applying a splint to the leg.

B. both before and after applying a splint to the leg.

C. every 5 minutes until arrival at the hospital.

D. only after the application of a splint to the leg.

Answer 11

B

It is important for the EMT to check the patient’s distal pulses, motor function, and sensation both before and after splinting bone and joint injuries. Document your findings in the prehospital care report.

Question 12

Choose:

You are treating a 17-year-old female who fell while playing basketball. Her right thigh is painful, swollen, and deformed. She is in considerable pain.

The most appropriate device for splinting her injury would be a:

A. inflatable splint.

B. pneumatic anti-shock garment.

C. traction splint.

D. pair of long board splints.

Answer 12

C

When a patient has a suspected isolated femoral shaft fracture (painful, swollen, and deformed thigh, and a leg that is flexed and will not straighten), the most appropriate splint is the traction splint.

Question 13

Choose:

If a commercial pelvic splint is not available, the next best alternative is:

A. backboard straps and a long wooden splint.

B. a pelvic wrap improvised from a sheet.

C. a sling and swathe.

D. cot straps and a backboard.

Answer 13

B

Question 14

Choose:

For a high-priority, unstable patient with musculoskeletal injuries, you should:

A. apply a cervical collar and then splint specific injuries before transport.

B. splint specific injuries before transport.

C. position the patient on the less injured side and then “load and go.”

D. immobilize the whole body on a long spine board and “load and go.”

Answer 14

D

Question 15

Choose:

A 22-year-old female patient slipped running down stairs, and has injured her right tibia and fibula. You have used an air splint to splint the injury.

To test an air splint, you can:

A. drum your fingers briefly on the side of the splint.

B. gently brush the length of the split with your fingertips.

C. see if you can cause a slight dent in the plastic with fingertip pressure.

D. ask the patient if the splint is tight enough without being painful.

Answer 15

C

Question 16

Choose:

The first effects of a bone injury are swelling of soft tissue and:

A. tearing of cartilage connected to the bone.

B. strain of muscles and sprain of ligaments associated with the bone.

C. referred pain from the injury to associated muscle and bone groups.

D. the formation of a blood clot in the area of the fracture.

Answer 16

D

bone healing process:

1. break causes soft tissue swelling and a blood clot in the fracture area
2. interruption of blood supply causes death of bone section
3. cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone

Question 17

Choose:

If you see angulation when assessing a patient, then:

A. the patient is bending the knees or arms.

B. a bone or bones are out of anatomical position.

C. the patient’s distal pulse must be reassessed.

D. splinting is unlikely to be of assistance.

Answer 17

B

Question 18

Choose:

When treating a patient with an open musculoskeletal injury to the thigh, how would you best treat the open wound?

A. Cover the open wound with a sterile dressing, pack it with ice, and wrap it with self-adhesive bandages.

B. Cover the open wound with a sterile dressing, elevate the extremity, and apply a cold pack to the area to help reduce swelling.

C. Cover the wound with bulky dressings, keep the extremity level, and transport immediately.

D. Splint the wound, cover it with compression bandages, and transport as soon as possible.

Answer 18

B

Question 19

Choose:

A 14-year-old girl has fallen from her bicycle. She sustained injuries when she landed with her arm extended to catch her fall. According to the principles of indirect mechanisms of injury, which of the following bones is least likely to have been injured in this fall?

A. Ulna

B. Thoracic vertebra

C. Clavicle

D. Radius

Answer 19

B

Question 20

Choose:

To realign an extremity, an EMT grasps the distal extremity while a partner places one hand above and one hand below the injury site, and then:

A. the partner supports the site while the first EMT creates gentle manual traction in the direction of the long axis of the extremity.

B. each EMT pulls in a sudden sharp motion away from the site of injury along the long axis of the extremity.

C. each EMT exerts gentle manual traction on either side of the injured site until the limb snaps into place.

D. the partner immobilizes the site with a splint before the first EMT creates gentle manual traction in the direction of the long axis of the extremity.

Answer 20

A

Question 21

True or false:

A pelvis wrap can be used if the pelvis shows instability.

Answer 21

true

Question 22

True or false:

You can consider using a pelvic wrap based on mechanism of injury (MOI).

Answer 22

true

Question 23

True or false:

A pelvic wrap can be used if the pelvis shows deformity.

Answer 23

true

Question 24

True or false:

A pelvic wrap should not be used unless the patient shows signs of shock.

Answer 24

false

Question 25

# True or false: An angulated break is when the broken bone segments are at an angle to one another.

Answer 25

true

Question 26

# True or false: A comminuted break is when a bone is broken in only one place.

Answer 26

false

Question 27

# True or false: A greenstick break is an incomplete break in a bone.

Answer 27

true

Question 28

# True or false: A fracture is any break in a bone.

Answer 28

true

Question 29

# Describe: most common type of hip dislocation

Answer 29

posterior hip dislocation

Question 30

# True or false: An anterior hip dislocation would probably present with the entire lower limb rotated inward.

Answer 30

false | it would be outward

Question 31

# True or false: A posterior hip dislocation presents with a bent knee and the foot may hang loose.

Answer 31

true

Question 32

# True or false: With a hip fracture, there is often a lack of sensation in the limb.

Answer 32

true

Question 33

# Choose: The part of the skeleton that includes the skull and spinal column is called the: ## Footnote **A.** appendicular skeleton. **B.** axial skeleton. **C.** boney skeleton. **D.** torso.

Answer 33

**B**

Question 34

# Choose: Which of the following is appropriate in the examination of a painful, swollen extremity of a conscious patient? ## Footnote **A.** Comparing the injured side to the uninjured side **B.** Gently attempting to flex the mid-portion of the bone to check for angulation **C.** Asking the patient to see if he can bear weight on the extremity **D.** Seeing if you can elicit crepitus on palpation

Answer 34

**A**

Question 35

# Choose: One of the more serious conditions that EMTs are confronted with would occur as follows: A fracture or crush injury causes bleeding and swelling within the extremity. Pressure and swelling caused by the bleeding within the muscle compartment become so great that the body can no longer perfuse the tissues against the pressure. Cellular damage occurs and causes additional swelling. Blood flow to the area is lost. The limb itself may be lost if the pressure is not relieved. **What is this condition called?** ## Footnote **A.** Compartment syndrome **B.** Crushing syndrome **C.** Fracture syndrome **D.** Perfusing syndrome

Answer 35

**A**

Question 36

# Choose: Your patient is a 28-year-old male who was ejected from his motorcycle after striking a parked vehicle. He has multiple deformities to his upper and lower extremities on both sides. **Which of the following would be the best way to immobilize this patient’s extremities prior to transport?** ## Footnote **A.** Immobilize the patient to a long backboard without splinting the extremities individually. **B.** Use traction splints for the lower extremities and allow the upper extremities to be immobilized by the long backboard. **C.** Use moldable splints for the upper and lower extremities, padding any voids to fully stabilize the fractures. **D.** Use padded board splints for the upper extremities and a PASG for the lower extremities.

Answer 36

**A**

Question 37

# Choose: Which of the following hazards may arise from *properly* splinting an injured extremity? ## Footnote **A.** Converting a closed fracture to an open one **B.** Ignoring life-threatening problems while focusing on an extremity injury **C.** Compromising circulation to the extremity **D.** All of the above

Answer 37

**B** | "splinting the patient to death"

Question 38

# Choose: A suspected musculoskeletal injury of the shoulder is best managed by which of the following techniques? ## Footnote **A.** Placing the arm in a sling and using a triangular bandage to secure it to the body **B.** Using a long-arm air splint **C.** Placing two long padded board splints on either side of the extremity, extending from the shoulder to the wrist **D.** Using an upper extremity traction splint

Answer 38

**A**

Question 39

# Choose: Which of the following is *not* a principle of splinting that must be considered by the EMT? ## Footnote **A.** Immobilize the site of an extremity injury from the joint above it to the joint below it. **B.** Check the distal neurovascular function before and after splinting. **C.** Splint an isolated extremity injury before moving the patient to the stretcher. **D.** Gently replace protruding bone ends back beneath the skin to prevent further contamination.

Answer 39

**D**

Question 40

# True or false: Another name for manual traction is tension.

Answer 40

true

Question 41

# True or false: A sprain is the stretching and tearing of ligaments.

Answer 41

true

Question 42

# True or false: Joints are places where bones articulate.

Answer 42

true

Question 43

# Choose: Your patient is a 20-year-old college student who has fallen from a third-level balcony onto a wooden deck below. The patient responds to verbal stimuli, is pale in color with moist skin, and has a very obvious deformity with protruding bone ends of his right forearm. **Which of the following is the best sequence of intervention for this patient?** ## Footnote **A.** Provide immediate manual in-line stabilization of the cervical spine; apply high-concentration oxygen by nonrebreather mask; perform a focused history and assessment; apply the cervical collar; apply a padded board splint, sling, and swathe to the forearm injury; and transport. **B.** Provide manual in-line stabilization of the cervical spine along with assessment of breathing, pulse, and the presence of significant hemorrhage; apply high-concentration oxygen; perform a rapid trauma exam; immobilize to a long backboard; and check with medical control about the need to splint the forearm injury prior to transport. **C.** Provide manual in-line stabilization of the cervical spine along with assessment of breathing, pulse, and the presence of significant hemorrhage; apply high-concentration oxygen; perform a rapid trauma exam; immobilize to a long backboard; transport; and splint the extremity en route if time and resources allow. **D.** Open the airway; assess breathing; check the carotid pulse; splint the forearm injury; immobilize the patient to a long backboard; apply high-concentration oxygen; and transport.

Answer 43

**C**

Question 44

# Choose: A painter falls from his ladder and tells you he has dislocated his shoulder again. When you attempt to splint the shoulder, it “pops back into place." **What should your next step be?** ## Footnote **A.** Check distal CSM, apply a sling and swathe, and transport the patient. **B.** Contact medical control for input into the best treatment for this patient. **C.** Check distal CSM, apply a traction splint, and transport the patient. **D.** Report the popping sound to the receiving physician when you arrive at the hospital.

Answer 44

**A**

Question 45

# Choose: Your patient is a 37-year-old man who tripped while walking down a hill and now has a painful, deformed right leg. Your assessment reveals that the foot is cold and mottled in appearance. You cannot detect a pulse in the foot or ankle. **Which of the following is the *best* course of action?** ## Footnote **A.** Transport rapidly to the nearest trauma center. **B.** Gently attempt to straighten the leg to regain a pulse before splinting. **C.** Splint the leg in the position in which it was found and transport without delay. **D.** Explain to the patient that, because you cannot detect circulation in his foot, his leg will most likely have to be amputated above the site of the injury.

Answer 45

**B**

Question 46

# True or false: Tendons are bands of connective tissue that bind the ligaments to muscles.

Answer 46

false

Question 47

# True or false: Muscles are the tissues or fibers that cause movement of body parts or organs.

Answer 47

true

Question 48

# True or false: Cartilage is connective tissue that covers the outside of the bone end and acts as a surface for articulation.

Answer 48

true

Question 49

# True or false: Ligaments are connective tissues that connect bone to bone.

Answer 49

True

Question 50

# Choose: There are general rules that apply to all types of splinting. **Which of the following is *not* a general rule of splinting?** ## Footnote **A.** Align long-bone injuries to anatomical position. **B.** In order to avoid loss of use of a limb, it is important to splint before moving, even if the patient is unstable. **C.** Assess distal CSM. **D.** Expose the injury.

Answer 50

**B** | treat life-threatening conditions first to avoid "splinting to death"

Question 51

# Choose: Which of the following *best* describes the compartment syndrome? ## Footnote **A.** A life-threatening condition caused by trapping the blood flow by a fracture when the bone ends cut the blood vessels **B.** A non-life-threatening condition caused by orthopedic injuries in which blood flow is stopped when the bone ends compress the blood vessels **C.** A serious condition caused by the bleeding and swelling from a fracture or crush injury that becomes so strong that the body can no longer perfuse the tissues against that pressure **D.** A serious condition caused by the amount of equipment that must be carried in the ambulance compartments

Answer 51

**C**

Question 52

# Choose: Which one of the following statements is *not true* concerning a knee injury? ## Footnote **A.** Fractures can occur to the proximal tibia and fibula. **B.** Fractures can occur to the patella. **C.** There could be pain and tenderness. **D.** Fractures can occur to the proximal femur.

Answer 52

**D**

Question 53

# Choose: Your patient is a 12-year-old female who fell onto her outstretched hands while rollerblading. She has a deformity of her forearm, about 2 inches proximal to her wrist. **This injury is a result of which of the following mechanisms?** ## Footnote **A.** Twisting motion **B.** Sudden acceleration **C.** Direct force **D.** Indirect force

Answer 53

**D** ## Footnote she probably landed on her hand — but the injury is to her forearm injury occurring in place that did not make contact means its indirect

Question 54

# Choose: Your patient is a 60-year-old woman who stepped off a curb and injured her ankle. Your exam shows that her left ankle is swollen and painful. **Which of the following should you do?** ## Footnote **A.** Explain to the patient that you cannot tell if her ankle is sprained or fractured until she is X-rayed at the emergency department, then splint the ankle. **B.** Explain to the patient that her ankle is fractured, and you must splint her ankle to prevent further injury and reduce pain. **C.** Transport the patient immediately to a trauma center, applying high-concentration oxygen en route. **D.** Explain to the patient that her ankle is sprained and transport her with her ankle elevated on a pillow and a cold pack applied to the injury.

Answer 54

**A**

Question 55

# Choose: You are treating a 16-year-old skateboarder who has fallen at the skate park. She has an angulated left forearm that she has in a guarded position. **When do you splint this injury?** ## Footnote **A.** During the primary exam **B.** En route to the hospital **C.** Immediately **D.** During the secondary exam

Answer 55

**D**

Question 56

# Choose: A new EMT who is treating a suspected femur injury asks his partner, “How much traction should I pull?” **The partner’s best reply is which of the following?** ## Footnote **A.** The amount of traction applied should be 15 pounds. **B.** No traction splint applied in the field pulls true traction; they must pull 20 pounds of countertraction. **C.** Pull enough traction to give the patient some relief from the pain. **D.** The amount of traction applied should be roughly 10% of the patient’s body weight and not exceed 15 pounds.

Answer 56

**D**

Question 57

# Choose: Which of the following is the *most* definitive sign of a fractured extremity? ## Footnote **A.** Pain upon palpation **B.** Swelling and redness along the shaft **C.** Mid-shaft angulation **D.** Absent distal pulses

Answer 57

**C** ## Footnote *A mid-shaft angulation is the MOST definitive sign of a fractured extremity. Many things can cause the other 3. Nothing except a fracture could cause the actual bone to be angulated along the shaft.*

Question 58

# Choose: A 34-year-old female ballerina is coming down from an aerial move and sustains a severe lateral ankle sprain. She needs to be carried off of the stage as she says she cannot walk on it and 911 is called. On evaluation, you note significant swelling and erythema around the lateral malleolus. There are the beginnings of a bruise at the base of the malleolus. She is squirming due to the pain and has trouble cooperating with even a simple musculoskeletal exam. **Which of the presenting signs is most suggestive of a significant underlying injury?** ## Footnote **A.** The presence of perimalleolar swelling **B.** The bruise forming at the base of the lateral malleolus **C.** Significant pain limiting cooperation with exam **D.** The inability to ambulate

Answer 58

**D** ## Footnote *By far one of the most objectively concerning signs of significant ankle injury is the inability to ambulate. This sign is an indication for ankle X-rays to be taken. While this is not an emergency requiring transport, the patient should be evaluated in the emergency department as soon as reasonably possible. The other key sign of underlying injury would be significant tenderness to palpation at the head of the 5th metatarsal or the medial midfoot area. The most common acute injury in theatrical dance is the ankle sprain, usually involving the lateral ligamentous structures. Proper ballet positioning, while beautiful and artful, also destabilizes the ankle and foot support when landing from a jump.*

Question 59

# Choose: The *first step* in the progression of compartment syndrome is that: ## Footnote **A.** cellular damage occurs and causes additional swelling. **B.** pressure and swelling caused by bleeding within a muscle compartment become so great that the body can no longer perfuse the tissues against the pressure. **C.** a fracture or crush injury causes bleeding or swelling in an extremity. **D.** blood flow to the area is lost, and the limb itself may be lost if the pressure is not relieved.

Answer 59

**C**

Question 60

# Choose: What is the primary concern about a splint that is applied too loosely? ## Footnote **A.** It could cause pressure sores to develop from skin rubbing against the splint. **B.** It could allow the bone fragments to move, which could cause further damage. **C.** The splint will cut off distal circulation. **D.** The patient will lose motor function in that extremity.

Answer 60

**B**