EMT CHAPTER 31

Ligament

A band of fibrous tissue that connects bones to bones. It supports and strengthens a joint

Sling

A bandage or material that helps to support the weight of an uninjured upper extremity

Swathe

A bandage that passes around the chest to secure an injured arm to the chest

Pelvic binder

A device to splint the bony pelvis to reduce hemorrhage from bone ends, Venous disruption, and pain

Splint

A flexible or rigid device used to protect and maintain the position of an injured extremity

Displaced fracture

A fracture in which bone fragments are separated from one another, producing deformity in the Limb

A fracture is MOST accurately defined as a(n): A. break in the continuity of the bone. B. total loss of function in a bone. C. abnormality in the structure of a bone. D. disruption in the midshaft of a bone.

A. break in the continuity of the bone.

Compartment syndrome

And elevation of pressure within a closed fascial compartment, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power; frequently seen in fractures below the knee or elbow and children

Open fracture

Any break in a bone in which the overlying skin has been broken

What is the primary goal of in-line traction?

Avoid further neurovascular compromise

When assessing a patient with a possible fracture of the leg, the EMT should:

Compare it to the uninjured leg

Which of the following musculoskeletal injuries would MOST likely result in deformity? A. Hairline fracture B. Moderate sprain C. Severe strain D. Displaced fracture

D. Displaced fracture

A supracondylar or intercondylar fracture is also known as a fracture of the: A. radial head. B. proximal radius. C. olecranon process. D. distal humerus.

D. distal humerus.

A "hip" fracture is actually a fracture of the: A. pubic symphysis. B. femoral shaft. C. pelvic girdle. D. proximal femur.

D. proximal femur.

Skeletal muscle is attached to the bone by tough, ropelike, fibrous structures called: A. ligaments. B. fascia. C. cartilage. D. tendons.

D. tendons.

Fractures of the proximal femur usually involve the hip joint. T/F

F Correct. Fractures of the proximal femur are usually called hip fractures, but they rarely involve the hip joint.

Position of function

I hand position in which the rest is slightly dorsiflexed and all finger joints are moderately flexed

A 17-year-old football player collided with another player and has pain to his left clavicle. He is holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the midshaft clavicle. After assessing distal pulse, sensory, and motor functions, you should:

Immobilize the injury with a sling and swathe

When splinting a possible fracture of the foot, it is MOST important for the EMT to:

Leave the toes exposed

Traction

Longitudinal force applied to a structure

Of the following musculoskeletal injuries, which is considered to be the LEAST severe?

Nondisplaced pelvic fracture

Which of the following musculoskeletal injuries has the greatest risk for shock due to blood loss?

Pelvic fracture

Which of the following fractures has the greatest potential for internal blood loss and shock?

Pelvis

Joint

Place where two bones come to contact

A motorcyclist crashed his bike and has close deformities to both of his midshaft femur's. He is conscious, but restless; his skin is cool and clammy; and his radio pulses are rapid and weak. The most appropriate splinting technique for this patient involves

Securing him to a long backboard

Skeletal muscle is also referred to as __________ muscle

Striated muscle

Fascia

The fiber like connective tissue that covers arteries, veins, tendons, and ligaments

Which of the following structures is regulated by smooth muscle?

blood vessels

Which of the following would you use to stabilize an AC separation?

sling and swathe

What is the primary goal of in-line traction? -Minimize pain -Avoid further neurovascular compromise -Reduce swelling -Prevent permanent disability

- Avoid further neurovascular compromise

Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome? -Referred pain -Limb deformity -Disproportionate pain -Hypersensation

- Disproportionate pain Disproportionate pain on passive stretch of muscles within the compartment is a sign of compartment syndrome.

In which situations should you splint the limb in the position of deformity? - When the deformity is the result of a dislocation and is severe - When you encounter resistance or extreme pain when applying traction - When distal pulses are absent - When the fracture is an open fracture

- When the deformity is the result of a dislocation and is severe - When you encounter resistance or extreme pain when applying traction

A disruption of a joint in which the bone ends are no longer in contact is known as what? -Dislocation -Fracture -Sprain -Strain

-Dislocation A dislocation is a disruption of a joint in which the bone ends are no longer in contact.

When assessing distal circulation in a patient's lower extremities, which pulse should you palpate? -Femoral -Dorsalis pedis -Popliteal -Iliac

-Popliteal You would palpate the popliteal artery in lower extremity wounds.

In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel? -Moderate -Serious -Severe -Critical

-Serious

Which of the following would you use to stabilize an AC separation? -Zippered air splint -Rigid splint -Sling and swathe -Traction splint

-Sling and swathe An AC separation occurs in the shoulder and so using a sling and swathe is an effective way to splint the injury.

You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury? -Splint from the shoulder joint to the wrist joint to stabilize the entire arm. -Apply a Sager traction splint to stabilize the joint. -Apply a sling and swathe to reduce pain. -Apply ice to reduce swelling.

-Splint from the shoulder joint to the wrist joint to stabilize the entire arm. When splinting a fracture in and around a joint, be sure to stabilize the bones above and below the injured joint.

Which of the following are goals of in-line traction? -Stabilize the fragments to prevent movement -Align the limb for splinting -Stop bleeding -Avoid neurovascular compromise

-Stabilize the fragments to prevent movement -Align the limb for splinting -Avoid neurovascular compromise

Rearrange the injuries from least to most severe based on the musculoskeletal injury grading system. 1) Dislocated fingers 2) Bilateral femur fracture 3) Displaced pelvic fracture 4) Pelvic fracture with hemodynamic instability 5) Nondisplaced long bone fracture

1) Dislocated fingers 5) Nondisplaced long bone fracture 3) Displaced pelvic fracture 2) Bilateral femur fracture 4) Pelvic fracture with hemodynamic instability

Sprain

A joint injury involving damage to supporting ligaments, and sometimes partial or temporary dislocation of bone ends

Which of the following scenarios is an example of a direct injury?

A passenger fractures her patella after it strikes the dashboard

Articular cartilage

A pearly white layer of specialized cartilage covering the articular surfaces on bones in synovial joints

Acromioclavicular joint

A simple joint with a bony projections of the scapula and the clavicle meet at the top of the shoulder

To effectively immobilize a fractured clavicle you should apply

A sling and swathe

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should: A. apply gentle manual traction in line with the limb and reassess for a pulse. B. carefully straighten the injured arm and secure it with padded board splints. C. splint the elbow in the position of deformity and transport immediately. D. make two or three attempts to restore distal circulation by manipulating the elbow.

A. apply gentle manual traction in line with the limb and reassess for a pulse.

Amputation

An injury in which part of the body is completely severed

Closed fracture

Any break in a bone in which the overlying skin is not broken

A construction worker's arm was severed just above the elbow when a steel girder fell on it. The stump is covered with a blood-soaked towel. The patient's skin is cool, clammy, and pale. The EMT should:

Apply a tourniquet just below the shoulder

A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. You should:

Apply padded board splints to both sides of the leg

You have applied a zippered air splint to a patient's left arm. During transport, the patient complains of increased numbness and tingling in his left hand. You reassess distal circulation and note that it remains present. Your MOST appropriate action should be to:

Assess the amount of air in the splint and let air out as necessary

Which of the following statements regarding compartment syndrome is correct? A. In most cases, compartment syndrome develops within a few minutes after an injury. B. Compartment syndrome typically develops within 6 to 12 hours after an injury. C. Most cases of compartment syndrome occur following a severe fracture of the pelvis. D. Compartment syndrome occurs because of increased pressure within the bone cavity.

B. Compartment syndrome typically develops within 6 to 12 hours after an injury.

When caring for a patient with a possible fracture of the scapula, the EMT should: A. assume that minimal force was applied to the back. B. carefully assess the patient for breathing problems. C. recognize that scapular fractures are life threatening. D. apply rigid board splints across the chest and back.

B. carefully assess the patient for breathing problems.

In general, musculoskeletal injuries should be splinted before moving the patient unless: A. transport time is less than 15 minutes. B. the patient is clinically unstable. C. deformity and swelling are present. D. the patient is in severe pain.

B. the patient is clinically unstable.

Fracture

Break in the continuity of a bone

In which of the following situations should the EMT splint an injured limb in the position of deformity? A. When distal circulation and neurological functions are absent B. If transport time to the hospital is greater than 20 to 30 minutes C. If resistance is encountered or the patient experiences severe pain D. If a traction splint will be used to immobilize the injured extremity

C. If resistance is encountered or the patient experiences severe pain

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should: A. manually stabilize the leg above and below the site of injury. B. gently manipulate the injured leg until the numbness dissipates. C. control the bleeding and cover the wound with a sterile dressing. D. assess distal pulses as well as sensory and motor functions.

C. control the bleeding and cover the wound with a sterile dressing.

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should: A. assess for a carotid pulse and assist her ventilations. B. administer oxygen and perform a rapid assessment. C. stabilize her head and perform a primary assessment. D. apply manual stabilization to both of her femurs.

C. stabilize her head and perform a primary assessment.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? A. Bilateral femur fractures B. An amputated extremity C. Nondisplaced long bone fractures D. Pelvic fracture with hypotension

D. Pelvic fracture with hypotension

With regard to musculoskeletal injuries, the zone of injury is defined as the: A. exact part of the bone or joint that was disrupted. B. part of the body that sustained secondary injury. C. area of obvious deformity over the site of impact. D. area of soft-tissue damage surrounding the injury.

D. area of soft-tissue damage surrounding the injury.

The musculoskeletal system refers to the: A. involuntary muscles of the nervous system. B. nervous system's control over the muscles. C. connective tissue that supports the skeleton. D. bones and voluntary muscles of the body.

D. bones and voluntary muscles of the body.

The MOST significant hazard associated with splinting is: A. reduction in circulation distal to the injury site. B. compression of nerves, tissues, and vasculature. C. aggravation of the injury or worsened pain. D. delaying transport of a critically injured patient.

D. delaying transport of a critically injured patient.

A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should: A. gently straighten her knee and apply a padded board splint. B. flex her knee slightly more and assess for distal circulation. C. keep her knee flexed and secure it with padded board splints. Correct D. make one attempt to return the patella to its normal position.

D. make one attempt to return the patella to its normal position.

Crepitus and false motion are: A. most common with dislocations. B. indicators of a severe sprain. C. only seen with open fractures. D. positive indicators of a fracture.

D. positive indicators of a fracture.

During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should: A. perform a focused physical exam with emphasis on the pelvis. B. defer spinal immobilization and transport to a trauma center. C. log roll the patient onto a long backboard and transport at once. D. stabilize the pelvis with a pelvic binder and protect the spine.

D. stabilize the pelvis with a pelvic binder and protect the spine.

An open fracture is MOST accurately defined as a fracture in which: A. a large laceration overlies the fracture. B. a bullet shatters the underlying bone. C. bone ends protrude through the skin. D. the overlying skin is no longer intact.

D. the overlying skin is no longer intact.

A disruption of a joint in which the bone ends are no longer in contact is known as what?

Dislocation

Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome?

Disproportionate pain

When treating an open extremity fracture, you should

Dress the wound before applying a splint

If you are unable to restore the distal pulse on scene, you should splint the limb in a straight position and provide prompt transport to the hospital. T/F

F Correct. If you are unable to restore the distal pulse, splint the limb in the position that is most comfortable for the patient and provide prompt transport to the hospital.

During your secondary assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes

Immobilizing her to a backboard and rapidly transporting

Which MOI causes a fracture or dislocation at a distant point?

Indirect force

A patient tripped, fell, and landed on her elbow. She is in severe pain and has obvious deformity to her elbow. You should

Manually stabilize her injury

Which of the following statements regarding shoulder dislocations is correct?

Most shoulder dislocations occur anteriorly

False motion

Movement that occurs in a bone at a point where there is no joint, indicating a fracture; also called free movement

What is the most reliable indicator of an underlying fracture?

Point tenderness

When assessing distal circulation in a patient's lower extremities which pulse should you palpate?

Popliteal

A 30-year-old man complains of severe pain to his right tibia following an injury that occurred the day before. The patient's leg is pale and he is unable to move his foot. The EMT should suspect that:

Pressure in the fascial compartment is elevated

The purpose of splinting a fracture is to

Prevent motion of bony fragments

Applying ice to and elevating an injured extremity are performed in order to:

Reduce pain and swelling

The pectoral girdle consists of

Scapulae and clavicles

A young male has a musculoskeletal injury and is unresponsive. You will not be able to assess

Sensory and motor functions

In the musculoskeletal system, under which category would you place a laceration of a major nerve or blood vessel?

Serious

Nondisplaced fracture

Simple crack in the bone that has not caused the bone to move from its normal anatomic function; also called a hairline fracture

You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury?

Splint from shoulder to wrist joint to stabilize the entire arm

A 31-year-old male fell and landed on his left elbow. Your assessment reveals that the elbow is grossly deformed, his forearm is cool and pale, and the distal pulse is barely palpable. His vital signs are stable and he denies any other injuries. Your transport time to the closest appropriate hospital is approximately 12 minutes. You should:

Splint the elbow in the position found and transport

A patient injured her knee while riding a bicycle. She is lying on the ground, she has her left leg flexed, is in severe pain, and cannot move her leg. Your assessment reveals obvious deformity to her left knee. Distal pulses are present and strong. The most appropriate treatment for her injury involves

Splinting the leg in the position in which it was found

A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone ends as well as partial stretching or tearing of the supporting ligaments.

Sprain

You respond to a soccer game for 16-year-old male with severe ankle pain. When you deliver him to the hospital, the physician tells you that he suspects a sprain. This means that

Stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred

Strain

Stretching or tearing of the muscle; also called a muscle pull

A fracture of the femoral shaft is best stabilized with a traction splint, such as a Sager splint. T/F

T Correct. A fracture of the femoral shaft is best stabilized with a traction splint, such as a Sager splint.

Lateral and medial dislocations to the knee are less common than posterior dislocations and are less likely to injure the popliteal artery. T/F

T Correct. Lateral and medial dislocations to the knee are less common than posterior dislocations and are less likely to injure the popliteal artery.

Which of the following is a drawback of an air splint?

Temperature changes affect air pressure in the splint

Point tenderness

Tenderness that is sharply localized at the site of the injury, found by gently palpating along the bone with tip of one finger

Zone of injury

The area of potentially damage soft tissue, adjacent nerves, and blood vessels surrounding an injury to a bone or joint

Tourniquet

The bleeding control method used when a route continues to bleed despite the use of direct pressure in elevation; useful if a patient is severely bleeding from a partial or complete amputation

Calcaneous

The heel bone

Glenoid fossa

The part of the scapula that joins with the humeral head to form the glenohumeral joint

Retroperitoneal space

The space between the abdominal cavity in the posterior abdominal wall, containing the kidneys, certain large muscles, and parts of the gastrointestinal tract

Reduce

To return a dislocated joint or fractured bone to its normal position; to set

The primary purpose for splinting a musculoskeletal injury is to:

prevent further injury.