Chapter 31 Orthopaedic Injuries
Deformity caused by a fracture would MOST likely be masked by: A. swelling. B. guarding. C. crepitus. D. ecchymosis.
A
The act of pulling on a body structure in the direction of its normal alignment is called: A. traction. B. reduction. C. stabilization. D. immobilization.
A
The musculoskeletal system refers to the: A. bones and voluntary muscles of the body. B. nervous system's control over the muscles. C. connective tissue that supports the skeleton. D. involuntary muscles of the nervous system.
A
The pectoral girdle consists of the: A. scapulae and clavicles. B. clavicles and rib cage. C. sternum and scapulae. D. acromion and clavicles.
A
The EMT would recognize which patient as suffering from multisystem trauma?
A 43-year-old male with extremity trauma and shock from a motor vehicle collision
When treating an injured geriatric patient, it is very important to:
Achieve an oxygen saturation of at least 95%
You are called to a nursing home for an elderly male patient who is unresponsive. On arrival, you find the patient in a wheelchair with a noticeable hematoma to his forehead and a skin tear to his left wrist. Staff states that the patient had an episode of chest pain just before suddenly passing out and falling to the ground. What should you do immediately?
Apply spine motion restriction precautions
You are transporting an elderly female who fell in a nursing home and displays outward rotation of her left leg. She has a lengthy medical history, including dementia. Currently, she is very quiet and receiving oxygen through a nasal cannula at 6 liters per minute. She also is secured to a long spine board. During your reassessment, you note her to be alert but confused, with slightly accelerated respirations and a strong radial pulse. You also note that her SpO2 has dropped from 97% on scene to 91%. You should:
Apply supplemental oxygen
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. A. strain B. sprain C. fracture D. dislocation
B
A fracture caused by minimal force that is associated with diseases such as cancer and osteoporosis is called a __________ fracture. A. greenstick B. pathologic C. transverse D. comminuted
B
A supracondylar or intercondylar fracture is also known as a fracture of the: A. radial head. B. distal humerus. C. proximal radius. D. olecranon process.
B
Bone marrow produces: A. platelets. B. blood cells. C. lymphocytes. D. electrolytes.
B
Skeletal muscle is also referred to as __________ muscle. A. smooth B. striated C. connective D. involuntary
B
When assessing a patient with a possible fracture of the leg, the EMT should: A. assess proximal circulation. B. compare it to the uninjured leg. C. carefully move it to elicit crepitus. D. ask the patient to move the injured leg.
B
Atrophy is a condition that occurs when: A. increased use of skeletal muscle causes an increase in its strength. B. the tendons that attach muscle to bone become stretched or injured. C. muscle decreases in size and function because of disease or trauma. D. carbon dioxide, lactic acid, and other wastes accumulate in the muscle.
C
Crepitus and false motion are: A. indicators of a severe sprain. B. only seen with open fractures. C. positive indicators of a fracture. D. most common with dislocations.
C
The EMT is correctly assessing a 2-year-old male patient who is unresponsive after being assaulted by the mother's live-in boyfriend when he:
Checks capillary refill time to help determine perfusion
An open fracture is MOST accurately defined as a fracture in which: A. bone ends protrude through the skin. B. a large laceration overlies the fracture. C. a bullet shatters the underlying bone. D. the overlying skin is no longer intact.
D
Bones are connected to other bones by bands of tough fibrous tissues called: A. bursa. B. tendons. C. cartilage. D. ligaments.
D
Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? A. an amputated extremity B. bilateral femur fractures C. nondisplaced long bone fractures D. pelvic fracture with hypotension
D
What is the first golden principle for prehospital multisystem trauma care?What is the first golden principle for prehospital multisystem trauma care?
Ensure safety of the rescue personnel and the patient
A female patient who is 35 weeks pregnant tripped and fell down 12 stairs. She now complains of back pain, numbness to her legs, and nausea. She is secured to a long spine board with spinal motion restriction precautions placed and is being non-emergently transported to the hospital for evaluation. En route, the patient exclaims that she is having contractions and thinks that her water may have broken. Which intervention should you perform immediately?
Examine her genitalia for crowning or bleeding
The EMT is correctly assessing the perfusion status of a 10-month-old when she:
Feels for a brachial pulse
Which statement accurately describes multisystem trauma?
Multisystem trauma has a noted higher incidence of morbidity and mortality
An 81-year-old woman with severe kyphosis and osteoporosis fell and now complains of neck pain, back pain, and nausea. You can palpate a lateral displacement of a cervical vertebrae. Given the patient's past medical history, what is most appropriate?
Place her in a supine position on the long spine board and pad all voids
A 78-year-old male pedestrian was struck by a car at a convenience store. The patient is conscious but confused, and has sustained multisystem trauma. What would represent the best sequence of care for this patient?
Primary assessment, oxygen, secondary assessment, spine motion restriction precautions, and all other care en route to the hospital
A 57-year-old male has been involved in a motor vehicle collision and is entrapped in his car. He is unresponsive, with agonal gurgling respirations and blood coming from his nose. His respirations show poor effort and are inadequate. The radial pulse is rapid and weak, and the skin cool and diaphoretic. An Emergency Medical Responder is holding manual spinal motion restriction. Which action would you perform first?
Suction the airway with a catheter
When treating a pediatric trauma patient, what is important for the EMT to remember?
The flexibility of the chest wall in a child can allow for internal injury without obvious external signs
The young pediatric patient is more prone to head injury because:
The head is proportionately heavier and the neck muscles are weaker
A 62-year-old female with severe kyphosis fell and hit the back of her head, which is now oozing blood from a small laceration. Family members state that she suddenly complained of a "very bad headache" before collapsing to the kitchen floor. She has snoring respirations and cyanosis in the extremities. Which intervention should you perform first?
Use a jaw-thrust maneuver
How would you tell a pregnant woman to restrain herself when traveling in a car?
Wear all seat belts normally, as you would if not pregnant
A car swerved to miss a deer in the road and hit a utility pole at a low rate of speed. Damage to the car is minimal, but the 82-year-old male passenger was not wearing a seat belt and hit his head on the dashboard. He presents as confused and diaphoretic. His daughter, the driver, states that he has a history of dementia, high blood pressure, and diabetes, as well as coronary artery disease. She adds that he took his insulin about 2 hours ago. Which question to the daughter would be most important at this time?
"Did he eat anything today?"
A 31-year-old unrestrained pregnant female was involved in a motor vehicle collision in which she struck the steering wheel. She now complains of chest and abdominal pain. She is conscious, alert, and oriented with no deficits noted to the airway, breathing, or circulation. When asking her questions regarding her status, which questions should you ask first?
"Do you feel as though you are having contractions?"
Family has called you for a 78-year-old female with a history of dementia, because she appears more confused than normal. The primary assessment reveals no life-threatening conditions. Her vital signs are pulse, 88 beats/min; respirations, 22 breaths/min; blood pressure, 134/66 mmHg; and SpO2, 95% on room air. Aside from the dementia, the patient has a history of hypertension, COPD, and breast cancer, which resulted in the removal of her right breast 11 years ago. Lately, she has had an upper respiratory infection and is telling family that she has a headache. Your first question to family should be:
"Do you know if she fell recently and hit her head?"
You are assessing an 86-year-old male who fell down a flight of stairs after getting out of bed to use the bathroom. He complains of severe head, neck, and back pain. Which question is most appropriate to ask this patient?
"Do you know what caused you to fall?"
You have been called to a nursing home for a confused 91-year-old male patient who became dizzy and fell, striking his head on the floor. Which statement made by the nurse should be of most concern to you?
"He has a heart valve problem and takes Coumadin to help prevent his blood from clotting."
A female who is 32 weeks pregnant was involved in a motor vehicle collision. She is currently secured to the long spine board, with other spinal motion restriction precautions taken. Which patient statement should concern the EMT most?
"I think that I just had a contraction."
You are presenting information on emergency care to a class of pregnant women. A participant asks you what the most frequent cause of injury is to a woman during pregnancy. What is the correct response?
"Motor vehicle collisions account for about half of all injuries sustained during pregnancy."
You have just arrived by the side of a 23-year-old female who is 37 weeks pregnant and apneic and pulseless after being shot in the abdomen. Regarding care of this woman, which statement would you provide to other rescuers on scene?
"Waiting for ALS backup is not beneficial; we need to provide CPR and get her to the hospital now!"
A 21-year-old male was thrown over the handlebars of his motorcycle when he rear-ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should: A. bind his legs together on the backboard, keep him warm, and transport without delay. B. apply traction splints to both of his legs, keep him warm, and transport without delay. C. splint each of his deformed femurs with long board splints and transport immediately. D. apply the PASG to stabilize his femurs and transport at once.
A
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 on the side of the injury is barely palpable. His vital signs are stable and he denies any other injuries. Your transport time to the closest appropriate hospital is approximately 15 minutes. You should: A. splint the elbow in the position found and transport. B. gently manipulate the elbow to improve circulation. C. gently straighten the elbow and apply an air splint. D. apply a heat pack to the elbow to reduce swelling.
A
In moving joints, the ends of the bones are covered with: A. articular cartilage. B. synovial tendons. C. muscular fascia. D. gliding cartilage.
A
Of the following musculoskeletal injuries, which is considered to be the LEAST severe? A. nondisplaced pelvic fracture B. open fractures of a long bone C. an amputation of an extremity D. multiple closed long bone fractures
A
The MOST commonly fractured bone(s) in the body is the: A. clavicle. B. scapula. C. radius and ulna. D. midshaft femur.
A
The primary purpose for splinting a musculoskeletal injury is to: A. prevent further injury. B. maximize distal circulation. C. make the patient comfortable. D. facilitate ambulance transport.
A
When caring for a patient with a possible fracture of the scapula, the EMT should: A. carefully assess the patient for breathing problems. B. apply rigid board splints across the chest and back. C. assume that minimal force was applied to the back. D. recognize that scapular fractures are life threatening.
A
Which of the following joints allows no motion? A. skull sutures B. sacroiliac joint C. shoulder joint D. sternoclavicular joint
A
Which of the following scenarios is an example of a direct injury? A. A passenger fractures her patella after it strikes the dashboard. B. A skier dislocates his knee after a twisting injury to the ankle. C. A person lands on his or her feet and fractures the lumbar spine. D. A child dislocates his elbow after falling on his outstretched arm.
A
Which of the following statements regarding compartment syndrome is correct? A. Compartment syndrome typically develops within 6 to 12 hours after an injury. B. Compartment syndrome occurs because of increased pressure within the bone cavity. C. In most cases, compartment syndrome develops within a few minutes after an injury. D. Most cases of compartment syndrome occur following a severe fracture of the pelvis.
A
You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival, you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position away from his body. There is an obvious anterior bulge to the area of injury. You should: A. assess distal pulse, motor, and sensory functions. B. gently attempt to move his arm toward his body. C. place a pillow under his arm and apply a swathe. D. flex his arm at the elbow and then apply a sling.
A
A female patient who is 36 weeks pregnant with twins tripped in a parking lot, hitting her head, her wrist, and her abdomen. She is alert and oriented and complains of a headache and abdominal and wrist pain. She denies shortness of breath and has an SpO2 of 96% on ambient air. Assessment reveals a large abrasion and hematoma to her forehead and abdomen as well as deformity to her left wrist. Which intervention would best treat the injuries the fetuses may have suffered?
Administering high-concentration oxygen through a nonrebreather mask
When treating a pregnant female who was involved in a traumatic event during her third trimester, the EMT must remember:
An elevated heart rate seen in shock may not be discernable from the elevated heart rate from the patient's increased blood volume
Which statement is true regarding care of the multisystem trauma patient?
Any threat to life should be managed as it is identified
A 37-year-old woman, who is four months pregnant, complains of abdominal and pelvic pain after being assaulted in her home by a live-in boyfriend. During the assault, he struck her in the head, chest, and abdomen with his fists and a chair as she lay on the floor. There are no obvious threats to the airway, breathing, or circulation. Her vital signs are pulse, 124 beats/min; respiration, 22 breaths/min; blood pressure, 114/68 mmHg; and SpO2, 98% on room air. Which intervention is needed for this patient?
Apply a nonrebreather mask with high-concentration oxygen
An elderly female fell and is now very confused. You are having a problem getting her past medical history. Her daughter states that she is typically alert and very well oriented. What is your next best action?
Ask the patient's daughter for the history
Which actions by the EMS crew have met the platinum ten minutes criteria?
Assessed, provided spinal motion restriction precautions, and initiated transport within 10 minutes of arriving on scene
A fracture is MOST accurately defined as a(n): A. total loss of function in a bone. B. break in the continuity of the bone. C. disruption in the midshaft of a bone. D. abnormality in the structure of a bone.
B
Applying ice to and elevating an injured extremity are performed in order to: A. prevent further injury. B. reduce pain and swelling. C. enhance tissue circulation. D. maintain extremity perfusion.
B
Common signs and symptoms of a sprain include all of the following, EXCEPT: A. swelling. B. deformity. C. ecchymosis. D. point tenderness.
B
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. splint the elbow in the position of deformity and transport immediately. B. apply gentle manual traction in line with the limb and reassess for a pulse. C. carefully straighten the injured arm and secure it with padded board splints. D. make two or three attempts to restore distal circulation by manipulating the elbow.
B
During your rapid 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: A. applying and inflating the pneumatic antishock garment (PASG) and transporting. B. immobilizing her to a backboard and rapidly transporting. C. applying a traction splint to immobilize her femur. D. carefully splinting each of her deformed extremities.
B
If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting: A. distal circulation. B. the patient history. C. bruising to the shoulder. D. the presence of deformity.
B
In general, musculoskeletal injuries should be splinted before moving the patient unless: A. the patient is in severe pain. B. the patient is clinically unstable. C. deformity and swelling are present. D. transport time is less than 15 minutes.
B
Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called: A. fascia. B. tendons. C. cartilage. D. ligaments.
B
The PASG is absolutely contraindicated in patients who have: A. pelvic fractures. B. pulmonary edema. C. bilateral femur fractures. D. any trauma below the pelvis.
B
Which of the following types of muscle is under direct voluntary control of the brain? A. cardiac B. skeletal C. smooth D. autonomic
B
A 17-year-old football player collided with another player and has pain to his left clavicular area. 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: A. perform a rapid secondary assessment. B. straighten his arm and apply a board splint. C. immobilize the injury with a sling and swathe. D. place a pillow under his arm and apply a sling.
C
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. The MOST appropriate method of splinting this injury involves: A. applying a traction splint to realign the deformity. B. applying and fully inflating the pneumatic antishock garment (PASG). C. applying padded board splints to both sides of the leg. D. binding the legs together and elevating them 6″ to 8″.
C
A subluxation occurs when: A. ligaments are partially severed. B. a fracture and a dislocation exist. C. a joint is incompletely dislocated. D. a bone develops a hairline fracture.
C
A(n) __________ fracture occurs in the growth section of a child's bone and may lead to bone growth abnormalities. A. greenstick B. diaphyseal C. epiphyseal D. metaphyseal
C
Assessing a person's neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT: A. assessing motor function. B. assessing sensory function. C. evaluating proximal pulses. D. determining capillary refill.
C
During your rapid secondary assessment of a 30-year-old male who fell 25′, 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. defer spinal immobilization and transport to a trauma center. B. perform a focused physical exam with emphasis on the pelvis. C. stabilize the pelvis with a pelvic binder and protect the spine. D. log roll the patient onto a long backboard and transport at once
C
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
Traction splints are used primarily to immobilize and secure fractures of the: A. hip. B. pelvis. C. femur. D. humerus.
C
Which of the following statements regarding shoulder dislocations is MOST correct? A. Posterior dislocations are most common. B. They are caused by forced arm adduction. C. Most shoulder dislocations occur anteriorly. D. They involve the acromion process and humerus.
C
Which of the following structures is regulated by smooth muscle? A. heart B. skeleton C. blood vessels D. diaphragm
C
With regard to musculoskeletal injuries, the zone of injury is defined as the: A. area of obvious deformity over the site of impact. B. exact part of the bone or joint that was disrupted. C. area of soft-tissue damage surrounding the injury. D. part of the body that sustained secondary injury.
C
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: A. elevate the injured arm and reassess distal sensory function. B. inflate the splint with more air until the patient is comfortable. C. assess the amount of air in the splint and let air out as necessary. D. remove the air splint and reimmobilize with padded board splints.
C
You suspect that your patient-a lethargic 6-month-old baby-is the victim of child abuse. When performing the primary assessment, which assessment parameter should you use to quickly establish his perfusion?
Capillary refill
An 89-year-old female with dementia, who is being cared for by her daughter, fell and now exhibits deformity to her left upper arm. As you attempt to splint her arm, she continually screams and pulls away from you. After several attempts, your best course of action should be to:
Coach the daughter on how to help apply the splint
An unrestrained female patient, who was involved in a minor motor vehicle collision, refuses EMS care or transport. She is seven months pregnant and is alert and oriented. When asked, she denies any complaint. Your best action would be to:
Contact medical direction for instructions
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. apply manual stabilization to both of her femurs. B. administer oxygen and perform a rapid assessment. C. assess for a carotid pulse and assist her ventilations. D. stabilize her head and perform a primary assessment.
D
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. assess distal pulses as well as sensory and motor functions. B. manually stabilize the leg above and below the site of injury. C. gently manipulate the injured leg until the numbness dissipates. D. control the bleeding and cover the wound with a sterile dressing.
D
Following direct trauma to the left upper back, a 44-year-old male presents with diaphoresis and restlessness. His blood pressure is 100/50 mm Hg, his pulse rate is 120 beats/min and weak, and his respirations are 24 breaths/min and labored. Your assessment reveals abrasions and contusions over the left scapula. You should: A. hyperventilate him with a bag-mask device and monitor his oxygen saturation. B. apply high-flow oxygen, perform a detailed secondary assessment, and transport. C. focus your assessment on his scapulae and clavicles and apply high-flow oxygen. D. apply high-flow oxygen, consider spinal precautions, and transport without delay.
D
The MOST reliable indicator of an underlying fracture is: A. guarding. B. severe swelling. C. obvious bruising. D. point tenderness.
D
The MOST significant hazard associated with splinting is: A. aggravation of the injury or worsened pain. B. reduction in circulation distal to the injury site. C. compression of nerves, tissues, and vasculature. D. delaying transport of a critically injured patient.
D
The disruption of a joint in which the bone ends are no longer in contact is called a: A. strain. B. sprain. C. fracture. D. dislocation.
D
What type of muscle contracts and relaxes to control the movement of the contents within its structures? A. cardiac B. skeletal C. striated D. smooth
D
Which of the following musculoskeletal injuries would MOST likely result in deformity? A. severe strain B. moderate sprain C. hairline fracture D. displaced fracture
D
Which of the following statements regarding striated muscle is correct? A. Striated muscle is involuntary because you have no conscious control over it. B. Most of the body's striated muscle is found within the walls of the blood vessels. C. Striated muscle tissue is attached directly to the bones by tough bands of cartilage. D. It forms the major muscle mass of the body and usually crosses at least one joint.
D
An 85-year-old male with a history of an irregular heartbeat, diabetes, renal failure, and stroke fell while getting out of bed, striking his head on the nightstand. He is alert and oriented and denies any complaint. Vital signs are all within normal limits. There is a minor abrasion on his forehead, but he denies any associated pain or headache. What should be your next priority?
Determine whether he takes blood thinners for the irregular heartbeat
An 83-year-old female fell down the basement stairs. Once at her side, she tells you that her left hip hurts and rates it as 10/10. Since the patient is downstairs, you recognize the need for assistance in extricating her from the residence. As you start the primary assessment, you note a dog at the top of the stairs starts growling at you. At this time, what is your primary concern?
Dog
Assessment of a 79-year-old female with a long history of medical complaints reveals tenderness and deformity to her left hip. Staff at the personal care home state that she slipped in some water and fell onto her buttocks. Currently, she is alert and oriented and describes the pain as 10/10. Regarding care of her leg, what is most appropriate care?
Maintain the leg in the position found and transfer the patient to a long spine board
When assessing and treating a traumatically injured female in her third trimester of pregnancy, the EMT must remember which important point?
Optimal care for the baby will come from caring for the mother
An unresponsive 10-year-old male was struck by a car while riding his bike. He has blood on his face and presents with snoring respirations. Respirations are approximately 10 breaths per minute, with cyanosis noted to his extremities. Manual spine motion restriction to the neck is being held by Emergency Medical Responders. What should you do next?
Perform a jaw-thrust maneuver
The mother of a 4-year-old boy states that he fell off the top bunk bed and hit his head. After falling, he appeared to seize for approximately 30 seconds. Currently, he has nonpurposeful movement to painful stimuli, with a patent airway and slow respirations. His radial pulse is intact, and his skin is warm and dry. You note urinary incontinence. After taking manual spine motion restriction precautions, what should you do next?
Perform a jaw-thrust maneuver and start positive pressure ventilation
The EMT is correctly using the pediatric assessment triangle on a 3-year-old male trauma patient when he:
Quickly determines the circulation based on skin color
A leading cause of death in children younger than 14 years could be prevented by
Safer driving of vehicles
An 84-year-old female fell down six steps, landing on carpet. She now complains of abdominal and pelvic pain. Her airway is open, breathing adequate, and radial pulse intact. Skin is cool and dry, with a noted skin tear to the left elbow with minor bleeding. EMRs report the following vital signs: pulse, 84 beats/min; respirations, 20 breaths/min; blood pressure, 126/68 mmHg; and SpO2, 97% on room air. Her family states that the patient is acting normally. The hips are easily moved and do not appear broken. The patient does not want to go to the hospital and is asking to refuse transport. Your next action would be to:
See which medications she is taking
After being assaulted by her boyfriend, an 18-year-old female who is 33 weeks pregnant is found unresponsive in her bedroom. She appears to have been beaten in the head and abdomen, as evidenced by multiple hematomas and lacerations to these areas. Which assessment finding should concern the EMT most and should be addressed first?
SpO2 of 93% on room air
