Chapter 31 EMT Orthopedic Injuries Q&A II

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

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

There is often a significant amount of blood loss, as much as ___ mL, after a fracture of the shaft of the femur

500 to 1,000

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.

When caring for a patient with a possible fracture of the scapula, the EMT should: Select one: 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. carefully assess the patient for breathing problems.

Blood in the urine is known as: Select one: A. hematuria. B. hemotysis. C. hematocrit. D. hemoglobin.

A. hematuria.

Improperly applying a splint can cause all of the following, EXCEPT: Select one: A. increase of distal circulation if the splint is too tight. B. delay in transport of a patient with a life-threatening injury. C. aggravation of the distal circulation. D. compression of nerves, tissues, and blood vessels.

A. increase of distal circulation if the splint is too tight.

Crepitus and false motion are:

A. positive indicators of a fracture.

Which of the following musculoskeletal injuries would MOST likely result in deformity?

B. Displaced fracture

In which of the following situations should the EMT splint an injured limb in the position of deformity?

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

Which of the following statements about compartment syndrome is NOT true? Select one: A. It occurs 6 to 12 hours after an injury. B. It most commonly occurs with a fractured femur. C. It is usually a result of excessive bleeding, a severely crushed extremity, or the rapid return of blood to an ischemic limb. D. It is characterized by pain that is out of proportion to the injury.

B. It most commonly occurs with a fractured femur

Because of local tenderness and swelling, it is easy to confuse a nondisplaced or minimally displaced fracture of the knee with a: Select one: A. tendon injury. B. ligament injury. C. dislocation. D. fracture-dislocation.

B. ligament injury.

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

B. tendons.

Which of the following statements regarding compartment syndrome is correct?

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

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

D. Displaced fracture

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life?

D. Pelvic fracture with hypotension

The MOST significant hazard associated with splinting is:

D. delaying transport of a critically injured patient.

The MOST significant hazard associated with splinting is: Select one: 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. delaying transport of a critically injured patient.

A supracondylar or intercondylar fracture is also known as a fracture of the:

D. distal humerus.

Signs and symptoms of a dislocated joint include all of the following, EXCEPT: Select one: A. marked deformity. B. tenderness on palpation. C. locked joint. D. ecchymosis.

D. ecchymosis.

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

D. proximal femur.

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:

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

An open fracture is MOST accurately defined as a fracture in which: Select one: 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. the overlying skin is no longer intact.

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: Select one: 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> stabilize her head and preform a primary assessment.

6 P's of musculoskeletal assessment

Pain, Paralysis, Parasthesias, Pulselessness, Pallor, and Pressure.

The zone of injury includes:

adjacent nerves, blood vessels, and surrounding soft tissue

Always check neurovascular function at the following times:

after any manipulation of limb, before applying splint, after applying splint

Dislocation of the ___ is usually associated with fractures of one or both malleoli

ankle

open fracture

any break in the bone in which the overlying skin has been damaged as well

closed fracture

any fracture in which the skin has not been broken

When should you use a traction splint?

as isolated femur fracture

24 year old patient fell off balance beam and landed on his arm. Complaining of pain in the upper arm, and there is obvious swelling. You know that swelling is a sign of:

bleeding

smooth muscle is found in the

blood vessels

The ___ is one of the most commonly fractured bones in the body

clavicle

a ___ fractures the bone at the point of impact

direct blow

A ___ produces actual deformity, distortion, of the limb by shortening, rotating, or angulation it

displaced fracture

Fracture are almost always associated with ____ of the surrounding soft tissue

ecchymosis

A ___ fracture occurs in a growth section of a child's bone, which may prematurely stop growth if not properly treated

epiphyseal

fascia

fibrous tissue that covers all skeletal muscle

A ___ fracture is an incomplete fracture that passes only pathway through the shaft of a bone but may still cause severe angulation

greenstick

____ produce severed damage to the skeleton, surrounding soft tissues, and vital internal organs

high-energy injuries

ligaments

hold joints together

a ___ may cause a fracture or dislocation at a distant point

indirect force

smooth

involuntary muscle

______ are held together in a tough fibrous structure known as a capsule

joints

Because of local tenderness and swelling, it is easy to confuse a non displaced or minimally displaced fracture at the knees with a:

ligament injury

Splinting will do all of the following:

make it easier to transfer the patient, help prevents restriction of distal blood flow, reduce pain

Signs and symptoms of a dislocated joint include:

marked deformity, tenderness or palpation, locked joint

94 year old man fell while walking. Heard pop and fell. You suspect what kind of fracture

pathologic

When caring for patients who have fallen, you must identify the ____ and the mechanism of injury so that you will not overlook associated injuries

point of contact

Basic types of splints:

rigid, formable, traction

A ____ is an injury to the ligaments, the articular capsule, the synovial membrane, and the tendons crossing the joint.

sprain

A ___ is a stretching of tearing of the muscle

strain

Signs and symptoms of knee ligament injury include all of the following:

swelling, point tenderness, joint effusion

joints are bathed and lubricated by _____ fluid

synovial

point tenderness

tenderness sharply located at the site of an injury

traction

the act of exerting a pulling force on a structure

You respond to a 19 year old woman who was kicked in the leg by a horse. She is alert and oriented. She has point tenderness at the site of the injury. You should compare the limb to:

the opposite uninjured limb

In-line ___ is the act of exerting a pulling force on a body structure in the direction of its normal alignment

traction

joint

where two bones contact

Which of the following statements regarding compartment syndrome is correct? Select one: 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. Compartment syndrome typically develops within 6 to 12 hours after an injury.

The musculoskeletal system refers to the: Select one: 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. bones and voluntary muscles of the body

A "hip" fracture is actually a fracture of the:

A. proximal femur.

Skeletal muscle is attached to the bone by tough, ropelike, fibrous structures called:

A. tendons.

An open fracture is MOST accurately defined as a fracture in which:

A. the overlying skin is no longer intact.

The musculoskeletal system refers to the:

B. bones and voluntary muscles of the body.

A fracture is MOST accurately defined as a(n):

B. break in the continuity of the bone

When caring for a patient with a possible fracture of the scapula, the EMT should:

B. carefully assess the patient for breathing problems

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

B. distal humerus.

In general, musculoskeletal injuries should be splinted before moving the patient unless: Select one: 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. the patient is clinically unstable.

In which of the following situations should the EMT splint an injured limb in the position of deformity? Select one: 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.

With regard to musculoskeletal injuries, the zone of injury is defined as the: Select one: 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. area of soft-tissue damage surrounding the injury.

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

C. 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: Select one: 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. stabilize the pelvis with a pelvic binder and protect the spin.

In general, musculoskeletal injuries should be splinted before moving the patient unless:

C. the patient is clinically unstable.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? Select one: A. An amputated extremity B. Bilateral femur fractures 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:

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

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: Select one: 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. control the bleeding and cover the wound with a sterile dressing.

A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should

D. keep her knee flexed and secure it with padded board splints.

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

D. keep her knee flexed and secure it with padded board splints.

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:

D. stabilize her head and perform a primary assessment.

While transporting a patient, you can continue to recheck the splint you applied. You know that improperly applying a splint can cause:

a delay in transport of patten with a life threatening injury, a reduction of distal circulation, a compression of nerves, tissues and blood vessels

articular cartilage

a thin layer of cartilage, covering the articular surface of bones in synovial joints

displaced fracture

any injury the makes the limb appear in an unnatural position

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: Select one: 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. apply gentle manual traction in line with the limb and reassess for a pulse.

the bones in the skeleton produce ________ in the bone marrow

blood cells

hematuria

blood in the urine

A ___ fracture is a fracture in which the bone is broken into more than two fragments.

comminuted

A _____ is a disruption of a joint in which the bone ends are no longer in contact

dislocation

statements regarding the treatment of an ambulance:

in some areas, wrapping the amputated part in a dry sterile dressing is appropriate. In some areas wrapping the amputated part in the dressings moistened with sterile saline is appropriate. after wrapping the amputated part, place it in a plastic bag

True statements about compartment syndrome

it occurs 6-12 hours after an injury. It is usually a result of excessive bleeding, a severely crushed extremity, or a rapid return of blood to an ischemic limb. It is characterized by pain that is out of proportion to the injury

The knee is especially susceptible to ___ injuries, which occur when abnormal bending or twisting forces are applied to the joint

ligament

A ___ is also known as a hairline fracture

non displaced fracture

regardless of the extent and severity of the damage to the skin, you should treat any injury that breaks the skin as a possible:

open fracture

____ is the most reliable indicator of an underlying fracture

point tenderness

Signs and symptoms of sprains include:

point tenderness, pain preventing the patient from moving or using the limb normally, instability of the joint indicated by increased motion

Although substantial ligament damage always occurs with a knee dislocation, the more urgent injury is to the ___ artery, which is often lacerated or compressed by the displaced tibia

popliteal

Signs and symptoms associated with hip dislocation include all of the following:

severe pain in the hip, lateral and posterior aspects of the hip region are tender on palpation, being able to palpate the femoral head deep within the muscles of the buttock

striated

skeletal muscle

Fracture of the tibia and fibula are sometimes associated with ___ as a result of the distorted positions of the limb following injury

vascular injury