Chapter 31 Orthopedic

Applying a zippered air splint

1. Assess distal pulse and motor and sensory function. Support the injured limb and apply gentle traction as your partner applies oxygen, deflated splint 2. Zip up the splint, inflate it by pump or by mouth, and test the pressure. Check and record distal neurovascular function

ligaments

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 injured upper extremity.

swathe

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

fracture

A break in the continuity of a bone.

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.

Spiral.

A fracture caused by a twisting or spinning force, causing a long, spiral-shaped break in the bone. This is sometimes the result of abuse in young children.

displaced fracture

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

Oblique.

A fracture in which the bone is broken at an angle across the bone. This is usually the result of a sharp, angled blow to the bone.

Comminuted.

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

Pathologic.

A fracture of weakened or diseased bone, seen in patients with osteoporosis, infection, or cancer; often produced by minimal force.

Incomplete.

A fracture that does not run completely through the bone; a nondisplaced partial crack.

Epiphyseal.

A fracture that occurs in a growth section of a child's bone and may lead to growth abnormalities

Transverse.

A fracture that occurs straight across the bone. This is usually the result of a direct-blow injury.

crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

hematuria

Blood in the urine.

Applying a hare traction splint

Expose the injured limb and check pulse, motor, and sensory function. place the splint beside the uninjured limb, adjust the splint to proper length, and prepare the straps Support the injured limb as your partner fastens the ankle hitch about the foot and ankle Continue to support the limb as your partner applies gentle in-line traction to the ankle hitch and foot Slide the splint into position under the injured limb Pad the groin and fasten the ischial strap Connect the loops of the ankle hitch to the end of the splint as your partner continues to maintain traction. Carefully tighten the ratchet to the point that the splint holds adequate traction. Secure and check support straps. Assess pulse and motor and sensory functions Secure the patient and splint to the backboard in a way that will prevent movement of the splint during patient movement and transport.

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

If resistance is encountered or the patient experiences severe pain

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

Nondisplaced pelvic fracture

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

Pelvic fracture with hypotension

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

Pelvis

compartment syndrome

Swelling within a confined anatomic compartment that produces dangerous pressure, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power; frequently seen in fractures below the elbow or knee in children

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

TRUE

Smooth muscle

also called involuntary muscle

Skeletal muscle:

also called striated muscle or voluntary muscle

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:

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

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.

Apply a Vacuum Splint

asses distal and motor and sensory function. Your partner will stabilize and support the injury Place the splint and wrap it around the limb Draw the air out of the splint through the suction valve, and then seal the valve. Assess distal pulse and motor and sensory function

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

carefully assess the patient for breathing problems.

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

compare it to the uninjured leg.

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.

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

distal humerus.

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.

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

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

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

leave the toes exposed.

The MOST reliable indicator of an underlying fracture is:

point tenderness.

Crepitus and false motion are:

positive indicators of a fracture.

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 primary purpose for splinting a musculoskeletal injury is to:

prevent further injury.

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

reduce pain and swelling.

The pectoral girdle consists of the:

scapulae and clavicles.

The skeleton is divided into the following:

skull, thoracic cage, pectoral girdle (shoulder girdle) , upper extremity, pelvis, lower extremity

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:

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

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

tendons

Skeletal muscle is directly attached to the bone by tough, rope-like structures known as ________ which are extensions of the______

tendons; fascia

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

the overlying skin is no longer intact.

glenoid fossa

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

Applying a rigid splint

1. Provide gentle support and in-line traction for the limb. Assess distal pulses and motor and sensory function 2. Place the splint alongside or under the limb. Pad between the limb and the splint as needed to ensure even pressure and contact. 3. Secure the splint to the limb with bindings 4. Asses and record distal neurovascular function

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 (contact surfaces on the ends) of bones in synovial joints.

nondisplaced fracture

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.

acromioclavicular (AC) joint

A simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder.

Apply a sagar traction splint

After exposing the injured area, check the patient's pulse and motor and sensory functions. Adjust the thigh strap so that it lies anteriorly secured. Estimate the proper length of the splint by placing it next to the uninjured limb. Fit the ankle pads to the ankle Place the splint at the inner thigh, apply the thigh strap at the upper thigh, and secure snugly tighten the ankle harness just above the malleoli. Secure the cable ring against the bottom of the foot. Extend the splint's inner shaft to apply traction of about 10% of body weight Secure the splint with elasticized cravat bandages Secure the patient to a backboard. Check pulse and motor and sensory function

Greenstick.

An incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation; occurs in children.

amputation

An injury in which part of the body is completely severed.

open fracture

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

closed fracture

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

Applying an Unzippered Air Splint

Assess distal pulse and motor and sensory function. Your partner should support the injured limb. Place your arm through the splint to grasp the patient's hand or foot. Apply gentle traction while sliding the splint onto the injured limb your partner will inflate the splint by pump or by mouth. Assess distal pulse and motor and sensory function

Which of the following structures is regulated by smooth muscle?

Blood vessels

ecchymosis

Blue or black discoloration associated with a closed wound; signifies bleeding within or under the skin; also see contusion.

Which of the following statements regarding compartment syndrome is correct?

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

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

Displaced fracture

dislocation

Disruption of a joint in which ligaments are damaged and the bone ends are no longer in contact.

Fractures of the proximal femur usually involve the hip joint.

FALSE

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.

FALSE

traction

Longitudinal force applied to a structure.

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.

joints

Places where two bones come into contact.

The muscular system includes three types of muscles:

Skeletal, smooth, and cardiac

strain

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

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

TRUE

point tenderness

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

zone of injury

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

tourniquet

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

calcaneus

The heel bone.

sciatic nerve

The major nerve to the lower extremities; controls much of muscle function in the leg and sensation in most of the leg and foot.

fibula

The outer and smaller bone of the two bones of the lower leg.

tibia

The shinbone; the larger of the two bones of the lower leg, responsible for supporting the major weight-bearing surface of the knee and the ankle.

retroperitoneal space

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

reduce

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

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.

With regard to musculoskeletal injuries, the zone of injury is defined as the:

area of soft-tissue damage surrounding the injury.

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.

The musculoskeletal system refers to the:

bones and voluntary muscles of the body.

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

break in the continuity of the bone.

Caring for musculoskeletal injuries

cover open wounds with a dry, sterile dressing, and apply to control bleeding. Assess distal pulse and motor and sensory function. If bleeding cannot be controlled, quickly apply a tourniquet Apply a splint and elevate the extremity about 6 inches (15 cm), or slightly above the level of the heart. Assess distal pulse and motor and sensory function Apply cold packs if there is swelling, but do not place them directly on the skin Position the patient for transport and secure the injured area.

The MOST significant hazard associated with splinting is:

delaying transport of a critically injured patient.

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.

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

proximal femur.

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 ____________ 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

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:

stabilize her head and perform a primary assessment.

Which of the following are goals of in-line traction?

stabilize the fragments to prevent movement avoid neurovascular compromise align the limb for splinting

Skeletal muscle is also referred to as __________ muscle.

striated

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

the patient is clinically unstable.

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