Chapter 30- Musculoskeletal system
The _____ represents an area for growth in the length of a long bone. A) diaphysis B) epiphysis C) epiphyseal disk D) periosteum
epiphyseal disk
The part of the bone that the articular cartilage covers directly is the _____.
epiphysis
bones
provide movement, protect internal organs, supports soft tissues, and provide attachment for skeletal muscles, produce blood cells[red marrow]
If the distal extremity is pulseless or cyanotic
try to align it to the anatomical position using gentle traction. As with longbone splinting, get all of your equipment ready before starting the splinting process.
Surface markings: Define meatus
tunnel or canal
Injury to Bones and Connective Tissue
Fracture: any break in a bone (open or closed) Comminuted—broken in several places Greenstick—incomplete break Angulated—bent at angle Dislocation: "coming apart" of a joint
Bones
Framework Formed of dense connective tissue Vascular and susceptible to bleeding or injury Shapes: Irregular, Long, Flat, Short
Padded Rigid Splint
From elbow past fingertips Roll of bandage placed in hand Sling and swathe
What is the final stage of healing following a fracture? A) osteoclast remodeling B) formation of granulation tissue C) formation of the callus D) osteoblast deposition
Osteoclast remodeling
Splinting Forearm, Wrist, and Hand Injuries
Padded rigid splint From elbow past fingertips Roll of bandage placed in hand Sling and swathe
Assessment: Ankle/Foot Injury
Pain Swelling Possible deformity
The strong white fibrous material covering the bones is called the: a. Perineum b. Marrow c. Periosteum d. Shell
Periosteum
Extremities
The portions of the skeleton that include the clavicles, scapulae, arms, wrists, and hands (upper extremities) and the pelvis, thighs, legs, ankles, and feet (lower extremities)
Manual Traction
The process of applying tension to straighten and realign a fractured limb before splinting. Also called tension.
Musculoskeletal injuries are caused by direct, indirect and ____ force. a. Positive b. Penetrating c. Negative d. Twisting
Twisting
What is an impacted fracture?
Two fragments are pressed tightly together. Treatment involves immobilization and sometimes repositioning
When do you use a traction splint?
When it is an isolated mid shaft femur fracture
Dislocation
"Coming apart" of a joint
(A) For a pelvic wrap, lay a sheet, folded flat, approximately 10 inches wide onto the backboard. (B) Bring the sides of the sheet together. (C) Tie the sheet firmly without overcompression to complete the pelvic wrap.
...
Fractures of the femur typically cause a ____-pint blood loss over the first 2 hours. a. 1 b. 2 c. 3 d. 4
2
How many bones are in the body?
206
When do the bones of the sternum become completely ossified?
25 years
the half-ring splint, Hare, and Fernotrac
A bipolar splint cradles the leg between two metal rods
Sprains are categorized according to the: A) a. Extent of ligament damage B) d. Type of tissue involved C) b. Number of cartilages damaged D) c. Type of tendons damaged
A) a. Extent of ligament damage
Which organ can have an 'organ fracture,' causing massive internal hemorrhage? A) d. Liver B) a. Appendix C) c. Intestine D) b. Bladder
A) d. Liver
What is the second stage of the fracture healing process?
After several months, new blood vessels have formed (angiogenesis)
What is the first stage of the fracture healing process?
After several weeks, the periosteum is beginning to heal and lay down scar tissue. Trabecular bone has begun to grow over the break
Assessment: Hip Dislocation/Fracture
Anterior hip dislocation Posterior hip dislocation Pain and unable to stand
Hip Dislocation/Fracture Assessment
Anterior hip dislocation Posterior hip dislocation Rotation of leg and foot Pain and unable to stand
Fracture
Any break in a bone
Fracture
Any break in bone (open or closed)
An elderly man complains of severe pain in his upper thigh and hip after a fall. The leg on the affected side is shortened and internally rotated. Which action would be appropriate? A) d. Pad behind the knee for comfort. B) b. Apply PASG and inflate leg segments. C) c. Attempt to reduce the dislocation. D) a. Apply a traction splint.
B) b. Apply PASG and inflate leg segments.
An easy way to remember the various components of musculoskeletal injury assessment is to recall: A) a. The four M's of musculoskeletal assessment B) d. The six P's of musculoskeletal assessment C) c. The mnemonic TIC D) b. The mnemonic ARM-LEGS
B) d. The six P's of musculoskeletal assessment
Joints
Bending
A PASG can be used in place of which other type of splint? A) b. Ridged B) a. Flexible C) d. Air splint D) c. Sling and swath
C) d. Air splint
What is a strain?
Caused by over stretching or over exertion
The object of realignment of deformed extremities is to assist in restoring effective
Circulation
What are the three types of fractures?
Comminuted Green stick Angulated
Which type of fracture breaks the bone into several fragments?
Commuted
Ligaments
Connective tissues that connect bone to bone
Treatment: Femoral Shaft Fracture
Control bleeding Assess distal CSM Apply traction splint Reasses distal CSM Treat for shock
The callus that forms around a bone fracture is comprised of _____ tissue. A) bone B) hyaline cartilage C) fibrocartilage D) granulation
Fibrocartilage
Greenstick
Incomplete break
Assessment: Femoral Shaft Fracture
Intense pain Possibly open fracture Injured limb may be shortened
Shapes of Bones
Irregular Long Short Flat
What is Rheumatoid arthritis? And what does it affect?
It is an autoimmune disease in which patients become allergic to their own joints Affects synovial membranes and small, fine joint (such as fingers)
The bones found in the arm and thigh are example of?
Long bones
What are osteocytes?
Mature bone cells that become trapped at maturity in a matrix
Strain
Muscle injury resulting from over-stretching or overexertion of the muscle
Tendons
Muscle to bone
Tissues or fibers that cause movement of the body parts or organs are called
Muscles
MTB
Muscles, Tendons, Bones
Which of the following is not a main factor in the development of osteoporosis? A) diet deficient in calcium B) lack of exercise C) normal aging D) hormone deficiencies
Normal aging
Which of the following does not contain a sinus? A) ethmoid B) sphenoid C) frontal D) occipital
Occipital
Six P's of Assessment
Pain or tenderness Pallor (pale skin) Parasthesia (pins and needles) Pulses diminished or absent Paralysis Pressure
Describe flat bones and name some examples
Parallel to the surfaces of the body and have a protective function. There is a broad attachment surface. Examples: skull, ribs
What does CSM stand for?
Pulse, circularity,motor, sensory
The muscular system
Rectus abdominis Sartorius Vastus medialis Masseter Deltoid Sternocleidomastoid Pectoralis major Biceps External oblique Triceps Quadriceps femoris Tibialis anterior
Bone marrow is the site of production for which of the following? a. Calcium b. Protein c. Red blood cells d. Fat
Red blood cells
Traction splint
Sager Hare
Compartment Syndrome
Serious condition caused when tissues such as blood vessels and nerves are constricted from swelling, tight dressing or cast
The stretching or tearing of ligaments is called a: a. Dislocation b. Fracture c. Sprain d. Strain
Sprain
Injury to Bones and Connective Tissue
Sprain: stretching and tearing of ligaments Strain: overstretching of muscle
compartment syndrome
Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue.
What is the epiphyseal plate?
The border between the end of the metaphysis and the beginning of an epiphysis. The only place where growth occurs, stimulated by growth hormone.
Dislocation
The disruption or "coming apart" of a joint
Describe the anatomy of elements of the musculoskeletal system. (pp. 696-702, 703-704)
The musculoskeletal system is composed of all the body's bones, joints, and muscles, as well as cartilage, tendons, and ligaments. The bones of the axial skeleton include the skull (including the cranium and face), the sternum, the ribs, and the spine including the cervical, thoracic, and lumbar vertebrae, the sacrum, and the coccyx. pay special attention to the appendicular skeleton, particularly the extremities —the upper extremities (clavicles, scapulae, arms, wrists, and hands) and the lower extremities (pelvis, thighs, legs, ankles, and feet)
Define ligaments
Tissue that connects bone to bone
Define a tendon
Tissue that connects muscle to bone
Muscles
Tissues or fibers that cause movement of body parts and organs: skeletal (voluntary), smooth (involuntary), and cardiac (myocardial)
Shoulder Girdle Injuries
Treatment Assess distal CSM Use sling and swathe Do not attempt to straighten or reduce Reassess distal CSM
Joints
bending
The long shaft of a bone such as the femur is called its ______.
diaphysis
You are evaluating a 28-year-old female patient who was the belted driver in a car-versus-tree motor vehicle crash. She is also 30 weeks' pregnant. She is complaining of severe abdominal pain with cramping, and you can see blood soaking into her shorts and onto the driver's seat. As you prepare for a rapid extrication, you are worried that she may have experienced: A) a. Abruptio placentae B) c. Liver laceration C) b. Femoral artery laceration D) d. Premature labor
A) a. Abruptio placentae
As a paramedic, you realize that your ability to quickly recognize and treat a musculoskeletal injury helps to limit: A) b. Loss of use B) a. Disease C) c. Morbidity D) d. Mortality
A) b. Loss of use
'Buddy splinting' refers to a technique in which a broken: A) c. Finger or toe is taped to an adjacent but uninjured finger or toe B) b. Arm is secured to a rigid splint C) d. Leg is secured by holding the injury in place against a long backboard D) a. Arm is secured to a long backboard
A) c. Finger or toe is taped to an adjacent but uninjured finger or toe
Femoral Shaft Fracture Assessment
Assessment Intense pain Possibly open fracture Injured limb may be shortened Use a traction splint to immobilize isolated femoral shaft fractures.
Knee Injury
Assessment Pain and tenderness Swelling Deformity with swelling Treatment Assess distal CSM Immobilize in current position Reassess distal CSM
Ligaments
Bone to bone
Inside and Fracture
Bones are vascular. Bone marrow is involved in the production of red blood cells. There are many types of fractures. Greenstick fractures, comminuted fractures, and fractures without displaced bone ends do not appear deformed. Swelling and inflammation are the body's natural responses to injury. The body sends blood and cells to the affected area to fight infection. This causes a swollen, often warm extremity around the injury.
BLB
Bones, Ligaments, Bones
Vitamin _____ is required to produce the organic matrix that allows bones to be pliable or hold teeth in their sockets. A) A B) B C) C D) D
C
You are evaluating a 14-year-old female patient who fell off a top bunk and onto a binder. You expose her abdomen and can see a line of demarcation from the edge of the binder across both lower quadrants. When you palpate the abdomen, it is soft and nontender in all quadrants, and she rates her pain at 3 out of 10. Her heart rate is 86 beats/min, her respiratory rate is 20 breaths/min, her blood pressure is 114/60 mm Hg, and her skin is normal. You suspect that your patient: A) c. May have perforated her stomach B) b. Likely has massive internal bleeding C) a. Appears to only have superficial injuries but should still be evaluated by a physician D) d. Will likely have liver swelling
C) a. Appears to only have superficial injuries but should still be evaluated by a physician
A patient injured his hand while punching someone with a closed fist. You anticipate his injury to be to the: A) c. Second phalange B) d. Thumb C) a. Fifth metacarpal D) b. First carpal
C) a. Fifth metacarpal
What is Periosteum?
Fibrous coevering of the bone. It is the source of vessels and nerves. Ruptures of the periosteum are the source of bone pain.
The splints that are most commonly used to immobilize joint injuries in the position found are?
Formable splints
Which is the first to occur following a bone fracture? A) migration of fibroblasts B) formation of a hematoma C) osteoblast proliferation D) development of granulation tissu
Formation of a hematoma
What are the four types of musculoskeletal injures?
Fracture Dislocation Sprain Strain
Fracture from the Outside
Patients with skeletal injuries—especially those involving long bones and multiple bones—will experience shock. You may see patients who have fractures without obvious deformity. This is why you splint all actual and suspected musculoskeletal fractures. Some patients may appear to have a fracture but actually don't. The swelling—especially in areas where the bone is close to the skin—can cause the appearance of fracture.
A traction splint is contradicted if there is a _____ injury
Pelvis, hip, or knee
Both swelling and clotting associated with broken bones is due to the destruction of blood vessels in the.....
Periosteum
Joints
Places where bones articulate, or meet
Musculoskeletal Injuries Assessment
Rapidly identify and treat life-threatening conditions Be alert for injuries besides grotesque wound Pain and tenderness Deformity and angulation Grating (crepitus) Swelling Bruising Exposed bone ends Nerve/blood vessel compromise (decreased CMS) Compartment syndrome
What are the three basic types of splints? a. Rigid, formable, and traction b. PASG, board and ladder c. Padded, soft and anatomical d. Air, cardboard, and vacuum
Rigid, formable, and traction
The prominent portions of the cheeks are made up of the _________________ bones.
Zygomatic bone
What is the Potts fracture?
a fracture where the ankle turns and the ligament tears off the bone or fractures it
comminuted fracture
a fracture where the bone is broken in several places
crepitus
a grating sensation or sound made when fractured bone ends rub together
What bones are lined up vertically for support & are parallel to the center of gravity
axial bones
angulated fracture
fracture in which the broken bone segments are at an angle to each other.
Bones
framework. Bones provide the body with structure, store salts and metabolic materials, and provide a site for the production of red blood cells.
Define epiphysis
the end of the bone
What is a comminuted fracture?
the impact shatters the bone into multiple small fragments.
sprain
the stretching and tearing of ligaments
Whenever possible, ____ rescuers should be used to apply a traction splint. a. two b. three c. four d. five
three
...
(A) Blood at the meatus of the penis is a sign of a pelvic fracture. (B) A pelvic wrap can help to stabilize a fractured pelvis. Shown here is a commercial pelvic binding device placed on a severely injured patient with an open pelvic fracture.
When does ossification begin in a developing fetus? A) 6th month B) 30th day C) 3rd month D) 4th month
3rd month
How many phalanges are there in the body? A) 14 B) 28 C) 56 D) 7
56
What is the Colles' fracture?
A common fracture in which the radius breaks as a result of a fall
Comminuted Fracture
A fracture in which the bone is broken in several places
Angulated Fracture
A fracture in which the broken bone segments are at an angle to each other
What is an open (compound) fracture?
A fracture where the bone fragment penetrates the skin, leaving the bone open to infection. (but bone doesn't have to be sticking out to be considered a compound fracture)
Crepitus
A grating sensation or sound made when fractured bone ends rub together
Define bones
A hard but flexible living structure that provide support for the body and protection to vital organs. They store salts and metabolic materials and provides site for the protection of red blood cells
What is a joint?
A place where bones articulate or meet
Traction Splint
A splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. Traction splints are used primarily on femoral shaft fractures.
Open Extremity Injury
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 would with associated injury to the bone.
open extremity injury
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.
Closed Extremity Injury
An injury to an extremity with no associated opening in the skin
closed extremity injury
An injury to an extremity with no associated opening in the skin.
Treatment: Knee Injury
Assess distal CSM Immobilize in current position Reassess distal CSM
Treatment: Ankle/Foot Injury
Assess distal CSM Stabilize limb Lift limb Place cravats under ankle Lower limb into pillow Tie pillow around ankle Apply ice pack as needed
Treatment: Shoulder Girdle Injuries
Assess distal CSM Use sling and swathe Do not attempt to straighten or reduce Reasses distal CSM
Ankle/Foot Injury Assessment
Assessment Pain Swelling Possible deformity
Pelvic Injuries Assessment
Assessment Pain in pelvis, hips, or groin Pain when pressure applied Cannot lift legs Lateral rotation of foot Unexplained pressure in bladder Bleeding from the urethra, rectum or vagina.
Shoulder Girdle Injuries
Assessment Pain in shoulder Dropped shoulder Severe blow to back over scapula Describe how you would use a sling and swathe. List the steps of application.
Realigning Deformed Extremity
Assists in restoring effective circulation to extremity and to fit it to splint If not realigned, splint may be ineffective, causing increased pain and possible further injury If not realigned, increased chance of nerves, arteries, and veins being compromised Increased pain is only momentary
As we age, our bones become ____ resulting in bones that are more brittle and easy to break. a. Deficient in magnesium b. Deficient in calcium c. High in iron d. High in potassium
B
Which hollow organ is most commonly injured as a result of blunt force trauma? A) d. Uterus B) a. Small intestine C) b. Spleen D) c. Stomach
B) a. Small intestine
Self-Healing Nature of Bone
Because of the self-healing property of bones, it is very important for a broken bone to be immobilized quickly and to remain immobilized to heal properly. Break causes soft tissue swelling and a blood clot in the fracture area. Interruption of blood supply causes the bone section to die. Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone.
Angulated
Bent at angle
Components of Musculoskeletal System
Bones Joints Muscles Cartilage Ligaments Tendons
Self-Healing Nature of Bone
Break cause soft tissue swelling and a blood clot in the fracture area Interruption of blood supply causes the bone section to die Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone
What is an angulated fracture?
Broken bone segments are at a angle to each other
Comminuted
Broken in several places
Following blunt abdominal trauma, the primary problem that develops for the patient is: A) c. Pain B) b. Ileus C) a. Hemorrhage D) d. Swellin
C) a. Hemorrhage
A condition where the abdominal wall is damaged and underlying abdominal structures are protruding through the abdominal wall is known as: A) a. Abdominal contusion B) c. Abdominal inversion C) b. Abdominal evisceration D) d. Abdominal protrusion
C) b. Abdominal evisceration
When an expectant mother experiences significant abdominal trauma, the placenta can separate from the uterine wall. This condition is known as: A) a. Abruptio placental previa B) c. Placenta previa C) b. Abruptio placentae D) d. Uterine rupture
C) b. Abruptio placentae
Principles of Splinting
Care for life-threatening problems first Expose injury site Assess distal CSM Align long-bone injuries to anatomical position Do not push around protruding bones back into place Immobilize both injury site and adjacent joints Choose splinting method based on severity of condition and priority decision Apply splint before moving patient to stretcher Pad voids
Principles of Splinting
Care for life-threatening problems first Expose injury site Assess distal CSM Align long-bone injuries to anatomical position Do not push protruding bones back into place Immobilize both injury site and adjacent joints Choose splinting method based on severity of condition and priority decision Apply splint before moving patient to stretcher Pad voids
Describe short bones and name some examples
Compact on the surface, with spongy centers, and are cuboidal. Examples: Wrist and ankle bones
When splinting your patient who has a serious fracture to which you will be applying a traction splint, the EMT should: a. first move the patient to a stretcher b. leave any open leg wounds exposed so bleeding can be monitored c. replace protruding bones as soon as priorities are arranged d. secure the injury site and the joints above and below
D
Your patient is complaining of muscle spasms in the lower leg. Your choice of treatment would be to: A) d. Administer compression B) a. Administer medication C) c. Apply ice D) b. Apply heat
D) b. Apply heat
Which of the following organs is in the retroperitoneal space? A) a. Bladder B) d. Spleen C) c. Liver D) b. Kidney
D) b. Kidney
Before performing a reduction of a dislocated joint, which class of medication should be administered to help with muscle relaxation? A) d. Narcotics B) b. Anesthetics C) a. Analgesics D) c. Benzodiazepines
D) c. Benzodiazepines
The greatest factor in the amount of energy causing trauma to a patient is: A) b. The angle at which an object strikes the body B) a. Patient weight C) d. The insulting object's weight D) c. The insulting object's velocity
D) c. The insulting object's velocity
Surface markings: define Facet
Flattened surface of a joint attachment
Cartilage
Flexibility
Define a green stick fracture
It is an incomplete fracture
What is the function of the synovial membranes?
It secretes fluid that lubricates the bones.
What is the musculoskeletal system composed of?
Joints, muscles, as well as cartilage, tendons and ligaments
What are the 6 P's?
Pain Pale Parathesis Pulses Paralysis Pressure
Forearm, Wrist, and Hand Injuries
Signs Forearm: deformity and tenderness Wrist: deformity and tenderness Hand: deformity and pain; dislocated fingers
Surface markings: Define Epicondyle
Smaller prominence above the condyle
Splinting Forearm, Wrist, and Hand Injuries
Soft splint Roll of bandage placed in hand Tie forearm, wrist, and hand into fold of one pillow or between two pillows Tape finger to adjacent uninjured finger
Which bones would contain significant amounts of red bone marrow in an adult? A) femur B) sternum C) humerus D) tibia
Sternum
Sprain
Stretching and tearing of ligaments
Which bone contains the ear structures? A) parietal B) maxillary C) temporal D) sphenoid
Temporal
Sprain
The stretching and tearing of ligaments
Tendons
Tissues that connect muscle to bone
Cartilage
Tough tissue that covers the joint ends of bones and helps for certain body parts such as the ear, septum, trachea and breastbone (connections between ribs and sternum)
greenstick fracture
an incomplete fracture
sprain
an injury in which the ligaments holding bones together are stretched too far and tear
closed extremity injury
an injury to an extremity with no associated opening in the skin
Traction splints come in two basic varieties
bipolar and unipolar
What are osteoblasts?
bone-forming cells ("B"=build)
ligaments
connective tissue that connect bone to bone
Cartilage
flexibility
Bones, joints, muscles, cartilage, tendons, and ligaments make up the
musculoskeletal system.
The indications for a traction splint are a possible mid-shaft femur fracture with: a. either knee or ankle involvement b. no joint or lower leg injury c. extensive blood loss d. an open fracture
no joint or lower leg injury
Pelvic fractures and femoral shaft fractures
often indicate more severe internal injuries
During osteogenesis, which of the following cells would appear first? A) fibroblast B) osteocyte C) osteoblast D) osteoclast
osteoblast
Hazards of Splinting
"Splinting patient to death": splinting before life-threatening conditions addressed Not ensuring ABC's Too tight: compresses soft tissues Too loose: allows too much movement Splinting in deformed position
Hazards of Splinting
"Splinting patient to death"—splinting before life-threatening conditions addressed Not ensuring ABC's Too tight—compresses soft tissues Too loose—allows too much movement Splinting in deformed position
patient assessment: femoral shaft fracture
1. Pain often intense 2. May be open or closed 3. Muscle spasm may cause leg shortening and bone overlap
What is a communicated fracture?
A bone broken in several places
What is the last stage in the repair of a fracture?
A bony callus
Treatment: Tibia/Fibula Injury
Air inflated splint Two-splint method Single splint with ankle hitch
Greenstick Fracture
An incomplete fracture
Tibia/Fibula Injury
Assessment Pain and tenderness Swelling Possible deformity Treatment Air inflated splint Two-splint method Single splint with ankle hitch
The first vertebra is called the _____. A) axis B) atlas C) cervical D) dens
Atlas
In a sprain, which of the following is injured? A) d. Tendon B) b. Ligament C) c. Muscle D) a. Bone
B) b. Ligament
Physiology of Musculoskeletal System
Bones: framework Joints: bending Muscles: movement Cartilage: flexibility Ligaments: connect bone to bone Tendons: connect muscle to bone
After consulting with medical direction, a decision has been made to attempt realignment of a badly angulated tibia-fibula fracture. While attempting to realign the bone fragments, you observe obvious anatomic resistance to your effort. You should: A) a. Administer a muscle relaxant, and reattempt realignment B) d. Pull harder C) b. Cease your efforts to realign, and transport D) c. Gently rotate the limb, reapply traction, and then splint
C) b. Cease your efforts to realign, and transport
_____________muscles are involved in movement. A) a. Cardiac B) b. Involuntary C) c. Skeletal D) d. Smooth
C) c. Skeletal
Surface markings: Define Fossa
Depression
Which type of bone is the primary source of red marrow in an adult? A) irregular B) long C) short D) flat
Flat
Bones bleed
Fractures cause blood loss within the bone.
Which bones do not belong to the axial skeleton? A) skull B) ribs C) hip bone D) spinal column
Hip Bone
Surface markings: define foramen
Hole or opening
Treatment: Pelvic Injuries
Move patient as little as possible Determince CSM distal to injury Straighten lower limbs to anatomical postion Stabilize lower limbs Assume spinal injuries Treat for shock
Muscles
Movement
Injury to Bones and Connective Tissue
Not all injuries can be confirmed as a fracture in the field Splinting an extremity with a suspected fracture helps prevent blood loss from bone tissues
The _____ contain enzymes capable of breaking down the calcium matrix of bone tissue. A) osteoblasts B) osteoclasts C) fibroblasts D) osteogenic cells
Osteoclasts
The cells that tear down and remodel bone are the ________________.
Osteoclasts
Which of these is the most differentiated and oldest? A) fibroblast B) osteoblast C) osteocyte D) chondroblast
Osteocyte
Vitamin D deficiency in an adult causes the condition known as _____. A) rickets B) osteoporosis C) osteomalacia D) giantism
Osteomalacia
What is the third stage of the fracture healing process?
Over the next months or years, the bone shape returns to normal as osteovlasts absorb extra cells and osteoblasts generate new cells and bone. The bone will be thickened somewhat at the fracture site.
Strain
Overstretching of muscle
The strong, white, fibrous membrane that covers bones and through which blood vessels and nerves pass is called
Periosteum
The pectoral girdle is made up of the clavicle and the ________________.
Scapula
Three types of muscle
Skeletal muscle Cardiac muscle Smooth muscle
What are the bands of connective tissues that bind the muscles to bones?
Tendons
Traction Splint Treatment
Used for splinting a femur injury Provide counter traction in the field Contraindicated if Pt has pelvis, hip, knee, avulsion or partial amputation
Treatment: Traction Splint
Used for splinting a femur injury Provide counter traction in the field Contraindicated if Pt has pelvis, hip, knee, avulsion, or partial amputation
Which of the following is an axial bone? A) femur B) vertebra C) ilium D) tibia
Vertebra
The signs and symptoms of a bone or joint injury include all of the following except: a. Grating b. Swelling c. Vomiting d. Bruising
Vomiting
greenstick fracture
a partial fracture of a bone (usually in children)
The femur inserts into the pelvic girdle at the ____________________.
acetabulum
fracture
any break in a bone
Ligaments
are connective tissues that sup- port joints by attaching the bone ends and allowing for a stable range of motion.
What are osteoclasts?
bone-reabsorbing cells that destroy old bone
muscles
cells and tissues that allow movement of an organ or body part
Surface markings: define fissure
cleft
Fractures, dislocations, sprains, and strains are musculoskeletal injuries that are caused by
direct force, indirect force, and twisting force. Injuries should be splinted prior to moving the patient.
You are treating a 19 year old who twisted his left knee playing racquet ball. The signs and symptoms of a knee injury may include any of the following except: a. pain and tenderness b. swelling c. deformity d. discoloration to the thigh
discoloration to the thigh
Describe Sesamoid bones and name some examples
embedded in tendons to change the direction of movement, like a pulley Examples: patella, the big toe bone
The junction between the diaphysis and epiphysis is called the _____.
epiphyseal disk
Which sinus inflammation in the skull could most commonly lead to deafness?
ethmoid sinus
Your 52 year old male patient stepped off the curb into the street when a large truck cut the corner too close and ran him over. He has numerous fractures and is in a lot of pain. Multiple fractures, especially of the ___ can cause life-threatening external and internal bleeding. a. radius b. ulna c. femur d. tibia
femur
Your patient has a serious fracture to which you will be applying a traction splint. What is the bone that is most likely fractured? a. pelvis b. humerus c. femur d. clavicle
femur
What are the 4 general types of bones?
flats bones long bones short bones sesamoid bones
cartilage
flexible connective tissue attached to bones at joints
A soft spot in a newborn's skull is called a __________________.
fontanel
angulated fracture
fracture in which the broken bone segments are at an angle to each other
Which type of bone fracture occurs as an incomplete break in the bone?
greenstick
bones
hard but flexible living structures that provide support for the body and protection to vital organs
bones
hard but flexible living structures that provide support for the body and protection to vital organs.
Your 52 year old male patient stepped off the curb into the street when a large truck cut the corner too close and ran him over. He has numerous fractures and is in a lot of pain. After splinting and treating the patient for shock, you decide en route to the ED to apply cold, too. Applying cold packs to fractures: a. helps to reduce swelling b. stops bleeding from the bone c. eliminates the need for a pressure bandage d. stops all the pain and discomfort
helps to reduce swelling
Elderly patients are more susceptible to ___ fractures because of brittle bones or bones weakened by disease. a. hip b. tibia c. heel d. spine
hip
Fracture management is not generally the highest priority compared to other problems identifies during the primary survey of the patient. Fractures can introduce complications, however, which may include all of the following except: a. excessive bleeding b. increased pain from movement c. paralysis of the extremity d. increased distal sensation
increased distal sensation
compartment syndrome
injury caused when tissues such as blood vessels and nerves are constricted within a space as from swelling or from a tight dressing or cast
fracture
interrupt, break, or destroy
Splinting of long bone fractures
involves immobilizing adjacent joints.
direct force
is a person being struck by an automobile, causing crushed tissue and fractures.
An open extremity injury
is one in which the skin has been broken.
A closed extremity injury
is one in which the skin has not been broken.
A closed extremity injury
is one in which the skin has not been broken. An open extremity injury is one in which the skin has been broken.
Muscles
movement
What are Osteoprogenitor cells?
multipotential skeletal cells
strain
muscle injury resulting from overstretching or overexertion of the muscle
Most cases of bone cancer probably involve an increase in the activity of the _____ cells.
osteoclast
strain
overstretch in a muscle or tendon
Strain
overstretching of muscle
Your 50 year old female patient has sustained a fracture to her right tibia. To ensure proper stabilization and increase comfort when applying a rigid splint: a. place the patient on a stretcher before splinting b. place the patient on a long spine board before splinting c. pad the spaces between the body part and the splint d. ensure that the splint conforms to the body curves
pad the spaces between the body part and the splint
Your 36 year old female patient had a serious fall. She is complaining of an unexplained sensation of having to empty her bladder. She may have experienced a ___ fracture. a. femur b. hip c. pelvic d. none of these
pelvic
The _____ allows a bone to increase its diameter during periods of growth.
periosteum
The outer covering of each bone, made from fibrous connective tissue, is called the ________________.
periosteum
joints
places where bones articulate, or meet
Surface markings: Define crest
ridge
Surface markings: Define Tuberosity
roughened, rounded knob
You are treating a 68 year old male who was found on the floor in the hallway at the country nursing home. You suspect that he may have had a syncopal episode and also sustained a fractured hip. This decision is based on the injured limb appearing: a. slightly swollen b. shorter than the other extremity c. longer than the other extremity d. mottled and cold
shorter than the other extremity
Injuries to bones and joints
should be splinted prior to moving the patient.
Surface markings: Define Spine or spinous process
slender projection
Surface markings: Define Tubercle
smaller knob
The _______________ suture joins the temporal and parietal bones of the skull.
squamosal
A traction splint counteracts
the muscle spasms and greatly reduces the pain associated with a long-bone femur fracture. Steps for using traction splint: (1) Take Standard Precautions. Expose area to be splinted. (2) Manually stabilize leg. Apply manual traction. (3) Assess CSM distal to injury. (4) Adjust splint to proper length. Position it at or under injured leg. (5) Apply proximal securing device (ischial strap). (6) Apply distal securing device (ankle hitch). (7) Apply mechanical traction. (8) Position and secure support straps. (9) Re-evaluate proximal and distal securing devices. Reassess CSM distal to injury. (10) Secure patient's torso and traction splint to long spine board to immobilize hip and prevent movement of splint.
extremities
the portions of the skeleton that include the clavicles, scapulae, arms, wrists, and hands (upper extremities) and the pelvis, thighs, legs, ankles, and feet ( lower extemities)
manual traction
the process of applying tension to straighten and realign a fractured limb before splinting
Which of the following is not true about rigid splints? a. they require that the limb be moved into anatomical position b. they tend to provide the greatest support c. they are ideally used to splint long bones d. they can immobilize joint injuries in the position found
they can immobilize joint injuries in the position found
If you determine the musculoskeletal injury is isolated, then you can perform a(n): A) a. Focused assessment B) b. Ongoing assessment C) c. Rapid trauma assessment D) d. Head-to-toe assessment
A) a. Focused assessment
Mortality secondary to solid abdominal organ injury is primarily caused by: A) a. Hemorrhagic shock B) d. Organ death C) c. Infection D) b. Ileus
A) a. Hemorrhagic shock
Which penetrating object is least likely to have a straight trajectory through the body? A) b. Bullet B) c. Glass shard C) d. Knife D) a. Arrow
A) b. Bullet
A mnemonic for remembering signs and symptoms of musculoskeletal injury is: A) b. DCAP-BTLS B) a. AVPU C) d. SAMPLE D) c. OPQRST
A) b. DCAP-BTLS
patient assessment: shoulder girdle injuries
-Pain in the shoulder may indicate several types of injuries - A dropped shoulder, with the patient holding the arm of his injured side against the chest, often indicates a fracture of the clavicle -A severe blow to the back over the scapula may cause a fracture of that bone Check the entire shoulder girdle, feel for deformity and tenderness where the clavicle joins the anterior scapula. Feel and look along the entire clavicle for deformity from the sternum medially to the shoulder laterally. Note if the head of the humerus can be felt or moves in front of the shoulder. This is a sign of possible anterior dislocation.
10% of the patients body weight not exceeding 15 pounds
...
Assessment Musculoskeletal Injuries
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Does the patient have adequate CSM distal to the musculoskeletal injury?
...
Does the patient have multiple fractures, multiple trauma, or shock?
...
Should I align the angulated extremity fracture?
...
Some patients may appear to have a fracture but actually don't. The swelling—especially in areas where the bone is close to the skin—can cause the appearance of fracture.
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contreindicators Traction splint
...
patient care: shoulder girdle injuries
1) Assess distal CSM 2) Its not practical to use a rigid splint for injuries to the shoulder, use a sling and swathe and don't tie around the shoulder if there is a possible spinal injury 3) If there is evidence of a possible anterior dislocation of the head of the humerus place a thin pillow between the patients arm and chest before apply the sling and swathe 4) Do not attempt to straighten or reduce any dislocation 5) Reassess distal CSM
patient care: femoral shaft fracture
1) Control any bleeding by applying direct pressure forcefully enough to overcome the barrier of muscle mass 2) Treat for shock, utilize high-concentration oxygen 3) Assess distal CSM 4) Apply a traction splint. 5) Reassess distal CSM (NOTE: The traction splint should not be applied if you suspect there may be additional injuries or fractures to the area of the kneed or tibia/fibula of the same limb.)
Explain the bone development starting from an embryo (3 step process)
1. Bones begin in the embryo as cartilage that gradually calcifies. 2. Hollow areas form and spread up and down the bones. Nutrient arteries and matrices develop 3. Finally, the diaphysis and metaphysis become truly separate
patient assessment: hip fracture
1. Fracture of the proximal femur or femur head 2. Pain localized but sometimes in knees 3. Surrounding tissues discolored (may be delayed) 4. Swelling 5. Unable to move limb or stand 6. Foot on injured side usually turns outwards 7. Injured side may be shorter
You are treating a 44-year-old female patient who was struck by a car while crossing the street and was thrown 25 feet. She is responding to verbal stimuli, does not move appropriately, and has a pulse rate of 132 beats/min, a respiratory rate of 32 breaths/min, a blood pressure of 88/68 mm Hg, and pale and clammy skin. When you remove her clothing, her upper abdominal quadrants are bruised, rigid, and tender. Appropriate care for this patient includes: A) b. Establishing a large-bore IV B) d. Providing oxygen via nasal cannula C) c. Positioning her in the left lateral recumbent position to protect her airway D) a. Administering fentanyl for pain
A) b. Establishing a large-bore IV
Your crew is called to an assisted-care facility for a 73-year-old female who fell while getting out of the shower. On arrival you observe that the patient is in a considerable amount of pain and complains of left proximal leg pain. The knee of the affected leg is flexed and the leg is shortened and internally rotated. This presentation is typical of what type of injury? A) c. Distal femur fracture B) d. Proximal femur fracture C) a. Dislocation of the hip D) b. Dislocation of the knee
A) c. Distal femur fracture
Your crew is called to a local skating rink to treat a 42-year-old female who fell. She is complaining of severe elbow pain and is supporting the affected limb against her body. To manage this situation effectively, you should: A) c. Splint the arm in the position found, using a pillow or blanket B) a. Rotate the arm to 90 degrees and secure it with a rigid splint C) b. Rotate the arm to 90 degrees and secure it with a sling and swathe D) d. Splint the arm in the position found, using a traction splint
A) c. Splint the arm in the position found, using a pillow or blanket
Your crew is called to the scene of a sports injury at a local park. A 43-year-old female injured her ankle while sliding into home base. There is gross deformity at the joint that appears consistent with a severe dislocation. She is in a tremendous amount of pain and has extreme difficulty when trying to wiggle her toes. Her distal pulse is absent. Proper intervention would include analgesics and: A) b. Attempted reduction by pulling on the toes B) a. Attempted reduction by pulling on the talus C) d. Splinting the injury in the position found, using a pillow or blanket D) c. Attempted reduction by taking the ankle through its full range of motion
B) a. Attempted reduction by pulling on the talus
A break that involves several breaks in the bone, causing bone fragment damage, is called a(n): A) d. Spiral fracture B) a. Comminuted fracture C) c. Open fracture D) b. Greenstick fracture
B) a. Comminuted fracture
As a rule, fractures and dislocated joints should be: A) b. Immobilized with a soft splint B) a. Immobilized in anatomic position and in a position of comfort C) c. Reduced in the field D) d. Repositioned in the field
B) a. Immobilized in anatomic position and in a position of comfort
You respond to a patient complaining of shoulder pain after falling from a bicycle and landing on his outstretched hand. As a paramedic, you know this type of MOI is classified as: A) d. Twisting B) b. Indirect C) c. Penetrating D) a. Direct
B) b. Indirect
Your crew is called to a local park for a 34-year-old male who injured his shoulder while playing softball. There is swelling at the left shoulder where the clavicle meets the proximal humerus. If this is the patient's only injury, what device should you use for immobilization? A) c. Short backboard B) d. Sling and swathe C) b. Rigid splint D) a. Long backboard
B) d. Sling and swathe
Following recognition of a pelvic fracture, your next intervention should be to: A) d. Provide pharmacologic pain management B) b. Apply a traction splint C) a. Apply a pelvic binder D) c. Inflate the abdominal compartment only of a pneumatic antishock garment
C) a. Apply a pelvic binder
The best indicator of bladder or internal genitalia injury in the male patient is: A) d. Scrotal swelling and bruising B) c. Prehospital Foley catheter placement to look for blood in the urine C) a. Blood at the urethral meatus D) b. Swelling of the penis
C) a. Blood at the urethral meatus
Treatment: Hip Discoloration/Fracture
CSM Move patient onto spine board Immobilize limb with pillows and blankets Secure patient to spine board Reassess distal CSM
What is a sprain?
Caused by stretching and tearing of a ligament
Signs: Forearm, Wrist, and Hand Injuries
Deformity and tenderness -Discolorated fingers for hands and pain
Your 19 year old male patient fell while playing basketball. You suspect that he broke his right tibia. Proper splinting of a closed fracture is: a. Done with an air splint and gentle traction b. Done with the pneumatic antishock garment c. Designed to prevent closed injuries from becoming open ones d. Completed in the hospital by a surgeon
Designed to prevent closed injuries from becoming open ones
Mechanisms of Musckuloskeletal Injury
Direct Force Indirect Force Twisting (rotational) Force
What are the three types of mechanism that cause musculoskeletal injures?
Direct force Twisting force Indirect force
The three types of mechanism that cause musculoskeletal injuries include
Direct, indirect, and twisting
You are evaluating a 16-year-old male patient who was playing hockey with his friends at an outdoor skating rink when he slammed against his hockey stick, driving the handle deep into his epigastric region. He believes he fell on top of the stick and it caught under his ribs. He is also in obvious respiratory distress, and his abdomen appears slightly sunken; he seems unable to take a full breath. Which of the following interventions is contraindicated in this patient? A) d. Performing rapid sequence intubation B) a. Performing bag-mask ventilations without an ETT in place C) b. Having the patient lie supine D) c. Inflating a pneumatic antishock garment
D) c. Inflating a pneumatic antishock garment
Which of the following injuries can be caused by a shearing mechanism following abdominal trauma? A) d. Liver injury B) a. Bladder perforation C) b. Intestinal tearing along the aorta D) c. Kidney tearing at the ligamentum teres Points Earned: 0.0/1.0
D) c. Kidney tearing at the ligamentum teres
What is a dislocation?
Disruption of a joint, the soft tissue of the joint capsule and ligaments must be stretched beyond the normal range of motion and torn
Once the decision has been made to realign a fracture site, you should: A) d. Wait to perform the procedure and realign only if the patient loses distal circulation B) b. Continue realignment attempts until the gross deformity has been reduced C) a. Continue realignment attempts until distal pulses are present D) c. Make only one attempt at realignment
D) c. Make only one attempt at realignment
Injury to Bones and CT
Not all injuries can be confirmed as a fracture in the field Splinting an extremity with a suspected fracture helps prevent blood loss from bone tissues
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EMTs must learn specific techniques for immobilizing particular injuries but at the same time must foster creativity while applying the general rules of splinting.
A fracture of a child's bone at the epiphyseal plate commonly leads to: A) b. Infection B) d. Torn ligaments and tendons C) a. Frequent breakage of bones in the future D) c. Unusual deformity of the joint or an unnatural bending
D) c. Unusual deformity of the joint or an unnatural bending
Your patient is a 6 year old who has a leg fracture. In children, the majority of the long bone growth occurs in the: a. Bone marrow b. Growth plate c. Periosteum d. Growth shaft
Growth plate
Bones
Hard but flexible living structures that provide support for the body and protection for vital organs
Surface markings: Define sinus
Hollow space
What are the effects of excess growth hormone in children vs adults?
In children, it leads to a giant but normally proportioned body In adults it leads to thickened bones and features
Compartment Syndrome
Injury caused when tissues such as blood vessels and nerves are constricted within a space as from swelling or from a tight dressing or cast
What is the disease Osteoarthritis? And what does it affect?
It is a degenerative disease, resulting from wear and tear on joints 1. it affects articular cartilage primarily. The disappearance of cartilage causes bones to rub together, causing inflammation, bone spurs, and bone deterioration 2. It affects large joints first, but can spread to any joints
What is a greenstick fracture?
It is an incomplete fracture with part of the bone intact. Common in the soft bones of children
What are the four different types of bones?
Long bones-in arms and thigh Short bones-in hands and feet Flat bones-sternum and ribs Irregular bones- spinal column
Advantages of Splinting
Minimizes movement of disrupted joints and broken bone ends Prevents add'l injuries to soft tissues (nerves, arteries, veins, muscles) Decreases pain Minimize blood loss Can prevent a closed fracture from becoming an open fracture
Advantages of Splinting
Minimizes movement of disrupted joints and broken bone ends Prevents additional injury to soft tissues (nerves, arteries, veins, muscles) Decreases pain Minimizes blood loss Can prevent a closed fracture from becoming an open fracture For any splint to be effective, it must immobilize adjacent joints and bone ends. A deformed extremity can be realigned if necessary to restore effective circulation or fit it into a splint. Effective splinting may require some ingenuity. Splints often come in either rigid, formable, or traction style.
Pelvic Injuries Treatment
Move patient as little as possible Determine CSM distal to injury Straighten lower limbs to anatomical position Stabilize lower limbs Assume spinal injuries Treat for shock Consider using a pelvic wrap, pneumatic anti-shock garments, or a pelvic binder to immobilize an unstable pelvis.
What is a pathologic fracture?
Occurs secondary to a weak spot from disease in the bone.
patient care: hip fracture
One of the following methods can be used to stabilize a hip fracture Bind the Legs together, Padded Board & Apply an anti-shock garment
Treatment: Splinting Long Bone and Joints
Select splint appropriate to injury SP Manually stabilize injury site Assess CSM Realign injury if deformed or if distal extremity is cyanotic or pulseless Measure or adjust splint; move it into position Apply and secure splint to immobilize injury site, adajacent joints Reassess CSM distal to injury
What is cartilage?
Tough tissue that covers the joint ends of bones and helps form certain body parts such as the ear
The death rate from closed fractures of the femur dropped form 80 percent to under 20 percent in the post-World War 1 period due to the invention of the: a. PASG b. IV bag c. Traction splint d. Tourniquet
Traction splint
long bones
bones found in the arm and leg, humerus, radius, ulna, femur, tibia. fibula
Define diaphysis
is the long section of the bone
Inside the epiphyses of each long bone, mostly ________________ can be found.
spongy bone
Ligaments
tie bone to bone.
Tendons
tie muscle to bone
ligaments
tissue that connects bone to bone
tendons
tissue that connects muscle to bone
muscles
tissues or fibers that cause movement of body parts and organs
Describe long bones and name some examples
weight-bearing, curved, and strong. They are both compact and spongy. Example: The limbs (humerus, ulna, radius, femur, tibia, etc.)
Shoulder Girdle Injuries The following are common signs and symptoms of an injury to the shoulder girdle
■ Pain in the shoulder may indicate several types of injury. Look for specific signs. ■ A dropped shoulder, with the patient holding the arm of his injured side against the chest, often indicates a fracture of the clavicle. ■ A severe blow to the back over the scapula may cause a fracture of that bone. (All the bones of the shoulder girdle can be felt except the scapula. Only the superior ridge of the scapula, called its spine, can be easily palpated. Injury to the scapula is rare but must be considered if there are indications of a severe blow at the site of this bone.) Check the entire shoulder girdle. Feel for deformity and tenderness where the clavicle joins the anterior scapula (the acromion). Feel and look along the entire clavicle for deformity from the sternum medially to the shoulder laterally. Note if the head of the humerus can be felt or moves in front of the shoulder. This is a sign of possible anterior dislocation or fracture.
You are treating a 22 year old male who you suspect has sustained a fracture to his right forearm. The treatment of a possible fracture includes the steps below: 1. take standard precautions 2. elevate the extremity 3. splint the injury 4. apply a cold pack What is the correct order of the steps? a. 2,3,4,1 b. 1,3,2,4 c. 3,2,4,1 d. 1,4,2,3
1,3,2,4
To apply a sheet as a pelvic wrap:
1. Complete a scene size-up and primary assessment. 2. Once you determine the patient is a candidate for a pelvic wrap (unstable pelvis with or without signs of shock or positive MOI), prepare a backboard with a sheet, folded flat, approximately 10 inches wide and lying across the backboard. 3. Carefully roll the patient to the backboard. Center the sheet at the patient's greater trochanter (the bony prominence at the proximal end of the femur). This will position the sheet lower than the iliac "wings." This is the correct position. 4. Bring the sides of the sheet around to the front of the patient. As you bring the sides of the sheet together and tie them, you will cause compression and stabilization of the pelvis. The sheet should feel firm enough on the pelvis to keep it in normal position without overcompression (Figure 30-18C). 5. Secure the sheet using ties or clamps so that the compression is maintained. NOTE: Some EMS services prefer to apply the pelvic wrap to the patient before movingthe patient to the backboard to reduce the pain of that move.
patient care: pelvic assessment
1. Minimize moving of patient 2. Assess distal PMS 3. Straighten Pt's lower limbs to anatomical position if no hip or lower limb injury 4. Place blanket between lwgs from groin to feet and tape legs together 5. Apply PASG if hypotensive (<90) 6. Assume spinal injuries and secure to backboard with full C-spine stabilization 7. Reassess distal PMS 8. High conc oxygen and treat for shock 9. Transport
Pelvic Injuries
1. Move the patient as little as possible. If you must move the patient, move him as a unit. Never lift the patient with the pelvis unsupported. Warning: Use caution when using a log roll to move a patient with a suspected pelvic fracture. Roll the patient gently to the uninjured side, when possible. 2. Determine CSM distal to the injury site. 3. Straighten the patient's lower limbs into the anatomical position if there are no injuries to the hip joints and lower limbs and if it can be done without meeting resistance or causing excessive pain. 4. Prevent additional injury to the pelvis by stabilizing the lower limbs. Place a folded blanket between the patient's legs, from the groin to the feet, and bind them together with wide cravats. Thin rigid splints can be used to push the cravats under the patient. The cravats can then be adjusted for proper placement at the upper thigh, above the knee, below the knee, and above the ankle. 5. If permitted by local protocol, apply a pneumatic anti-shock garment (PASG) to stabilize the pelvis in a patient with hypotension (blood pressure below 90). 6. Assume that there are spinal injuries. Immobilize the patient on a long spine board. When securing the patient, avoid placing the straps or ties over the pelvic area. 7. Reassess distal CSM. 8. Care for shock, providing high-concentration oxygen. 9. Transport the patient as soon as possible. 10. Monitor vital signs.
The general guidelines for realigning an extremity are as follows
1. One EMT grasps the distal extremity, while a partner places one hand above and one hand below the injury site. 2. The partner supports the site while the first EMT pulls gentle manual traction in the direction of the long axis of the extremity. If you feel resistance or if it appears that bone ends will come through the skin, stop realignment and splint the extremity in the position found. 3. If no resistance is felt, maintain gentle traction until the extremity is properly aligned and splinted. Generally, injured joints should be splinted in the position found unless the distal extremity is cyanotic or lacks pulses. If these conditions are present, try to align the joint to a neutral anatomical position using gentle traction, provided that no resistance is felt.
patient assessment: pelvic injuries
1. Pain in groin, hip, pelvis, back 2. Painful reaction when pressure is applied to iliac crests 3. Pt cannot lift legs from lying position ( don't ask Pt to do this) 4. Foot of injured side may turn out (lateral rotation) 5. Pt may have unexplained pressure on bladder and need to piss
To splint long-bone or joint injuries, follow these guidelines
1. Take appropriate Standard Precautions and, if possible, expose the area to be splinted. 2. Manually stabilize the injury site. This can be done either by you or by a helper. 3. Assess circulation, sensation, and motor function (CSM). Check for pulses and see if the patient can feel your touch distal to the injury. Ask the patient to wiggle his fingers or toes to assess movement. Do not ask the patient to grasp, press, or pull an extremity you believe may be fractured. This will cause unnecessary pain and may aggravate the injury. 4. Realign the injury if deformed or if the distal extremity is cyanotic or pulseless. Be sure to attempt to realign an injured joint only if the distal extremity is pulseless or cyanotic. 5. Measure or adjust the splint and move it into position under or alongside the limb. Maintain manual stabilization or traction during positioning and until the splinting procedure is complete. 6. Apply and secure the splint to immobilize adjacent joints and the injury site. 7. Reassess CSM distal to the injury.
What are the 6 primary functions of the skeletal system?
1. movement 2. Support of the body 3.physical protection of internal organs 4. Production of blood cells 5. Mineral storage (calcium, phosphorus, and magnesium) 6. Lipid storage
You are evaluating a 33-year-old female patient who was ejected from a motorcycle when her husband lost control on a corner. After exposing her body, you observe abrasions across her right flank and abdomen and note that bruising is developing along the posterior aspect of her right flank. Based on this information, you suspect that your patient: A) d. May have internal abdominal injuries B) a. Has fatal injuries C) b. Is in decompensated hemorrhagic shock D) c. Likely has superficial abdominal injuries only
A) d. May have internal abdominal injuries
When assessing musculoskeletal injuries, paramedics should: A) d. Not be concerned with differentiating among sprains, strains, and fractures B) a. Make every attempt to diagnose the injury correctly C) c. Manage patients as though they have a strain D) b. Manage patients as though they have a sprain
A) d. Not be concerned with differentiating among sprains, strains, and fractures
What would you expect to find during your assessment of a patient you believe may have internal abdominal traumatic injuries? A) d. Tenderness B) a. A soft abdomen C) c. Obvious external blood loss D) b. Early development of a rigid and distended abdomen
A) d. Tenderness
You are treating a 40-year-old female patient who was stabbed in the right upper quadrant with a steak knife. Oxygen has been administered, and the entry wound has been covered with a sterile dressing. Appropriate care for this patient includes: A) d. Transport to the closest trauma center B) c. Transport to the closest emergency department for a blood transfusion C) a. Administration of IV epinephrine to help the patient compensate D) b. IV fluids infusing at a KVO rate
A) d. Transport to the closest trauma center
Realigning Deformed Extremity
Assists in restoring effective circulation to extremity and to fit it to splint If not realigned, splint may be ineffective, causing increased pain and possible further injury If not realigned, increased chance of nerves, arteries, and veins being compromised Increased pain is only momentary
Which of the following is correct regarding the use of traction splints? A) d. Traction splints are used to reduce open, midshaft long-bone fractures. B) b. Traction splints are used for isolated midshaft femur fractures. C) c. Traction splints are used for proximal femur fractures or hip dislocations. D) a. Traction splints are used for dislocations of the knee with associated femur fracture.
B) b. Traction splints are used for isolated midshaft femur fractures.
Immobilization of an injured femur requires: A) d. Only one rescuer B) c. At least two rescuers C) b. At least three rescuers D) a. A four-person crew
B) c. At least two rescuers
A bone break common in children, in which the bone is bent but only broken on the outside of the bend, is called a: A) d. Stress fracture B) c. Greenstick fracture C) b. Comminuted fracture D) a. Closed fracture
B) c. Greenstick fracture
A critical assessment finding during your evaluation of a patient who experienced abdominal trauma is: A) d. Pain B) c. Hypovolemic shock C) b. Bruising D) a. Anxiety
B) c. Hypovolemic shock
A grade 2 sprain usually results in: A) a. A dislocated joint B) c. Immediate pain and swelling C) b. An unstable joint D) d. Vascular compromise
B) c. Immediate pain and swelling
One of the most common causes of vascular abdominal injuries is: A) b. Blast injuries B) c. Improper use of seat belts C) d. Knife wounds D) a. Bone fracture fragments
B) c. Improper use of seat belts
Following a traumatic pancreatic injury, the major concern becomes: A) b. Hyposecretion of insulin B) c. Leakage of digestive enzymes into the peritoneal space C) a. Hypersecretion of insulin D) d. Massive hemorrhage
B) c. Leakage of digestive enzymes into the peritoneal space
You and your partner have splinted a possible midshaft radial-ulna fracture. After applying the splint, PMS is reevaluated, noting that the pulse is absent. Your next action would be to: A) b. Contact medical control B) c. Loosen the splint C) a. Apply ice D) d. Realign the injury
B) c. Loosen the splint
You are evaluating an extremity fracture of the lower arm. You find a distal pulse; however, your patient states there is numbness below the sight of the injury. Using the 6 P's of assessment, you state this is: A) b. Paralysis B) c. Paresthesia C) a. Pallor D) d. Pressure
B) c. Paresthesia
As a paramedic, you recognize the greatest potential of blood loss is from a fracture of the: A) c. Rib B) d. Pelvis C) b. Humerus D) a. Femur
B) d. Pelvis
You are managing an unresponsive 50-year-old female patient who was in a car-versus-tree motor vehicle crash. She is in the driver's seat wearing a chest strap but no waist belt. Her pulse rate is 134 beats/min, her respiratory rate is 36 breaths/min, and her blood pressure is 76/52 mm Hg. The imprint of her seat belt is clearly defined across her chest and abdomen, and her abdomen is rigid and bruising. You suspect that your patient may have: A) c. A tension pneumothorax B) d. Ruptured a blood vessel C) b. A ruptured spleen D) a. A cardiac tamponade
B) d. Ruptured a blood vessel
Other than hemorrhage, the major cause of mortality following a traumatic duodenal rupture is: A) b. Ileus B) d. Spillage of intraluminal contents into the peritoneum C) a. Bowel infarction from ischemia D) c. Inability to digest food/malnutrition
B) d. Spillage of intraluminal contents into the peritoneum
You are evaluating a 28-year-old female patient who was the belted driver in a car-versus-tree motor vehicle crash. She is also 30 weeks' pregnant. She is complaining of severe abdominal pain with cramping, and you can see blood soaking into her shorts and onto the driver's seat. As you prepare to extricate the patient, you advise everyone on scene that you are going to immobilize the patient: A) a. In a traditional manner B) d. With padding underneath her right hip and pelvis only to elevate the right side of her pelvis C) b. On her left side on the backboard with padding in the spaces D) c. With padding under her feet and legs supine on the backboard
B) d. With padding underneath her right hip and pelvis only to elevate the right side of her pelvis
A fracture or dislocation should be realigned when: A) b. The lower leg is involved B) d. The site is bleeding C) a. Circulation is impaired D) c. The patient reports extreme pain
C) a. Circulation is impaired
Traction splints are designed specifically to be used for what type of injuries? A) d. Tibia fractures B) c. Pelvic fractures C) a. Femur fractures D) b. Knee dislocations
C) a. Femur fractures
Before manipulating any injured extremity, you must: A) a. Administer intravenous analgesic per medical direction B) c. Place the patient on high-flow oxygen C) b. Assess distal pulses, sensation, and motor function D) d. Position the patient on a long backboard
C) b. Assess distal pulses, sensation, and motor function
Your crew is called to a local nightclub for a 23-year-old male with a hand injury. The patient tells you that he hit a brick wall when he missed his intended target. The patient's knuckles and the entire back of his hand are edematous and painful. His hand has limited movement of the distal phalanges. His hand is open and his fingers are bent. To immobilize this injury, you should: A) d. Straighten the fingers and then immobilize the hand B) b. Close the hand into a fist and then immobilize the hand C) c. Immobilize the hand in a position of function D) a. 'Buddy splint' the fingers together
C) c. Immobilize the hand in a position of function
Paramedics play a vital role in early abdominal trauma management by: A) d. Triaging with patients who may or may not have suffered internal injuries following abdominal trauma B) a. Controlling internal bleeding C) c. Providing rapid response and rapid transport to a trauma center D) b. Identifying for the surgeons which organ is bleeding
C) c. Providing rapid response and rapid transport to a trauma center
Prehospital management of internal genitalia or bladder injury includes: A) c. Foley catheter placement B) b. Flushing saline into the genitalia with a plastic catheter C) d. Attention to the ABCs and treating hemorrhagic shock if present D) a. Applying a compression bandage to the genitalia
C) d. Attention to the ABCs and treating hemorrhagic shock if present
The most serious concern of a bladder rupture is: A) a. Loss of the body's ability to eliminate urine B) b. Massive hemorrhage C) d. Shock and/or peritonitis D) c. Urine and blood leakage
C) d. Shock and/or peritonitis
Which of the following solid organs can be injured with trauma to the upper left abdominal quadrant? A) c. Pancreas B) a. Appendix C) d. Spleen D) b. Kidney
C) d. Spleen
How does prehospital management of solid organ injury differ from management of hollow organ injury? A) b. Solid organ injuries require less fluid resuscitation. B) c. Solid organ injuries require treatment at a trauma center, unlike hollow organ injuries. C) d. There is no difference in prehospital management. D) a. Hollow organ injuries require less fluid resuscitation.
C) d. There is no difference in prehospital management.
Based on your knowledge of anatomy, you would suspect a patient with a stab wound in the upper right quadrant to be at risk for: A) c. A perforated bladder, causing infection B) d. A perforated stomach, causing infection C) b. A lacerated spleen, causing internal hemorrhage D) a. A lacerated liver, causing internal hemorrhage
D) a. A lacerated liver, causing internal hemorrhage
A major risk for both an expectant mother and her fetus following a serious traumatic event is: A) d. Preecclampsia B) c. Placenta previa C) b. HELLP syndrome D) a. Abruptio placentae
D) a. Abruptio placentae
Appropriate care for abdominal organs protruding through the abdominal wall includes: A) b. Covering the organs with a dry dressing B) c. Inserting the organs back into the body C) d. Having the patient lie supine and providing aggressive pain management D) a. Covering the organs with moist dressing
D) a. Covering the organs with moist dressing
A Colles fracture refers to what area of the body? A) b. Mandible B) d. Ribs C) c. Proximal tibia D) a. Distal radius
D) a. Distal radius
When the diaphragm ruptures: A) d. The chest wall cannot expand normally B) c. Partially digested food does not flow from the stomach into the duodenum C) b. Chest cavity organs can fall into the abdominal cavity D) a. Herniation of the abdominal contents upward into the chest cavity occurs
D) a. Herniation of the abdominal contents upward into the chest cavity occurs
You are managing a 25-year-old male patient who was involved in a gang-related fight; police have secured the scene. During your assessment, you find several stab wounds along the patient's right flank and lower back. The patient is awake and anxious, in obvious pain. While your partner obtains vital signs, appropriate management for the stab wounds includes: A) a. Applying wet sterile dressings over each wound and then an occlusive dressing B) c. Only covering them with an occlusive dressing C) d. Packing each wound with gauze to control internal bleeding D) b. Covering the wounds with gauze or trauma dressings
D) b. Covering the wounds with gauze or trauma dressings
To reduce pain and swelling in the first 24 hours after a sprain, apply: A) a. Heat and ice, alternating every 3 to 4 hours B) d. Warm soaks C) b. Heat first, and then ice, once the muscles are warmed D) c. Immobilization and ice
D) c. Immobilization and ice
You are called to the ski patrol headquarters of a ski resort because there has been a skiing accident. When you arrive, you find a 23-year-old male patient immobilized and in obvious pain. He reportedly lost control on the mogul run and tumbled down the side, eventually striking a tree. During your assessment, his abdomen is slightly rigid with rebound tenderness. There is no abdominal bruising; it just appears slightly red. His pulse rate is 82 beats/min, his respiratory rate is 18 breaths/min, his blood pressure is 136/72 mm Hg, his skin is normal, and he rates his pain as a 10 out of 10. Based on these findings, you suspect: A) d. Spleen rupture B) b. Pelvis fracture C) a. Massive internal hemorrhage D) c. Potential intestinal rupture
D) c. Potential intestinal rupture
After controlling the airway and any severe external bleeding in a patient with traumatic abdominal injuries, the most important treatment is to: A) d. Stabilize any musculoskeletal injuries B) a. Establish two large-bore IVs C) b. Provide aggressive pain management D) c. Provide early rapid transport to a trauma center
D) c. Provide early rapid transport to a trauma center
A fracture of the femur can result in blood loss of up to: A) c. 1000 mL B) a. 250 mL C) b. 500 mL D) d. 2000 mL
D) d. 2000 mL
Your ambulance crew is called to a scene where a 42-year-old female fell from a second-story balcony and landed on her outstretched right arm. There is gross deformity at the shoulder. The patient is unconscious. You should address immobilization of the deformed right shoulder by: A) c. Applying a traction splint B) b. Applying a sling and swathe C) a. Applying a sling D) d. Immobilizing the patient to a long backboard
D) d. Immobilizing the patient to a long backboard
If an expectant mother improperly wears a seat belt too high and is involved in a motor vehicle crash, she could experience what condition? A) b. Placenta previa B) a. Fetal decapitation C) c. Preterm labor D) d. Placental abruption
D) d. Placental abruption
Which of the following is a solid abdominal organ? A) c. Stomach B) b. Intestines C) a. Gallbladder D) d. Spleen
D) d. Spleen
Hollow organ rupture is most frequently caused by which of the following mechanisms? A) c. Skiing accidents B) a. Contact sport collisions C) b. Restrained drivers in motor vehicle crashes D) d. Unrestrained drivers in motor vehicle crashes
D) d. Unrestrained drivers in motor vehicle crashes
The most common bones to receive stress fractures are: A) a. Bones of the arm B) c. Ribs C) b. Long bones D) d. Weight-bearing bones
D) d. Weight-bearing bones
Purposes and general procedures for splinting
Emergency care for all suspected extremity fractures starts by splinting. For any splint to be effective, it must immobilize adjacent joints and bone ends.Effective splinting minimizes the movement of disrupted joints and broken bone ends, and it decreases the patient's pain. It helps prevent additional injury to soft tissues such as nerves, arteries, veins, and muscles. It can prevent a closed fracture from becoming an open fracture, a much more serious condition, and it can help to minimize blood loss. In the case of the spine, splinting on a backboard prevents injury to the spinal cord and helps to prevent permanent paralysis.
How are hematomas produced?
Fractures that tear blood vessels (common)
A break in the continuity of the skin of a fractured extremity is considered a(n) ____ bone or joint injury. a. Simple b. Open c. Closed d. Grating
Open
Assessment: Knee Injury
Pain and tenderness Swelling Deformity with swelling
Assessment: Tibia/Fibula Injury
Pain and tenderness Swelling Possible deformity
Assessment: Pelvic Injuries
Pain in pelvis, hips, or groin Pain when pressure applied Cannot lift legs Lateral rotation of the foot Unexplained pressure in bladder Bleeding from the urethra, rectum or vagina
Assessment: Shoulder Girdle Injuries
Pain in shoulder Dropped shoulder Severe blow to back over scapula
6 P's of Assessment
Pain or tenderness Pallor (pale skin) Parasthesia (pins and needles) Pulses diminished or absent Paralysis Pressure
Assessment: Musculoskeletal Injuries
Rapidly identify and treat life-threatening conditions Be alert for injuries besides grotesque wound Pain and tenderness Deformity and angulation Grating (crepitus) Swelling Bruising Exposed blood cells Nerve/blood vessel compromise (decreased CMS)
Have I fully addressed life threats and maintained my priorities even in the presence of a grossly deformed extremity? Does the patient have an injury that requires splinting?
Remind students that they need to use their senses of sight, touch, and hearing during their assessment of patients with musculoskeletal injuries. They will need to look past obvious signs and probe for multiple injuries in order to make a complete assessment of the patient.
Soft Splint
Roll of bandage placed in hand Tie forearm, wrist, and hand into fold of one pillow or between two pillows Tape finger to adjacent uninjured finger
Treatment: Musculoskeletal Injuries
SP PA Spinal precautions, if necessary Splint any suspected extremity fractures after treating life-threatening conditions Cover open wounds with sterile dressings
Examples of a bipolar traction splint include all of the following except: a. Hare b. Sager c. Fernotrac d. Half-ring
Sager
Splinting Long Bone and Joints Treatment
Select splint appropriate to injury Standard precautions Manually stabilize injury site Assess circulation, sensation, and motor function Realign injury if deformed or if distal extremity is cyanotic or pulseless Measure or adjust splint; move it into position Apply and secure splint to immobilize injury site, adjacent joints Reassess CSM distal to injury
Compartment Syndrome
Serious condition caused when tissues such as blood vessels and nerves are constricted from swelling, tight dressing or cast Assessment will involve your sight, hearing, and touch. Compartment syndrome results from increased swelling in the muscle compartment/area, which progresses to cellular death from loss of blood flow. The best treatment if it is suspected is to treat the underlying injury; i.e., splint the wound.
The patella is classified as a/an _____ bone by some anatomists.
Sesamoid
Your 19 year old female patient was snowboarding when she injured her right shoulder. It appears to be out of the socket and in an unusual position. When a joint is locked in the position like this, the EMT should: a. Splint the joint in the position found b. Pull traction and straighten the joint c. Use a long backboard as a full body splint d. Disregard splinting and transport immediately
Splint the joint in the position found
Musculoskeletal Injuries Treatment
Take standard precautions Perform primary assessment Take spinal precautions, if necessary Splint any suspected extremity fractures after treating life-threatening conditions Cover open wounds with sterile dressings Effective splinting immobilizes adjacent joints and bone ends and minimizes the movement of disrupted joints and broken bone ends.
One method of treating pelvic injuries is the pelvic wrap. Performed with commercially available devices or formed from a sheet (these steps are described in the following text), the wrap reduces internal bleeding and pain while providing stabilization to the pelvis. It may also prevent further injury. Since many systems no longer carry the pneumatic anti-shock garment (PASG), the pelvic wrap provides an alternative treatment for suspected pelvic fracture.
To apply a sheet as a pelvic wrap: 1. Complete a scene size-up and primary assessment. 2. Once you determine the patient is a candidate for a pelvic wrap (unstable pelvis with or without signs of shock or positive MOI), prepare a backboard with a sheet, folded flat, approximately 10 inches wide and lying across the backboard. 3. Carefully roll the patient to the backboard. Center the sheet at the patient's greater trochanter (the bony prominence at the proximal end of the femur). This will position the sheet lower than the iliac "wings." This is the correct position. 4. Bring the sides of the sheet around to the front of the patient. As you bring the sides of the sheet together and tie them, you will cause compression and stabilization of the pelvis. The sheet should feel firm enough on the pelvis to keep it in normal position without overcompression. 5. Secure the sheet using ties or clamps so that the compression is maintained. NOTE: Some EMS services prefer to apply the pelvic wrap to the patient before moving the patient to the backboard to reduce the pain of that move.
Hip Dislocation/Fracture Treatment
Treatment Assess distal CSM Move patient onto spine board Immobilize limb with pillows and blankets Secure patient to spine board Reassess distal CSM Be sure to assess for distal circulatory, sensory, and motor functions before and after immobilizing a hip dislocation. To immobilize a hip fracture, consider using padded boards, binding the legs together, or applying pneumatic anti-shock garments.
Ankle/Foot Injury Treatment
Treatment Assess distal CSM Stabilize limb Lift limb Place cravats under ankle Lower limb into pillow Tie pillow around ankle Apply ice pack as needed Describe the assessment findings and immobilization techniques for the following types of injuries: shoulder girdle injury, pelvic fracture, hip dislocation/fracture, femoral shaft fracture, knee injury, tibia/fibula fracture, ankle/foot injury. Improvise splints. Assemble common household items and ask students to create splints.
Femoral Shaft Fracture Treatment
Treatment Control bleeding Assess distal CSM Apply traction splint Reassess distal CSM Treat for shock Use a traction splint to immobilize isolated femoral shaft fractures.
traction splint
a splint that applies constant pull along fractured bone and to reduce muscle spasm in the limbs; traction splints are used primarily on femoral shaft fractures
traction splint
a splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. Traction splints are used primarily for femoral shaft fractures.
the Sager and the Kendrick traction devices
a unipolar splint has a single metal rod that is placed alongside the leg
The amount of traction that the EMT should pull when applying a Sager traction splint is: a. enough until the patient verbalizes relief b. about 10 percent of the patient's body weight up to 15 pounds c. minimal because it doesn't require traction d. about 15 percent of the patient's body weight up to 30 pounds
about 10 percent of the patient's body weight up to 15 pounds
You are treating a 62 year old female patient who fell down the basement stairs. She did not strike her head, but she is in a lot of pain form lower extremity fractures. There is a severe deformity of the right distal extremity and it is cyanotic or pulseless. You should: a. align with gentle traction before splinting b. apply a pillow splint to the extremity c. delay splinting until you are en route to the hospital d. contact medical direction immediately
align with gentle traction before splinting
Hazards of improper splinting include: a. aggravation of a bone or joint injury b. reduced distal circulation c. delay in transport of the patient with a life-threatening injury d. all of these
all of these
Pneumatic Anti-Shock Garment
also known as a MAST garment) may be used (where available) for splinting a suspected pelvic fracture in a patient with hypotension (blood pressure below 90).Some EMS systems also use the anti-shock garment for splinting hip,femoral, and multiple leg fractures.An anti-shock garment is to be applied in accordance with local protocols. In many localities, its application requires an order from a physician.
open extremity injury
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
dislocation
an injury in which a bone comes out of its joint
closed extremity injury
an injury to an extremity with no associated opening in the skin.
The 52 year old male patient you are treating has multiple leg fractures and exhibits the signs of shock. You should: a. apply two traction splints and pull tension to 30 pounds b. align in a normal position and transport on a backboard c. apply PASG at a splint and treat for shock d. apply a vacuum splint to each leg and transport quickly
apply PASG at a splint and treat for shock
If you decide that the 35 year old male patient you are treating for musculoskeletal injuries is unstable, you should do all of the following except: a. care for life-threatening problems first b. align the injuries in an anatomical positions c. immobilize the entire body to a long spine board d. apply two traction splints prior to securing the patient on a long spine board
apply two traction splints prior to securing the patient on a long spine board
The indications for a traction splint
are a painful, swollen, deformed mid-thigh with no joint or lower leg injury.A traction splint is contraindicated if there is a pelvis, hip, or knee injury; if there is an avulsion or partial amputation where traction could separate the extremity;or if there is an injury to the lower third of the leg that would interfere with the ankle hitch.
Tendons
are bands of connective tissue that bind the muscles to bones. The tendons allow for the power of movement across the joints.
Which procedure is done at least twice whenever a splint is applied? a. elevation of the injured extremity b. manual stabilization of the injured extremity c. assessment for circulation, sensation and motor function distal to the injury d. application of gentle manual traction
assessment for circulation, sensation and motor function distal to the injury
Your 45 year old female patient has a grossly deformed ulnar and radius fracture that will need to be properly splinted. The objective of realignment is to: a. minimize blood loss and reduce pain b. immobilize the bone ends and adjacent joints c. assist in restoring circulation and to fit the extremity into a splint d. prevent incorrect healing and avoid surgery
assist in restoring circulation and to fit the extremity into a splint
indirect force
can be just as powerful. For example, a well-known injury pattern occurs when people fall from heights and land on their feet. Pelvic fractures may be the result of direct or indirect force. Usually cause injuries to the knees, femurs, pelvis, and spinal column. In fact, most injuries to the upper extremities are caused by forces applied to an outstretched arm. In the course of a fall, the person reaches out with an arm in an effort to break the fall and, in doing so, often breaks the radius, ulna, or clavicle, or dislocates the shoulder.
Twisting or rotational forces
can cause stretching or tearing of muscles and ligaments, as well as broken bones, such as occur when a ski digs into the snow while the skier's body rotates. Sporting activities such as football, basketball, soccer, in-line skating, skiing, snowboarding, and wrestling—in addition to motor-vehicle collisions—account for many musculoskeletal injuries. a rapid deceleration causes the knees to strike the dash of a car; a fall on ice causes a twisting force to the ankle
Spongy bone is also referred to as _____ bone.
cancellous
You have a 22 year old female who ell on an outstretched arm. A splint properly applied to a closed bone injury, such as a colles fracture, should help prevent all of the following except: a. damage to muscles, nerves, or blood vessels b. an open bone injury c. motion of bone fragments d. circulation to the extremity
circulation to the extremity
There are basically three types of mechanisms that cause musculoskeletal injuries:
direct force, indirect force, and twisting force.
If patient has multiple trauma or appears to have shock
do not waste time splinting individual fractures. Place patient on long spine board and secure limbs to board. Splint individual fractures en route if time and priorities allow.
Define metaphysis
is the intermediate(transitional) area between the diaphysis and the epiphysis. This is where the growth occurs in young bones
The object of realignment (straightening)
is to assist in restoring effective circulation to the extremity and to fit it to a splint. Some injuries, such as certain wrist fractures, may be easily splintable because they are only slightly deformed. In this case, the only reason to attempt realignment is to restore circulation to the hand if it appears to be cyanotic or lacks a pulse.
Surface markings: define condyle
large knob or rounded surface
Surface markings: Define Trochanter
large projection of the femur
Appendicular bones are mostly what?
limbs and girdles that attach limbs to the axial system
extremities
limbs on the body, especially hands and feet
What is the purpose of articular cartilage
lines bone-to-bone joints, allowing frictionless movement
The bones of the upper arm are classified as _____ bones.
long
Which bone contains the foramen magnum?
occipital
joints
places where bones connect: hinge, pivot, gliding, ball and socket
Splinting
protects the patient from further injury.
Your 55 year old female patient was crushed by a vehicle. You suspect that she may have a pelvic injury. When stabilizing her, you should do all of the following except: a. assume there is a spinal injury b. determine distal function c. apply PASG if the patient is hypotensive d. raise the lower legs
raise the lower legs
You are treating a 35 year old female who was the front-sear, unrestrained passenger in a rear-end collision. Her right tibia struck the lower dashboard of the car. If the lower leg is cyanotic or lacks a pulse when a knee joint injury is assessed, the EMT should: a. splint it in the position in which it was found b. transport the patient to the hospital immediately c. realign with gentle traction is no resistance is met d. call for assistance from a paramedic unit
realign with gentle traction is no resistance is met
The method od splinting should be dictated by the: a. time when the injury occurred b. severity of the patient's condition and the priority decision c. distance to the destination hospital d. presence or absence of pain
severity of the patient's condition and the priority decision
You are treating a 22 year old female who fell off the roof of her house. Your primary assessment of this patient with multiple musculoskeletal injuries reveals that the patient is unstable; care should include all of the following except: a. manage the ABC's b. immobilize the patient on a long spine board c. transport the patient immediately d. splint each injury individually
splint each injury individually
flat bones
sternum, shoulder blades and ribs
Sprain
stretching and tearing of ligaments
Bones provide the body with
structure, store metabolic materials, and produce red blood. Joints are the places where bones articulate to create movement.
comminuted fraction
the bone is splintered or crushed into small fragments
What happens if the open plate is injured?
the bone will stop growing
dislocation
the disruption or "comming apart" of a joint
tendons
tissues that connect muscle to bone
cartilage
tough tissue that covers the joint ends of bones and helps form certain body parts such as the ear
cartilage
tough tissue that covers the joint ends of bones and helps to form certain body parts such as the ear.
irregular bones
vertebrae
The thought of realigning an angulated injury can be a frightening one. However, remember these points:
• If the extremity is not realigned, the splint may be ineffective, causing increased pain and possible further injury (including an open fracture) during transportation. • If the extremity is not realigned, the chance of nerves, arteries, and veins being compromised increases. When distal circulation is compromised or shut down, tissues beyond the injury become starved for oxygen and die. • Pain is increased for only a moment during realignment under traction. Pain is reduced by effective splinting.
The following are common signs and symptoms of a hip dislocation:
■ Anterior hip dislocation. The patient's entire lower limb is rotated outward and the hip is usually flexed. ■ Posterior hip dislocation (most common). The patient's leg is rotated inward, the hip is flexed, and the knee is bent
Fractures of the pelvis may occur with falls, in motor-vehicle collisions, or when a person is crushed by being squeezed between two objects. Pelvic fractures may be the result of direct or indirect force. The following are common signs and symptoms of a pelvic injury:
■ Complaint of pain in the pelvis, hips, groin, or back. This may be the only indication, but it is significant if the mechanism of injury indicates possible fracture. Usually, obvious deformity is associated with the pain. ■ Painful reaction when pressure is applied to the iliac crests (wings of the pelvis) or to the pubic bones. ■ Complaint that the patient cannot lift his legs when lying on his back. (Do not test for this, but do check for sensation.) ■ Foot on the injured side may turn outward (lateral rotation). This also may indicate a hip fracture. ■ Patient has an unexplained pressure on the urinary bladder and the feeling of having to empty the bladder. ■ Bleeding from the urethra, rectum, or vaginal opening in the setting of a high-impact mechanism of injury. Blood at the meatus of the penis (opening of the urethra) is a finding unique to pelvic trauma/fracture.
