EMT Chapter 30

A patient has an injury to the elbow and forearm. While you are conducting the reassessment, which statement made by the patient should concern you most?

"My hand feels like it is going to sleep."

A 13-year-old boy flipped his bicycle and landed on outstretched arms, which caused a fracture to his collar bone. This is an example of:

An indirect force injury

Which statement about compartment syndrome is true?

"It describes swelling in the tissues that can result in the loss of an extremity."

An alert and oriented auto mechanic had his right thigh pinned between the bumpers of two cars. Assessment findings include deformity and swelling to the right hip area and mid-thigh, along with ecchymosis and swelling to the right knee. The patient complains of excruciating pain to the right leg. Which set of instructions given to other EMTs on the scene would be appropriate?

"Let's provide spine motion restriction precautions now, get the patient in the ambulance, and then provide more care to the leg en route."

Which statement about traction splints is true?

"Mechanical traction should be applied until the mechanical traction is equal to the manual traction and the patient experiences a reduction in pain."

A 67-year-old female complains of severe left lower leg pain. She states that she was walking across the room when she suddenly heard a "crack" and felt excruciating pain in her leg. Her left tibia appears to be deformed and ecchymotic, as well as tender on palpation. Her vital signs are pulse 96 beats/min, respirations 28 breaths/min, blood pressure 168/74 mmHg, and SpO2 98%. Additionally, the patient states that her doctor told her that the steroids she takes can weaken her bones, placing her at greater risk for fractures. Appropriate care for this patient would include:

Application of a splint to the leg

Which bodily activity is a function of a voluntary muscle?

Chewing food

A patient has swelling and deformity to the wrist. After splinting, in which position should the hand be placed?

Fingers curled inward

A patient with diagnosed osteoporosis is more likely to sustain which type of bone injury?

Fracture

The rapid secondary assessment of a male patient who was thrown off a motorcycle indicates instability and pain on palpation to the pelvic area. What is the EMT's primary concern related to this injury?

Internal blood loss

What is an emergency care measure for a patient with a possible bone fracture that can be an effective means to reduce pain?

Splinting the fracture

You are caring for a male patient who was ejected from the passenger side of a vehicle that was traveling at a high rate of speed when it left the roadway and overturned several times. During your primary assessment, you note the patient to have blood in the airway, rapid and shallow breathing, an absent radial pulse, and a weak and rapid carotid pulse. You also visualize that his left leg is severely injured, with gross visible angulations from suspected multiple fractures. Your partner is triaging the other occupants of the vehicle and you can hear the wail of the arriving fire department vehicles. Given this situation, what should you do first?

Suction the airway with a hand-operated suction machine while trying to minimize cervical spine motion

A vacuum splint has just been applied to the injured arm of a patient who fell backward from a chair while hanging drapes. Which statement or question should the EMT make or ask next after placing the splint?

"I am going to feel your wrist for a pulse now."

While on standby at a semi-professional baseball game, you are summoned onto the field at home plate for a player who complains of severe leg pain after colliding with the catcher of the opposing team. The primary assessment shows no threats to the airway, breathing, or circulation. The secondary assessment reveals a severely deformed knee that is swollen and ecchymotic. The leg is pale and cool, and the patient cannot move his leg when asked to do so. In addition, you cannot palpate a pedal pulse. What should the EMT's priority action be at this time?

Attempt to straighten the leg until a pulse returns

When using an air splint, the EMT must remember that air splints:

Can decrease circulation in the extremity

An alert and oriented 22-year-old male fell off a tractor and now complains of pain to his right leg. As you quickly scan the patient, you note deformity to the tibia-fibula area of the lower extremity. After conducting the primary assessment and manually stabilizing the leg, which action should the EMT take?

Check for a pedal pulse

A patient was struck in the right upper arm with a baseball bat. Which sign or symptom indicates the highest probability that the humerus has been fractured?

Crepitus felt on palpation

The secondary assessment of a patient who complains of right leg pain after falling down several stairs reveals a break in the skin where a fractured tibia bone broke through and then recessed back into the leg. The EMT should recognize this as which type of injury?

Open fracture

Family members report that their 62-year-old mother complained of dizziness and right leg weakness just before falling down a flight of stairs. Your assessment indicates that the patient is responsive, but confused and talking with garbled speech. Her breathing is adequate and her radial pulse is strong. Vital signs are pulse 84 beats/min, respirations 18 breaths/min, blood pressure 188/110 mmHg, and SpO2 96%. There is an open fracture to her right forearm. When instructed to do so, the patient does not move the fingers of her right hand. When caring for this patient, which sequence of actions seems most appropriate?

Provide spine motion restriction precautions to include a cervical collar, long spine board, and straps before extricating her to the ambulance for immediate transport

A football player injured his knee during practice and is in pain. His left knee is swollen, ecchymotic, and flexed in an upward position. Your partner reports that the distal skin is warm, and he has located a weak pedal pulse. Which action should you perform immediately?

Splint the knee in the position found prior to providing transport to the hospital

A female patient with osteoporosis stepped sideways on her foot and has suffered an open tibial fracture to the distal portion of her right leg. Which intervention indicates that appropriate care is being given for this injury?

The bone end and soft tissue wounds are covered with a sterile dressing

A young man was riding a motorcycle when he was hit head on by a car and thrown from the bike. Your scene size-up reveals him to be lying supine in the roadway with obvious deformity to his right thigh and left ankle, with blood noted on his pants in these areas. The patient assessment reveals he is unresponsive with snoring respirations and is breathing irregularly at 16 times per minute. His radial pulse is moderate in strength, and his skin is warm and dry. Which action should be performed first by the EMT?

Provide manual cervical spine motion restriction

A 9-year-old boy has fallen from a swing. Assessment findings reveal no threats to the airway, breathing, or circulation, but do indicate deformity, pain, and swelling to his right wrist. The right radial pulse is strong and is accompanied by skin that is pink and warm to the touch. Which action indicates that the EMT is properly caring for this patient?

Applying cold packs to the wrist to reduce swelling

You have been called for a male worker complaining of arm pain. At the scene, the 31-year-old patient states that his arm was crushed between two heavy boxes that shifted while being stacked by a forklift. He had minimal pain at that time, but now his right forearm is swollen and painful, especially with movement. The patient also states that the arm and fingers feel as if they are "asleep." You note decreased strength to the arm and a radial pulse that is weak when compared to the left arm. There is no deformity to the arm and the skin is intact, although hard on palpation. Vital signs are pulse 88 beats/min, respiration 18 breaths/min, and blood pressure 134/76 mmHg. Given these assessment findings, the EMT should be suspicious of:

Compartment syndrome

Firefighters are extricating the driver of a small car that was struck broadside by a delivery truck at a moderate rate of speed. The patient was unrestrained, and the car sustained severe damage to the driver's side. As the male patient is pulled from the car, you note severe deformity to his left thigh area where an open femur fracture has been bleeding severely. Your primary assessment shows the patient to be responsive to painful stimuli, with an open airway and adequate breathing at 20 breaths per minute. His radial pulse is present but rapid at a rate of 124. After applying oxygen and stopping the leg bleed with direct pressure, the EMT should immediately:

Conduct a rapid secondary assessment

A 57-year-old male fell 20 feet while setting up holiday lights on his roof. He impacted the ground feet first and has suffered open fractures to both tibias, with both bones protruding through the skin. Your assessment reveals him to be responsive to painful stimuli. His airway is open, his breathing is rapid, and his radial pulse is weak. The skin is cool and diaphoretic. Vital signs are pulse 132 beats/min, respirations 24 breaths/min, and blood pressure 106/90 mmHg. According to family, the patient has no pertinent medical history. Your partner is providing positive pressure ventilation. At this point in the patient's care, it is a priority for you to:

Look for other injuries

Which assessment finding would contraindicate the use of the traction splint?

Deformity of the hip

Which question is best asked when attempting to determine the degree of sensation in the hand of a patient who has an elbow injury?

"Can you tell me which finger I am touching?"

Which assessment finding, in a 32-year-old female involved in a motor vehicle collision, should the EMT recognize as potentially life threatening?

Deformity of the left femur

Which statement about different musculoskeletal injuries is true?

A sprain is an injury to a joint with possible damage to or tearing of ligaments

An elderly female patient fell and now complains of right hip and right knee pain. When assessing her, which finding would you find most concerning?

Absent pedal pulse

While evaluating a patient who experienced a fall, you note crepitus in the left forearm in the area of the wrist. Crepitus in the wrist is typically caused by:

Bone ends grinding together

The greatest benefit of applying a traction splint in the field to a deformed femur and thigh is that it can:

Decrease the pain

A splint applied too loosely can lead to which complication?

Laceration of previously intact blood vessels

A young female patient was walking on a 7-foot-high retaining wall when she lost her balance, stumbled, and fell from the wall. She impacted a concrete sidewalk surface with her left foot and left hand. Your assessment reveals ecchymosis, deformity, and edema to both the left foot and the left hand. Based on the concept of injury caused by indirect force, where else should the EMT look for injury?

Left hip

A female lifeguard fell 10 feet from her chair and now has deformity, swelling, and ecchymosis to her right lower leg. The leg also is rotated medially. Another lifeguard has taken and is maintaining manual cervical spine motion restriction. As your partner conducts the primary assessment and finds no life threats or disturbances in her mental status, you should perform which action first?

Manually stabilize the lower right leg

Which bone injury would be said to occur in the appendicular skeletal system?

Right hip fracture

You arrive on the scene to help another crew with the extrication from an attic of a female who fell while retrieving holiday decorations. As a result of the fall, the patient has an open fracture to her left lower leg. The patient has been fully immobilized to a long board and has a rigid splint in place to her left leg. What would indicate the extremity has been improperly splinted?

The patient is able to flex her left ankle when directed to do so

A patient has a history of tendonitis to the right elbow. Based on this history, the EMT would understand that the:

Tissue connecting the muscle to the bones of the elbow is inflamed

Your partner is off from work for an extended period because he is having surgery for a torn ligament. Which structure is in need of that surgery?

Tissue that connects one bone to other bones

Which type of muscle tissue is found in the forearm?

Voluntary

Which statement regarding voluntary muscles is true?

Voluntary muscles generally connect to the bones of the skeletal system

A patient with a closed fracture to the forearm has been properly splinted when which other structures are properly immobilized?

Wrist and elbow

Which statement shows that an EMT understands field care of a patient with a possible joint dislocation?

"The care for a patient with a joint injury is identical to that for a patient with a fracture."

A patient fell and sustained an open fracture to the left humerus. However, assessment reveals the bone to have pulled back into the arm. Bleeding from the site is controlled. How will splinting the left arm benefit this patient?

Decrease the opportunity for further injury to nerves and blood vessels

A patient whom you transported several days ago stops by your station to thank you. He reports that he was diagnosed with a strain to the lower right leg. As such, you recognize which structure as being affected by that injury?

Muscle

You arrive at a hunting camp for a hunter who stumbled over a rock and caught himself on his outstretched arm. The patient denies hitting his head or neck. There are no threats to the airway, breathing, or circulation. The patient has swelling and ecchymosis to his left wrist. A radial pulse is readily palpated and the skin in the hand is warm to the touch. Which instructions given by the EMT to other rescuers indicates proper care of this patient?

"After we splint his wrist, we will need to elevate it during transport to decrease the opportunity for swelling."