EMT-B, Ch 31: Orthopaedic Injuries

Skill Drill What are the seven steps of applying a sager traction splint?

1) After exposing the injured area, check the patient's pulse and motor and sensory functions. Adjust the thigh strap so that it lies anteriorly when secured. 2) Estimate the proper length of the splint by placing it next to the uninjured limb. Fit the ankle pads to the ankle. 3) Place the splint at the inner thigh, apply the thigh strap at the upper thigh, and secure snugly. 4) Tighten the ankle harness just above the malleoli. Secure the cable ring against the bottom of the foot. 5) Extend the splint's inner shaft to apply traction of about 10% of body weight. 6) Secure the splint with elasticized cravat bandages. 7) Secure the patient to a backboard. Check pulse and motor and sensory function.

Skill Drill What are the two steps of applying a zippered air splint?

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

Skill Drill What are the three steps of applying an unzippered air splint?

1) Assess distal pulse and motor and sensory function. Your partner should support the injured limb. Place your arm through the splint to grasp the patient's hand or foot. 2) Apply gentle traction while sliding the splint onto the injured limb. 3) Your partner will inflate the splint by pump or by mouth. Assess distal pulse and motor and sensory function.

Skill Drill What are the three steps of applying a vacuum splint?

1) Assess distal pulse and motor and sensory function. Your partner will stabilize and support the injury. 2) Place the splint and wrap it around the limb. 3) Draw the air out of the splint through the suction valve, and then seal the valve. Assess distal pulse and motor and sensory function.

Skill Drill What are the four steps for caring for musculoskeletal injuries?

1) Cover open wounds with a dry, sterile dressing, and apply pressure to control bleeding. Assess distal pulse and motor and sensory function. If bleeding cannot be controlled, quickly apply a tourniquet. 2) Apply a splint and elevate the extremity about 6 inches (15 cm), or slightly above the level of the heart. Assess distal pulse and motor and sensory function. 3) Apply cold packs if there is swelling, but do not place them directly on the skin. 4) Position the patient for transport and secure the injured area.

Skill Drill What are the eight steps of applying a hare traction splint?

1) Expose the injured limb and check pulse, motor, and sensory function. Place the splint beside the uninjured limb, adjust the splint to proper length, and prepare the straps. 2) Support the injured limb as your partner fastens the ankle hitch about the foot and ankle. 3) Continue to support the limb as your partner applies gentle in-line traction to the ankle hitch and foot. 4) Slide the splint into position under the injured limb. 5) Pad the groin and fasten the ischial strap. 6) Connect the loops of the ankle hitch to the end of the splint as your partner continues to maintain traction. Carefully tighten the ratchet to the point that the splint holds adequate traction. 7) Secure and check support straps. Assess pulse and motor and sensory functions. 8) Secure the patient and splint to the backboard in a way that will prevent movement of the splint during patient movement and transport.

Skill Drill What are the four steps of applying a rigid splint?

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

Skill Drill What are the three steps of splinting the hand and wrist?

1) Support the injured limb and move the hand into the position of function. Place a soft roller bandage in the palm. 2) Apply a padded board splint on the palmar side with fingers exposed. 3) Secure the splint with a roller bandage.

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

A. Displaced fracture

In which of the following situations should the EMT splint an injured limb in the position of deformity? Select one: A. If resistance is encountered or the patient experiences severe pain B. If transport time to the hospital is greater than 20 to 30 minutes C. If a traction splint will be used to immobilize the injured extremity D. When distal circulation and neurological functions are absent

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

Which of the following musculoskeletal injuries has the GREATEST risk for shock due to blood loss? A. Pelvic fracture B. Posterior hip dislocation C. Unilateral femur fracture D. Proximal humerus fracture

A. Pelvic fracture --> The pelvic cavity can accommodate a large volume of blood. Shock in a patient with a pelvic injury is usually due to injury to femoral veins or arteries. Bilateral femur fractures can also cause severe blood loss (up to 1 liter per femur).

The musculoskeletal system refers to the: Select one: A. bones and voluntary muscles of the body. B. connective tissue that supports the skeleton. C. involuntary muscles of the nervous system. D. nervous system's control over the muscles.

A. bones and voluntary muscles of the body.

The MOST significant hazard associated with splinting is: Select one: A. delaying transport of a critically injured patient. B. compression of nerves, tissues, and vasculature. C. aggravation of the injury or worsened pain. D. reduction in circulation distal to the injury site.

A. delaying transport of a critically injured patient.

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

A. proximal femur.

To effectively immobilize a fractured clavicle, you should apply a(n): A. sling and swathe. B. air splint over the entire arm. C. rigid splint to the upper arm, then a sling. D. traction splint to the arm of the injured side.

A. sling and swathe. --> The quickest and most effective way to immobilize a fractured clavicle (collarbone) is to apply a sling and swathe. The sling will help minimize movement of the clavicle itself, while the swath will minimize movement of the arm on the affected side.

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should: Select one: A. stabilize her head and perform a primary assessment. B. assess for a carotid pulse and assist her ventilations. C. apply manual stabilization to both of her femurs. D. administer oxygen and perform a rapid assessment.

A. stabilize her head and perform a primary assessment.

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should: Select one: A. carefully straighten the injured arm and secure it with padded board splints. B. apply gentle manual traction in line with the limb and reassess for a pulse. C. make two or three attempts to restore distal circulation by manipulating the elbow. D. splint the elbow in the position of deformity and transport immediately.

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

With regard to musculoskeletal injuries, the zone of injury is defined as the: Select one: A. part of the body that sustained secondary injury. B. area of soft-tissue damage surrounding the injury. C. area of obvious deformity over the site of impact. D. exact part of the bone or joint that was disrupted.

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

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should: Select one: A. gently manipulate the injured leg until the numbness dissipates. B. control the bleeding and cover the wound with a sterile dressing. C. assess distal pulses as well as sensory and motor functions. D. manually stabilize the leg above and below the site of injury.

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

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

B. distal humerus.

When treating an open extremity fracture, you should: A. apply a splint and then dress the wound. B. dress the wound before applying a splint. C. irrigate the wound before applying a dressing. D. allow the material that secures the splint to serve as the dressing.

B. dress the wound before applying a splint. --> Prior to splinting an open extremity fracture, you should cover the wound with a dry, sterile dressing. This will help control any bleeding and decreases the risk of infection. Irrigating an open fracture should be avoided in the field; this also increases the risk of infection—especially if foreign material is flushed into the wound.

A patient tripped, fell, and landed on her elbow. She is in severe pain and has obvious deformity to her elbow. You should: A. assess distal pulses. B. manually stabilize her injury. C. assess her elbow for crepitus. D. apply rigid board splints to her arm.

B. manually stabilize her injury. --> When caring for a patient with an orthopaedic injury, you should first manually stabilize the injury site; this will prevent further injury. You should then assess pulse, motor functions, and sensory functions distal to the injury. Splint the injury using the appropriate technique, and then reassess pulse, motor functions, and sensory functions. Do not intentionally assess for crepitus; this is a coincidental finding that you may encounter during your assessment and should not be elicited.

The purpose of splinting a fracture is to: A. reduce the fracture if possible. B. prevent motion of bony fragments. C. reduce swelling in adjacent soft tissues. D. force the bony fragments back into anatomic alignment.

B. prevent motion of bony fragments. --> The purpose of splinting a fracture is to prevent motion of the bony fragments, thus minimizing the possibility of neurovascular damage. Splinting is not intended to force bony fragments into anatomic alignment, nor will it reduce swelling (ice reduces swelling). You should never try to reduce a fracture.

A patient injured her knee while riding a bicycle. She is lying on the ground, has her left leg flexed, is in severe pain, and cannot move her leg. Your assessment reveals obvious deformity to her left knee. Distal pulses are present and strong. The MOST appropriate treatment for her injury involves: A. wrapping her entire knee area with a pillow. B. splinting the leg in the position in which it was found. C. straightening her leg and applying two rigid board splints. D. straightening her leg and applying and inflating an air splint.

B. splinting the leg in the position in which it was found. --> The patient likely has a dislocated knee. You should immobilize any joint injury in the position in which it was found—especially if distal pulses are present and strong. Attempting to straighten a dislocated joint may cause damage to the nerves and/or vasculature.

Skeletal muscle is also referred to as: A. smooth muscle. B. striated muscle. C. autonomic muscle. D. involuntary muscle.

B. striated muscle. --> Skeletal muscle, also called striated muscle because of its characteristic stripes (striations), attaches to the bones and usually crosses at least one joint, forming the major muscle mass of the body. This type of muscle is also called voluntary muscle because it is under direct voluntary control of the brain.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? Select one: A. An amputated extremity B. Nondisplaced long bone fractures C. Pelvic fracture with hypotension D. Bilateral femur fractures

C. Pelvic fracture with hypotension

A motorcyclist crashed his bike and has closed deformities to both of his midshaft femurs. He is conscious, but restless; his skin is cool and clammy; and his radial pulses are rapid and weak. The MOST appropriate splinting technique for this patient involves: A. applying rigid board splints. B. applying two traction splints. C. securing him to a long backboard. D. immobilizing his femurs with air splints.

C. securing him to a long backboard. --> In this particular case, it is more practical—and less time-consuming—to secure the patient to a long backboard. He is in shock and requires rapid transport. Taking the time to apply traction splints, air splints, or board splints will only delay transport.

During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should: Select one: A. perform a focused physical exam with emphasis on the pelvis. B. log roll the patient onto a long backboard and transport at once. C. stabilize the pelvis with a pelvic binder and protect the spine. D. defer spinal immobilization and transport to a trauma center.

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

You respond to a soccer game for a 16-year-old male with severe ankle pain. When you deliver him to the hospital, the physician tells you that he suspects a sprain. This means that: A. there is a disruption of the joint and the bone ends are no longer in contact. B. the patient has an incomplete fracture that passes only partway through the bone. C. stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred. D. the muscles of the ankle have been severely stretched, resulting in displacement of the bones from the joint.

C. stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred. --> A sprain is a joint injury in which there is both partial or temporary dislocation of the bone ends and partial stretching or tearing of the supporting ligaments. Sprains are typically marked by swelling, pain, and ecchymosis.

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

C. tendons.

An open fracture is MOST accurately defined as a fracture in which: Select one: A. a large laceration overlies the fracture. B. bone ends protrude through the skin. C. the overlying skin is no longer intact. D. a bullet shatters the underlying bone.

C. the overlying skin is no longer intact.

Which of the following statements regarding compartment syndrome is correct? Select one: A. In most cases, compartment syndrome develops within a few minutes after an injury. B. Most cases of compartment syndrome occur following a severe fracture of the pelvis. C. Compartment syndrome occurs because of increased pressure within the bone cavity. D. Compartment syndrome typically develops within 6 to 12 hours after an injury.

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

A fracture is MOST accurately defined as a(n): Select one: A. abnormality in the structure of a bone. B. total loss of function in a bone. C. disruption in the midshaft of a bone. D. break in the continuity of the bone.

D. break in the continuity of the bone.

When caring for a patient with a possible fracture of the scapula, the EMT should: Select one: A. recognize that scapular fractures are life threatening. B. assume that minimal force was applied to the back. C. apply rigid board splints across the chest and back. D. carefully assess the patient for breathing problems.

D. carefully assess the patient for breathing problems.

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

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

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

D. positive indicators of a fracture.

A young male has a musculoskeletal injury and is unresponsive. You will NOT be able to assess: A. false motion. B. distal pulses. C. capillary refill. D. sensory and motor functions.

D. sensory and motor functions. --> In order to assess sensory and motor functions (eg, Can you feel? Can you move?), the patient must be conscious, alert, and able to follow commands. False motion, distal pulses, and capillary refill are objective findings; therefore, they can be assessed in unresponsive patients.

In general, musculoskeletal injuries should be splinted before moving the patient unless: Select one: A. deformity and swelling are present. B. the patient is in severe pain. C. transport time is less than 15 minutes. D. the patient is clinically unstable.

D. the patient is clinically unstable.

True/False: Fractures of the proximal femur usually involve the hip joint.

False: Fractures of the proximal femur are usually called hip fractures, but they rarely involve the hip joint.

True/False: If you are unable to restore the distal pulse on scene, you should splint the limb in a straight position and provide prompt transport to the hospital.

False: If you are unable to restore the distal pulse, splint the limb in the position that is most comfortable for the patient and provide prompt transport to the hospital.

Rearrange the injuries from least to most severe based on the musculoskeletal injury grading system. a. Pelvic fracture with hemodynamic instability b. Displaced pelvic fracture c. Dislocated fingers d. Bilateral femur fracture e. Nondisplaced long bone fracture

Least > Most Severe 1) c. Dislocated fingers 2) e. Nondisplaced long bone fracture 3) b. Displaced pelvic fracture 4) d. Bilateral femur fracture 5) a. Pelvic fracture with hemodynamic instability

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

True

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

True

A disruption of a joint in which the bone ends are no longer in contact is known as what? a. Dislocation b. Fracture c. Sprain d. Strain

a. Dislocation

You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury? a. Splint from the shoulder joint to the wrist joint to stabilize the entire arm. b. Apply a Sager traction splint to stabilize the joint. c. Apply a sling and swathe to reduce pain. d. Apply ice to reduce swelling.

a. Splint from the shoulder joint to the wrist joint to stabilize the entire arm. --> When splinting a fracture in and around a joint, be sure to stabilize the bones above and below the injured joint.

Which of the following are goals of in-line traction? (Select all that apply) a. Stabilize the fragments to prevent movement b. Align the limb for splinting c. Stop bleeding d. Avoid neurovascular compromise

a. Stabilize the fragments to prevent movement b. Align the limb for splinting d. Avoid neurovascular compromise

Which of the following is a drawback of an air splint? a. Temperature changes affect air pressure in the splint. b. It does not provide uniform contact, so bone movement is possible. c. It restricts distal blood flow. d. It is complicated to use and requires multiple EMTs.

a. Temperature changes affect air pressure in the splint.

In which situations should you splint the limb in the position of deformity? (Select all that apply) a. When the deformity is the result of a dislocation and is severe b. When you encounter resistance or extreme pain when applying traction c. When distal pulses are absent d. When the fracture is an open fracture

a. When the deformity is the result of a dislocation and is severe b. When you encounter resistance or extreme pain when applying traction

What is the primary goal of in-line traction? a. Minimize pain b. Avoid further neurovascular compromise c. Reduce swelling d. Prevent permanent disability

b. Avoid further neurovascular compromise

Which MOI causes a fracture or dislocation at a distant point? a. Direct blow b. Indirect force c. Twisting force d. High-impact injury

b. Indirect force

In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel? a. Moderate b. Serious c. Severe d. Critical

b. Serious

Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome? a. Referred pain b. Limb deformity c. Disproportionate pain d. Hypersensation

c. Disproportionate pain --> Disproportionate pain on passive stretch of muscles within the compartment is a sign of compartment syndrome.

What is the most reliable indicator of an underlying fracture? a. Deformity b. Guarding c. Point tenderness d. Crepitus

c. Point tenderness

When assessing distal circulation in a patient's lower extremities, which pulse should you palpate? a. Femoral b. Dorsalis pedis c. Popliteal d. Iliac

c. Popliteal --> You would palpate the popliteal artery in lower extremity wounds.

Which of the following would you use to stabilize an AC separation? a. Zippered air splint b. Rigid splint c. Sling and swathe d. Traction splint

c. Sling and swathe --> An AC separation occurs in the shoulder and so using a sling and swathe is an effective way to splint the injury.