CH 38 Flashcards
Which of the following is an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury?
Prehospital fracture reduction
Pain reduction with heat
Generous use of analgesics
Prevention of gross contamination
Prevention of gross contamination
A 17-year-old man jumped from a second-story balcony and landed on his feet. He complains of pain to both of his heels and knees. Your assessment reveals swelling and ecchymosis to both of his feet. His vital signs are stable and he is breathing without difficulty. In addition to caring for his lower extremity injuries, it is most important that you:
start a large-bore IV line of an isotonic crystalloid.
apply spinal motion restriction precautions.
try to determine why he jumped from the balcony.
administer high-flow supplemental oxygen.
apply spinal motion restriction precautions.
Which of the following statements regarding a nondisplaced fracture is correct?
In a nondisplaced fracture, muscles pull the distal fracture fragment alongside the proximal one, causing them to overlap.
Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity.
Nondisplaced fractures are caused by low-energy trauma and occur when the ends of the fracture move from their normal positions.
Nondisplaced fractures occur when a massive compressive force is applied to the bone, causing it to become wedged into another bone.
Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity.
Which of the following statements regarding open-book pelvic fractures is correct?
Despite IV fluids, patients may remain hypotensive in the field.
Stabilization involves applying lateral pressure to the iliac crests.
Prehospital treatment should focus on relieving the patient’s pain.
Bleeding into the pelvic cavity is generally less than 2 L.
Despite IV fluids, patients may remain hypotensive in the field.
A 45-year-old man was cutting down a large tree when it collapsed, pinning him at the thighs. The patient’s wife found him approximately 4 hours after the incident. The patient is conscious and in severe pain. His blood pressure is 128/68 mm Hg, pulse is 120 beats/min and regular, and respirations are 22 breaths/min with adequate depth. In addition to supplemental oxygen and cardiac monitoring, which of the following treatments should you provide before the tree is removed from his legs?
Two large-bore IV lines with a 3- to 4-L crystalloid bolus and 1 mEq/kg of sodium bicarbonate
IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device
An IV of normal saline, fluid restriction, and amiodarone if the ECG shows a widened QRS complex
A large-bore IV line set to keep the vein open and 10 mL of a 10% solution of calcium chloride
IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device
Which of the following patients is at greatest risk for developing rhabdomyolysis?
Patient who was already dehydrated when he fractured his wrist
Patient with a femur fracture whose pain is not reduced by narcotics
Stroke patient lying on her back who was not found for 5 hours
Agitated patient who has not slept in more than 72 hours
Stroke patient lying on her back who was not found for 5 hours
A dislocation is considered an urgent injury because of its potential to cause:
severe hemodynamic instability.
neurovascular compromise.
significant internal bleeding.
proximal sensory and motor loss.
neurovascular compromise.
During your assessment of a patient with a femur fracture, you discover a rapidly expanding hematoma on the medial aspect of his thigh. What should you suspect?
Fasciitis
Arterial injury
Compartment syndrome
Venous thrombus
Arterial injury
Which of the following is typically the first complaint in a patient who is developing compartment syndrome?
Pallor to the extremity
Disproportionate pain
Absent distal pulses
Numbness and tingling
Disproportionate pain
The scapula and clavicle maintain stability of the:
olecranon process.
glenohumeral joint.
acromion.
acromioclavicular joint.
glenohumeral joint.
Which of the following structures is part of the axial skeleton?
Distal radius
Femoral shaft
Basilar skull
Proximal tibia
Basilar skull
In a closed femur fracture, blood loss may exceed what amount before enough pressure develops to tamponade the bleeding?
1,000 mL
250 mL
500 mL
750 mL
1,000 mL
The risk of a pulmonary embolism following musculoskeletal trauma is highest in patients with:
any proximal long bone fracture that occurred more than 72 hours ago.
upper extremity fractures that result in lengthy hospital admissions.
numerous rib fractures who are taking anticoagulant medications.
pelvic and lower extremity injuries that lead to prolonged immobilization.
pelvic and lower extremity injuries that lead to prolonged immobilization.
Common signs and symptoms of an acute pulmonary embolism include:
tachycardia and tachypnea.
left-sided heart failure.
pulmonary edema.
abdominal pain.
tachycardia and tachypnea.
You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should:
immediately stabilize both lower extremities.
manually stabilize his head and assess his airway.
carefully straighten his legs and assess distal pulses.
remove his helmet and apply a cervical collar.
manually stabilize his head and assess his airway.
Eliciting for crepitus during your exam of a deformed extremity:
is generally not performed, but will likely not cause further injury.
may cause further injury to the bone and surrounding soft tissues.
should be performed to help confirm the presence of a fracture.
should only be performed if the patient is not in significant pain.
may cause further injury to the bone and surrounding soft tissues.
Which of the following is a sign of bursitis?
Deformity
Pallor
Numbness
Erythema
Erythema
The likelihood of experiencing systemic complications from a musculoskeletal injury is related to the:
patient’s level of pain.
splinting method used in the field.
type of analgesia used to treat pain.
patient’s overall health.
patient’s overall health.
The goal of prehospital pain control in a patient with a musculoskeletal injury should be to:
use cryotherapy instead of narcotic analgesics.
diminish the patient’s pain to a tolerable level.
give enough analgesia to make the patient pain-free.
sedate the patient with diazepam or lorazepam.
diminish the patient’s pain to a tolerable level.
Which of the following is an example of an indirect injury?
Fractured ankle after stepping in a hole and twisting the lower leg
Patellar fracture after the knee strikes an automobile’s dashboard
Shoulder dislocation secondary to falling on an outstretched hand
Dislocated olecranon process following direct trauma to the elbow
Shoulder dislocation secondary to falling on an outstretched hand
Pneumatic splints are contraindicated for patients who:
are experiencing severe pain despite narcotic analgesia.
have a closed fracture involving the lower leg or forearm.
have an open fracture in which bone ends are exposed.
experienced a fracture or dislocation involving a major joint.
have an open fracture in which bone ends are exposed.
The most practical method of splinting multiple fractures in a critically injured patient is to:
use air splints so you can visualize the injuries.
sedate the patient before applying any splints.
apply vacuum splints en route to the hospital.
splint the axial skeleton using a scoop stretcher.
splint the axial skeleton using a scoop stretcher.
A 20-year-old female has a midshaft humeral fracture. Assessment reveals the presence of wrist drop. What should you suspect?
Radial artery injury
Brachial artery compression
Radial nerve injury
Brachial nerve injury
Radial nerve injury
Which of the following is one of the 6 Ps of musculoskeletal injury assessment?
Pallor
Palpation
Passive extension
Point tenderness
Pallor
