Chapter 38 Flashcards
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:
- apply spinal motion restriction precautions.
- administer high-flow supplemental oxygen.
- try to determine why he jumped from the balcony.
- start a large-bore IV line of an isotonic crystalloid.
Apply spinal motion restriction precautions
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?
- A large-bore IV line set to keep the vein open and 10 mL of a 10% solution of calcium chloride
- An IV of normal saline, fluid restriction, and amiodarone if the ECG shows a widened QRS complex
- IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device
- 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
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?
- Arterial injury
- Venous thrombus
- Compartment syndrome
- Fasciitis
Arterial injury
A 20-year-old female has a midshaft humeral fracture. Assessment reveals the presence of wrist drop. What should you suspect?
- Brachial artery compression
- Radial artery injury
- Brachial nerve injury
- Radial nerve injury
Radial nerve injury
Common signs and symptoms of an acute pulmonary embolism include:
- left-sided heart failure.
- tachycardia and tachypnea.
- pulmonary edema.
- abdominal pain.
Tachycardia and tachypnea
Eliciting for crepitus during your exam of a deformed extremity:
- should only be performed if the patient is not in significant pain.
- should be performed to help confirm the presence of a fracture.
- may cause further injury to the bone and surrounding soft tissues.
- is generally not performed, but will likely not cause further injury.
May cause further injury to the bone and surrounding soft tissues
The scapula and clavicle maintain stability of the:
- acromioclavicular joint.
- olecranon process.
- acromion.
- glenohumeral joint.
Glenohumeral joint
Which of the following structures is part of the axial skeleton?
- Basilar skull
- Proximal tibia
- Femoral shaft
- Distal radius
Basilar skull
Which of the following is an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury?
- Prevention of gross contamination
- Generous use of analgesics
- Prehospital fracture reduction
- Pain reduction with heat
Prevention of gross contamination.
Which of the following is typically the first complaint in a patient who is developing compartment syndrome?
- Disproportionate pain
- Pallor to the extremity
- Numbness and tingling
- Absent distal pulses
Disproportionate pain
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:
- carefully straighten his legs and assess distal pulses.
- remove his helmet and apply a cervical collar.
- manually stabilize his head and assess his airway.
- immediately stabilize both lower extremitie
Manually stabilize his head and asses his airway
Osteoporosis is most accurately defined as a(n):
- estrogen-related change in bone strength.
- reduced range of motion in the joints.
- progressive loss of bone marrow.
- significant decrease in bone density.
Significant decrease in bone density
Which of the following is a sign of bursitis?
- Pallor
- Numbness
- Deformity
- Erythema
Erythema
Which of the following patients is at greatest risk for developing rhabdomyolysis?
- Patient who was already dehydrated when he fractured his wrist
- Agitated patient who has not slept in more than 72 hours
- Stroke patient lying on her back who was not found for 5 hours
- 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
The goal of prehospital pain control in a patient with a musculoskeletal injury should be to:
- give enough analgesia to make the patient pain-free.
- use cryotherapy instead of narcotic analgesics.
- sedate the patient with diazepam or lorazepam.
- diminish the patient’s pain to a tolerable level.
Diminish the patients pain to a tolerable level
When assessing a trauma patient, it is most important to:
- avoid being distracted by visually impressive injuries.
- splint swollen, painful extremities as soon as possible.
- only splint fractures involving long bones at the scene.
- administer an analgesic promptly to minimize pain.
Avoid being distracted by visually impressive injuries
Pneumatic splints are contraindicated for patients who:
- have a closed fracture involving the lower leg or forearm.
- are experiencing severe pain despite narcotic analgesia.
- 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
Which of the following is an example of an indirect injury?
- Patellar fracture after the knee strikes an automobile’s dashboard
- Dislocated olecranon process following direct trauma to the elbow
- Fractured ankle after stepping in a hole and twisting the lower leg
- Shoulder dislocation secondary to falling on an outstretched hand
Should dislocation secondary to falling on a outstretched hand
Correctly splinting an injured extremity:
- helps to control internal bleeding by allowing clots to form where vessels are damaged.
- typically provides complete pain relief without the need to administer narcotic analgesia.
- effectively reduces swelling and inflammation by shunting blood away from the injured area.
- eliminates the need to elevate the extremity because immobilization causes blood stasis.
Helps to control internal bleeding by allowing clots to form where vessels are damaged
Pain and tenderness in the anatomic snuffbox is a classic finding in fractures of which bone?
- Calcaneus
- Scaphoid
- Clavicle
- Metacarpal
Scaphoid
In a closed femur fracture, blood loss may exceed what amount before enough pressure develops to tamponade the bleeding?
- 500 mL
- 250 mL
- 750 mL
- 1,000 mL
1,000 mL
The return of myoglobin to the systemic circulation following a crush injury could result in:
- hypophosphatemia.
- metabolic alkalosis.
- a decreased pH.
- hypokalemia.
A decreased pH.
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 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.
- Nondisplaced fractures are caused by low-energy trauma and occur when the ends of the fracture move from their normal positions.
Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity.
A 19-year-old man experienced direct trauma to his left elbow. Your assessment reveals gross deformity and ecchymosis. His arm is pink and warm, and he has a strong radial pulse. Your transport time to the hospital will be delayed. You should:
- carefully straighten the arm to facilitate placement of a vacuum splint.
- splint the elbow in the position found and reassess distal circulation.
- administer fentanyl for pain relief and then carefully straighten the arm.
- apply a sling and swathe to immobilize the injury and then apply heat.
Splint the elbow in the position found and reassess distal circulation
