LO8 Extremity Trauma (Chapter 14)

Question 1

Fractures

Answer 1

• open or closed
• neurovascular injuries may result from broken bones
• closed fracture causes loss of 1-2L of blood

Question 2

Dislocations

Answer 2

A joint dislocation is an extremely painful injury easy to identify because the normal join anatomies significantly distorted

Splint in position found unless no pulse then apply gentle traction to gain pulse

Question 3

Neurovascular injuries

Answer 3

The nerves and major blood vessels generally run beside each other usually in the flexor area of the major joints

They may be injured together and loss of circulation or sensation can be due to destruction, swelling or compression by bone fragments or hematoma’s

Question 4

Sprain

Answer 4

is a stretching or tearing of ligaments of a joint because of a sudden twist it will cause pain and swelling

Question 5

strain

Answer 5

is a stretching or tearing of a muscle or muscle tendon unit that will cause pain and often swelling

Question 6

Facia

Answer 6

a tough membrane that surrounds muscles and other structures

They create multiple close spaces known as compartments

Question 7

Compartment syndrome

Answer 7

a condition in which increase tissue pressure in a muscle compartment results in decreased blood flow leading to tissue hypoxia and possible muscle, nerves and vessels impairment can be permanent if the cells die

Crush injuries and closed fractures can cause bleeding and swelling contained within muscle creating pressure in the compartment

Lower leg injuries have the greatest risk of developing compartment syndrome

Question 8

Fasciotomy:

Answer 8

incision of the skin and underlying fascia to release the pressure

Question 9

Late signs and symptoms of compartment syndrome

Answer 9

5 p’s 
Pain 
Pallor 
Pulselessness 
Paresthesia (numbmness and tingling) 
Paralysis

Question 10

Crush injury and crush syndrome

Answer 10

Result from application of external force on the body

tHe injured tissues swell decreasing perfusion resulting in the tissue switching to anaerobic metabolism resulting in buildup of lactic acid

Most extremities can tolerate up to 4 hours of ischemia

Circulation is restored those toxic products are carried throughout the body this is known as crush syndrome

Aggressive hydration with saline is required

Question 11

Splinting

Answer 11

decreases pain and further damage to muscles, nerves and blood vessels by preventing further motion of the broken bone ends

Perform en route unless pt is stabe then splint before moving pt

Question 12

Straightening fractures to regain pulse

Answer 12

1. Confirm loss of pulse
2. Gently grasp extremity above and below break
3. Apply traction steadily and smoothly
4. Recheck pulse and sensation

Question 13

Rigid splint

Answer 13

can be made from many different materials including cardboard, hard plastic, metal or wood

Rigid splint should be well padded over boney prominences and should always immobilize one joint above and one joint below the fracture

Question 14

Soft splints

Answer 14

include pillow slings and air splints

Slings are good for immobilizing injuries to the clavicle shoulder upper arm elbow pillows or good splints for ankle or foot air splints are useful for lower arm lower leg

Question 15

Traction splint:

Answer 15

designed to stabilize fractures of the mid femur they should not be used in the hip fractures or if there more than one fracture in the lower extremity

If there is a suspected pelvic fracture do not use splint because it can cost for the damage

a load and go situation do not apply to split until critical life-saving interventions have been completed and the patient is in the ambulance on route

Question 16

Applying Hare traction splint

Answer 16

1. Assess PMS
2. Apply traction
3. Adjust splint length
4. Position under leg until under butt bone
5. Attach very top crotch strap
6. Secure ankle hitch and attack hook
7. Fasten leg straps
8. Re-evaluate all straps
9. crank
10. re-assess PMS

Question 17

Hip injuries

Answer 17

Most often in the narrow neck of the femur

The posteriorly dislocated hip is usually flexed and the patient will not be able to tolerate having a leg straightened it will almost always be rotated toward the midline

Question 18

Knee injuries

Answer 18

Quite serious because the blood vessels and nerves across the knee joint are often injured if the joint is in an abnormal position

If there is a loss of pulse or sensation apply gentle traction by hand if there’s resistance splint in the most comfortable position and transport

Question 19

Tibia and fibula injuries

Answer 19

Swelling and internal haemorrhage can cause compartment syndrome

Fractures of the distal fibula can be mistaken for sprains

Fractures of the lower leg and ankle may be splinted with a rigid splint or pillow

‘Elevated extremity to reduce the risk of developing compartment syndrome and reassess distal pulses frequently

Question 20

Shoulder injuries

Answer 20

The radial nerve travels quite closely around the humerus and may be injured and humeral fracture’s injury to the radial nerve resulting in ability of the patient to lift the hand

Scapular fracture’s may refer pain to the shoulder joint itself considerable force is required to fractured scapula evaluate for other chest injuries

Question 21

Elbow injuries

Answer 21

Difficult to differentiate between elbow fracture and dislocation
‘
Most common mechanism of injury is a fall on the outstretched arm

Never time to straighten or play traction to an elbow injury due to complexity of it