Orthopedic Trauma Chapter 38 Quiz & Flashcards

Questions and Answers

Common signs and symptoms of an acute pulmonary embolism include all of the following, EXCEPT:

Right-sided heart failure

Tachycardia and tachypnea

Pleuritic chest pain

Pulmonary edema (correct)

When you arrive at a motorcycle crash scene, what should you do for a rider with bilaterally deformed femurs?

Carefully straighten his legs and assess distal pulses

Immediately stabilize both lower extremities

Remove his helmet and apply a cervical collar

Manually stabilize his head and assess his airway (correct)

For a 40-year-old woman with unstable pelvis following a crash, after starting IV, what is your next step?

Run it wide open until her systolic blood pressure is greater than 100 mm Hg

Administer a 250-mL normal saline bolus and then reassess her blood pressure

Set the IV flow rate to keep the vein open unless her blood pressure falls below 70 mm Hg

Give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality (correct)

What is the most appropriate way to treat a patient with a Colles fracture?

Administer analgesia and then properly splint her injury Signup and view all the answers

In addition to stabilizing the suspected fracture site of a lower leg injury, what should you also do?

Immobilize the knee and the ankle Signup and view all the answers

For a young man with a traumatic left elbow injury, what should you do given that transport will be delayed?

Splint the elbow in the position found and reassess distal circulation Signup and view all the answers

If a patient with a suspected lower leg fracture experiences excruciating pain, what should you do?

Loosen the splint, elevate the leg, apply ice, and notify the hospital Signup and view all the answers

Before removing a tree that has pinned a patient at the thighs, what treatment should you provide?

IV therapy with a crystalloid fluid bolus and albuterol via nebulizer or mucosal atomizer device Signup and view all the answers

What is the most appropriate treatment intervention for a 68-year-old woman with acute dyspnea and chest pain after hip replacement?

Oxygenation and ventilation support and rapid transport Signup and view all the answers

The MOST appropriate treatment for a 71-year-old man with pain in his hip and neck after a fall includes:

Supplemental oxygen, spinal motion restriction precautions, an IV line of normal saline, stabilization of his hip with pillows, fentanyl if needed, and transport Signup and view all the answers

In addition to caring for a 17-year-old man with heel and knee pain after jumping from a balcony, what is MOST important?

Apply spinal motion restriction precautions Signup and view all the answers

Isolated musculoskeletal injuries often result in what?

Often result in short- or long-term disability Signup and view all the answers

Hematopoiesis is defined as the process of?

Generating blood cells Signup and view all the answers

Which of the following structures is NOT part of the axial skeleton?

Femoral shaft Signup and view all the answers

The appendicular skeleton is composed of the?

Pectoral girdle, pelvic girdle, and bones of the extremities Signup and view all the answers

Which of the following bones is MOST vulnerable to injury?

Clavicle Signup and view all the answers

The upper extremity joins the shoulder girdle at the?

Glenohumeral joint Signup and view all the answers

The carpals, especially the scaphoid, are MOST vulnerable to fracture when a person?

Falls on an outstretched hand Signup and view all the answers

The ischium, ilium, and pubis are fused together to form the?

Innominate bone Signup and view all the answers

Hip fractures are actually fractures of the?

Femoral neck Signup and view all the answers

The fibula?

Is not a component of the knee joint Signup and view all the answers

When a person jumps from a height and lands on his or her feet, direct trauma occurs to the?

Calcaneus Signup and view all the answers

___________ is a dense, fibrous membrane that is important for bone repair and maintenance.

Periosteum Signup and view all the answers

After 35 years of age, age-related decrease in bone density is accelerated in females because?

Of decreased estrogen levels secondary to menopause Signup and view all the answers

Osteoporosis is MOST accurately defined as a(n)?

Significant decrease in bone density Signup and view all the answers

The joints that connect the ribs to the sternum are examples of?

Cartilaginous joints Signup and view all the answers

Diarthroses?

Are the most mobile joints of the body Signup and view all the answers

A ____________ is a padlike sac or cavity located within the connective tissue, usually in proximity to a joint.

Bursa Signup and view all the answers

What structure helps maintain the stability of a joint and determines the degree of joint motion?

Ligament Signup and view all the answers

By maintaining a state of partial contraction, __________ muscle allows the body to maintain its posture.

Skeletal Signup and view all the answers

Skeletal muscles that are not used or exercised tend to?

Atrophy Signup and view all the answers

The energy for muscular contraction is derived from the metabolism of _ and results in the production of _.

Glucose, lactic acid Signup and view all the answers

Skeletal muscle is innervated by?

Somatic motor neurons Signup and view all the answers

The upper extremity's blood supply originates from the?

Subclavian artery Signup and view all the answers

The anterior and posterior tibial arteries are direct subdivisions of the?

Popliteal artery Signup and view all the answers

A pathologic fracture occurs when?

An occult medical condition causes abnormal bone weakness Signup and view all the answers

Which of the following is the BEST example of an indirect injury?

Shoulder dislocation secondary to falling on an outstretched hand Signup and view all the answers

Which of the following musculoskeletal injuries would MOST likely occur together?

Knee dislocation and tibial fracture Signup and view all the answers

What type of fracture occurs at an angle across the bone and is typically caused by direct or twisting force?

Oblique Signup and view all the answers

A stress fracture would MOST likely occur when?

The muscle develops faster than the bone and places exaggerated stress on the bone Signup and view all the answers

The MOST significant immediate risk associated with an open fracture is?

Hemorrhage Signup and view all the answers

In a closed femur fracture, blood loss may exceed _______ before enough pressure develops to tamponade the bleeding.

1,000 mL Signup and view all the answers

The MOST reliable sign of a fracture is?

Deformity Signup and view all the answers

Which of the following statements regarding a nondisplaced fracture is correct?

Nondisplaced fractures are generally caused by low-energy trauma and are typically not associated with deformity Signup and view all the answers

A patient standing with his or her head cocked toward a knocked-down left shoulder MOST likely has a fracture of the?

Left clavicle Signup and view all the answers

Eliciting for crepitus during your exam of a deformed extremity?

May cause further injury to the bone and surrounding soft tissues Signup and view all the answers

The BEST way to detect deformity or any other abnormality in an injured extremity is to?

Compare it to the extremity on the opposite side Signup and view all the answers

A subluxation occurs when?

A joint is partially dislocated Signup and view all the answers

A dislocation is considered an urgent injury because of its potential to cause?

Neurovascular compromise Signup and view all the answers

The sudden twisting of a joint beyond its normal range of motion, causing a temporary subluxation, is called a?

Sprain Signup and view all the answers

Immediate pain from the heel to the calf and a sudden inability for plantar flexion of the foot is MOST indicative of?

Achilles tendon rupture Signup and view all the answers

Signs of bursitis include all of the following, EXCEPT?

Deformity Signup and view all the answers

In contrast to osteoarthritis, rheumatoid arthritis?

Is a systemic inflammatory disease that affects joints and other body systems Signup and view all the answers

When assessing a multisystems trauma patient, it is MOST important to?

Avoid being distracted by visually impressive injuries Signup and view all the answers

Closed bilaterally fractured femurs can result in internal blood loss of up to?

3,000 mL Signup and view all the answers

After ensuring your own safety, your next priority when caring for a patient with an extremity injury is to?

Prevent further injury Signup and view all the answers

Which of the following is NOT one of the 6 Ps of musculoskeletal injury assessment?

Passive extension Signup and view all the answers

When assessing distal pulses in a patient with a lower extremity injury, it is MOST important to?

Compare the strength of the pulses in both lower extremities Signup and view all the answers

Which of the following medical conditions would MOST likely cause changes in sensation in a patient with an extremity injury?

Diabetes Signup and view all the answers

The goal of prehospital pain control in a patient with a musculoskeletal injury should be to?

Diminish the patient's pain to a tolerable level Signup and view all the answers

Swelling and inflammation associated with musculoskeletal injuries are reduced?

If cold packs are applied during the acute stage of the injury Signup and view all the answers

Correctly splinting an injured extremity?

Helps to control internal bleeding by allowing clots to form where vessels are damaged Signup and view all the answers

The FIRST step in splinting a musculoskeletal injury involves?

Exposing and assessing the injury site Signup and view all the answers

The MOST practical method of splinting multiple fractures in a critically injured patient is to?

Splint the axial skeleton using a long backboard Signup and view all the answers

You should NOT apply a pneumatic splint on a patient if he or she?

Has an open fracture in which bone ends are exposed Signup and view all the answers

The likelihood of experiencing systemic complications from a musculoskeletal injury is related to all of the following factors, EXCEPT the?

Splinting method used in the field Signup and view all the answers

Which of the following is NOT an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury?

Prehospital fracture reduction Signup and view all the answers

Compartment syndrome occurs when?

Pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death Signup and view all the answers

The return of myoglobin to the systemic circulation following a crush injury would result in all of the following conditions, EXCEPT?

Metabolic alkalosis Signup and view all the answers

The risk of a pulmonary embolism following musculoskeletal trauma is highest in patients with?

Upper extremity fractures that result in lengthy hospital admissions. Signup and view all the answers

Study Notes

Isolated Musculoskeletal Injuries

Generally associated with potential for short- or long-term disability.

Functions of the Musculoskeletal System

Hematopoiesis is the process of generating blood cells.

Axial vs. Appendicular Skeleton

The femoral shaft is NOT part of the axial skeleton.
The appendicular skeleton includes the pectoral girdle, pelvic girdle, and bones of the extremities.

Vulnerable Bones

The clavicle is the most vulnerable to injury compared to other bones like the sternum and scapula.

Shoulder Girdle

The upper extremity connects to the shoulder girdle at the glenohumeral joint.

Carpal Fractures

Scaphoid fractures are most likely to occur when falling on an outstretched hand.

Pelvic Structure

The innominate bone is formed by the fusion of the ischium, ilium, and pubis.

Hip Fractures

Generally occur at the femoral neck.

Fibula

Not a part of the knee joint structure.

Injury from Impact

Landing on feet after a jump primarily causes direct trauma to the calcaneus.

Bone Repair Structure

The periosteum is a dense, fibrous membrane important for bone repair.

Bone Density and Age

Decreased estrogen levels in females after menopause accelerate age-related bone density loss.

Osteoporosis

Defined as a significant decrease in bone density.

Joint Connections

Joints connecting ribs to sternum are cartilaginous joints.

Diarthroses Joints

Are the most mobile joints in the body, allowing extensive movement.

Bursa

A bursa is a padlike sac near a joint that helps reduce friction.

Joint Stability

Ligaments are crucial for maintaining joint stability and motion.

Muscle Function and Posture

Skeletal muscle helps maintain posture through partial contraction.

Muscle Atrophy

Occurs in skeletal muscles that are not used or exercised.

Energy for Muscle Contraction

Derived primarily from glucose, resulting in lactic acid production.

Skeletal Muscle Innervation

Innervated by somatic motor neurons, not involuntary nerves.

Blood Supply to Upper Extremities

Originate from the subclavian artery.

Tibial Arteries

Anterior and posterior tibial arteries are branches of the popliteal artery.

Pathologic Fracture

Occurs due to abnormal bone weakness from underlying medical conditions.

Indirect Injury Example

Shoulder dislocation can occur after falling on an outstretched hand.

Fracture Associations

Knee dislocation is commonly associated with tibial fractures.

Fracture Types

Oblique fractures occur at an angle, often caused by direct or twisting forces.

Stress Fractures

Result from muscular development exceeding that of bones, causing stress.

Risks from Open Fractures

Immediate risk primarily involves hemorrhage.

Blood Loss in Femur Fracture

Closed femur fractures can result in more than 1,000 mL of blood loss.

Confirmation of Fractures

Deformity is the most reliable sign of a fracture.

Nondisplaced Fracture Characteristics

Typically caused by low-energy trauma, not associated with deformity.

Clavicle Fracture Indicators

A patient with a head tilted toward a shoulder likely has a fractured clavicle.

Crepitus Examination Risks

Eliciting crepitus could exacerbate injuries.

Examining Deformed Extremities

Best observed by comparing to the uninjured extremity.

Subluxation Definition

Partial dislocation of a joint.

Dislocation Urgency

Considered urgent due to risks of neurovascular compromise.

Sprain Definition

Sudden twisting beyond normal motion range causing temporary subluxation.

Achilles Tendon Rupture Symptoms

Characterized by immediate pain from heel to calf and inability to plantar flex.

Bursitis Symptoms

Common signs include warmth, swelling, and erythema but not deformity.

Differences in Arthritis

Rheumatoid arthritis is a systemic inflammatory disease affecting multiple body systems.

Multisystem Trauma Assessment

Focus should remain on avoiding distractions from visually impressive injuries.

Internal Blood Loss from Bilateral Femur Fractures

Can exceed 3,000 mL.

Injury Care Prioritization

After ensuring safety, preventing further injury is the next priority.

6 Ps of Musculoskeletal Assessment

Passive extension is NOT one of the 6 Ps.

Comparing Distal Pulses

Important to assess the strength of pulses in injured lower extremities.

Sensation Changes in Extremity Injury

Diabetes could cause changes in sensation following extremity trauma.

Pain Control Goals

Aim to diminish pain to a tolerable level during prehospital care.

Cold Application

Reduces swelling and inflammation following acute injuries.

Splinting Purpose

Effective splinting helps control internal bleeding by facilitating clot formation.

Initial Splinting Step

Requires exposing and assessing the injury site first.

Splinting Multiple Fractures

The long backboard is the most practical method for immobilizing multiple fractures.

Pneumatic Splint Contraindications

Should not be used in cases of open fractures with exposed bone.

Systemic Complications Risk Factors

Influenced by health, injury location, and impact force, not splinting method.

Long-term Disability Prevention

Prehospital fracture reduction is NOT an intervention effective in preventing long-term disability.

Compartment Syndrome Definition

Results from pressure in a fascial compartment affecting circulation and potentially causing muscle death.

Myoglobin Concerns Post-Crush Injury

Increased myoglobin can lead to renal dysfunction but not metabolic alkalosis.

Pulmonary Embolism Risk

Highest in patients with pelvic and lower extremity injuries leading to prolonged immobilization.

Acute Pulmonary Embolism Symptoms

Signs include pleuritic chest pain, right-sided heart failure, tachycardia, and tachypnea, but not pulmonary edema.

Motorcycle Crash Protocol

Stabilize the head and assess the airway in supine patients with evident deformities.

Unstable Pelvis Management

Administer intravenous fluids to improve vital signs and mental status after injuries.### Colles Fracture Management
A Colles fracture is identified in a patient with stable vital signs and mild pain (2/10).
The best treatment approach involves administering analgesia followed by proper splinting of the injury.

Lower Leg Injury Assessment

An isolated injury to the left lower leg shows deformity and ecchymosis, with intact distal circulation and stable condition.
Essential treatment includes immobilizing both the knee and ankle to stabilize the fracture.

Elbow Injury Protocol

A patient with direct trauma to the left elbow presents with deformity and ecchymosis, but maintains good circulation.
The most suitable action is to splint the elbow in its current position and reassess distal circulation.

Managing Severe Pain and Complications

A young woman with a suspected lower leg fracture experiences excruciating pain despite narcotic treatment, with taut skin and weak pedal pulse upon reassessment.
Immediate actions should include loosening the splint, elevating the leg, applying ice, and notifying the hospital for further assistance.

Treatment for Pinning Trauma Victim

A patient trapped under a tree displays severe pain, stable vital signs but with a fast pulse and increased respiration rate.
Prior to tree removal, administer IV therapy with crystalloid fluid bolus and consider nebulized albuterol for airway support.

Dyspnea and Chest Pain After Hip Replacement

An elderly woman presents with acute dyspnea and sharp chest pain post-hip replacement, displaying stable vital signs.
The priority is oxygenation and ventilation support along with rapid transport to a medical facility.

Hip and Neck Injury in Elderly Patient

A 71-year-old man has experienced a fall, showing signs of a potential hip fracture and head hematoma but with stable vital signs.
Appropriate treatment includes spinal motion restriction, stabilization of the hip with pillows, oxygen support, and IV administration of normal saline.

Lower-Extremity Injury After Jump

A 17-year-old male reports pain in his heels and knees after jumping from a height, with swelling and ecchymosis observed in his feet.
Beyond addressing lower-extremity injuries, applying spinal motion restriction precautions is crucial to prevent further complications.

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Test your knowledge on orthopedic trauma with these flashcards from Chapter 38. This quiz will cover key concepts related to isolated musculoskeletal injuries and their implications. Ideal for students studying orthopedics or related medical fields.

Orthopedic Trauma Chapter 38 Flashcards