Itls - Extremity Trauma

Front 1

Why are fractures very painful?

Back 1

Nerve endings in the periosteum can rub together as the broken ends grate and cause significant pain to the patient.

Front 2

What areas are breakages considered life threatening?

Back 2

The femur and the pelvis can lead to significant blood loss leading to hypovolemia.

Front 3

What can the sharp ends of broken bones do?

Back 3

Lacerate and injure tissues, nerves and blood vessels that travel close to the bone. These injuries can come from direct lacerations from bone fragments or from swelling or hematoma.

Front 4

How much blood can be lost from a femur fracture?

Back 4

Up to 1 litre from a each femur fracture and 500cc for each pelvic fracture (there are usually more than one)

Front 5

What is a particular danger with an open fracture?

Back 5

Infection. If the bone ends are pulled back in during realignment then debris can be pulled into the wound and lead to sepsis.

Front 6

Why are major joint dislocations often true emergencies?

Back 6

They often have associated neurovascular compromise which can lead to amputation if this is not rectified quickly.

Front 7

What is it important to check for with dislocations?

Back 7

CMS distal to the dislocation

Front 8

How are amputations managed?

Back 8

Generally they can be controlled with direct pressure applied to the stump.

Cover the stump with a damp sterile dressing and apply pressure across the entire stump.

If bleeding cannot be controlled by pressure a tourniquet can be used.

Front 9

What should you do with the part?

Back 9

Do your best to locate the part and bring it to the hospital.

The part should be put in a sterile bag and then put in another bag with ice and water.

Never into ice alone and never use dry ice.

Front 10

What should you do with open wounds?

Back 10

Cover with a sterile dressing and bandage carefully.

Remove gross contamination such as gravel or leaves and wash smaller debris from the wound.

Front 11

What about tourniquets?

Back 11

Should not be needed unless the wound cannot be controlled.

A blood pressure cuff or pressure on an artery proximal to the wound may be appropriate.

Front 12

What should you do before and after any extremity manipulation, splinting or traction?

Back 12

Check CMS.

Front 13

Impaled objects should be stabilized in place except for which areas?

Back 13

The neck or the face where the airway is compromised.

Front 14

What is compartment syndrome?

Back 14

Trauma causes the muscles to bleed within their surrounding membranes which will not stretch. This increase in pressure is transferred to blood vessels and nerves.

This pressure can cut of circulation and compromise nerves.

Front 15

What are the signs of compartment syndrome?

Back 15

Symptoms develop over a period of hours. Early symptoms are pain and paresthesia (tingling, burning, pricking, or numbness).

Late symptoms are the five P's Pain, Pallor, Pulselessness, paresthesia and paralysis

Front 16

What are the ruleIs of splinting?

Back 16

You must adequately visualize the injured part. Cut clothes off and do not pull them

Check and record distal sensation and circulation before and after splinting. Check movement if possible. Pulses can be marked with a pen to note where they were palpated

If there is no pulse then apply gentle traction in an attempt to straighten it. Do not exceed ten pounds of pressure.

Cover open wounds will a sterile dressing before splinting.

Use a split that will immobilize one joint above and below the injury

Pad the splint well

Do not attempt to push bone ends back under the skin. Notify the doctor if this happens as a result of traction

Pad bone ends with bandages and keep moist if long transport times.

Front 17

When should splinting occur?

Back 17

During transport if it is a life threatening emergency.

Otherwise it should occur on scene.

Front 18

What generally causes pelvic injuries?

Back 18

MVC's and falls from great heights

Front 19

How are pelvic injuries identified?

Back 19

Gentle pressure being places on the illiac crests hips and pubis

Front 20

What is there the potential for with pelvic injuries?

Back 20

Bleeding leading to shock, patients should be transported rapidly.

Front 21

What can decrease bleeding from the pelvis?

Back 21

Circumferential stabilization of the pelvis

Front 22

What should a patient with a pelvic injury always have?

Back 22

SMR. Due to the high forces required to break the pelvis patients can easily have suffered injury to the spine.

Front 23

What is it best to use with a pelvic injury?

Back 23

A scoop stretcher

Front 24

Where do pelvic fractures usually occur?

Back 24

Usually midshaft but hip fractures are common.

Front 25

What develops after a femur fracture and what is used to rectify the problem?

Back 25

The muscle can spasm leading to allot of pain. This is managed through use of a traction splint.

Front 26

Where do hip injuries most commonly occur?

Back 26

In the narrow neck of the femur.

Front 27

Who must you consider a hip fracture in?

Back 27

Any elderly person who has fallen and has pain in the knee, hip or pelvic region.

Isolated knee pain may well be coming from damage to the hip.

Front 28

How can patients get a hip dislocation?

Back 28

Generally they are the result of the knees striking the dash causing a posterior dislocation.

Always check the hip very carefully in patients with knee injuries in MVC's

Front 29

What are complications with hip dislocations?

Back 29

This is an orthopedic emergency and can result in sciatic nerve injury or necrosis of the femoral head.

Front 30

What can be the result of collapsed veins from a hip dislocation?

Back 30

A large pulmonary embolus can form and be released once the hip is reduced

Front 31

Why are fractures or dislocation of the knee serious?

Back 31

Arteries are bound down above and below the knee joint and often bruised or lacerated if the joint is in an abnormal position.

Front 32

What can be the result of damage to the vessels?

Back 32

The lower leg may need to be amputated.

Front 33

What can be done if the pulse has been lost distal to the knee?

Back 33

The leg can be straightened and then if that is possible not more than 10 lbs of traction can be applied along the long axis of the leg

Front 34

What can happen with fractures of the tib and fib?

Back 34

They are often open due to the thin skin over the front of the tibia.

Often there is significant internal and/or external blood loss

The internal blood loss can lead to compartment syndrome and cause loss of pulse and sensation.

Front 35

What are some things to note about clavicle injuries?

Back 35

The most commonly fractured bone in the body.

Best immobilized with a sling and swathe.

Important to examine the ribs and chest very carefully whenever an injury to the arm or clavicle is discovered.

Front 36

What are shoulder injuries associated with?

Back 36

Severe injuries of the chest and neck

Front 37

What is treatment for elbow injuries?

Back 37

Both fractures and dislocations can be serious due to the danger of damage to vessels and nerves which run across the flexor surface.

Elbow injuries should always be splinted in the most comfortable position and the distal function clearly evaluate.

Never straighten or apply traction

Front 38

How are forearm and wrist injuries managed?

Back 38

A rigid splint with a roll of gauze held in the hand.

The forearm is also at risk of compartment syndrome.

Front 39

How are hand and foot injuries managed?

Back 39

A pillow can be used to support an ankle.

An alternative for hand injuries is to put a roll of gauze in the palm and arrange the fingers then to wrap the whole thing in one large dressing

Elevation will also reduce the bleeding dramatically during transport.