ATLS Module 8 - Musculoskeletal
Trauma Questions with Correct Answers
100%Pass
what are potentially life threatening extremity injuries? - ANSWER -major arterial
hemorrhage, bilateral femoral fractures, crush syndrome
what long bone fractures can be significant? - ANSWER -hemorrhage from all long
bone fractures can be significant, and femoral fractures often result in significant blood
loss into the thigh
Red text
a properly applied tourniquet must include arterial inflow... what happens if you only
occlude venous system? - ANSWER -increase hemorrhage and result in a swollen
cyanotic extremity
the risks of tourniquet use increase over time... if it must remain in place for a prolonged
period to save a life, what choice is made? - ANSWER -choice of life over limb is made
what do you do if a fracture is associated with an open hemorrhaging wound? -
ANSWER -realign and splint it while a second person applies direct pressure to the
open wound
in patients with amputated extremities... who is not a candidate for replantation? -
ANSWER -pt with multiple injuries who require intensive resuscitation and or
emergency surgery for extremity or other injuries
red text
in patients who may be a potential for replantation of amputated extremity, how do you
initially manage the wound? - ANSWER -thoroughly wash the amputated part with
isotonic solution (ringers lactate) and wrap it in moist, sterile gauze... then wrap it in
moistened steril towel, place in plastic bag and transport with pt in an insulated cooling
chest with crushed ice
*be careful not to freeze it though
people with bilateral femur fractures vs unilateral femur fractures - ANSWER -they are
at significantly greater risk for significant blood loss, severe associated injuries,
pulmonary complications, multiple organ failure, and death
What can crush syndrome lead to? - ANSWER -aka traumatic rhabdomyolysis
, *if left untreated, can lead to acute renal failure and shock
*muscular insult is a combo of direct muscle injury, muscle ischemia, and cell death with
release of myoglobin
what is indicative of rhabdomyolysis when myoglobin levels arent available? - ANSWER
-dark amber colored urine + serum creatine kinase of 10,000 U/L
What can rhabdomyolysis lead to? - ANSWER -metabolic acidosis
hyperkalemia
hypocalcemia
DIC
what is the management of rhabdomyolysis? - ANSWER -early & aggressive IV fluids
during resuscitation is critical to protecting kidneys and prevent renal failure
what is the goal of initial fracture immobilization? - ANSWER -realign injured extremity
in as close to anatomic position as possible and prevent excessive motion at fracture
site
what are the 3 goals when assessing the extremities? - ANSWER -1. id life threatening
injuries (primary survey)
2. id limb threatening injuries (secondary survey)
3. conduct systematic review to avoid missing other MSK injuries
what do you always consider any open wound with an associated fx on a limb until
proven otherwise? - ANSWER -open fracture
what is abnormal motion through a joint segment indicative of? - ANSWER -tendon or
ligamentous rupture
for the circulatory evaluation, palpate the distal pulses in each extremity and assess
capillary refill of the digits... what do you do if hypotension limits digital exam of pulse? -
ANSWER -use doppler probe to detect blood flow
what joint may dislocated and reduce spontaneously and not present with any gross
external or radiographic anomalies until physical exam of the joint shows instability? -
ANSWER -knee dislocations
*ankle brachial index of <0.9 indicates abnormal arterial flow secondary to injury or
peripheral vascular dz
*red text
what is the only reason to forgo x-ray before treating dislocation or fracture? - ANSWER
-presence of vascular compromise or impending skin breakdown
*commonly seen with fracture dislocations of the ankle
Trauma Questions with Correct Answers
100%Pass
what are potentially life threatening extremity injuries? - ANSWER -major arterial
hemorrhage, bilateral femoral fractures, crush syndrome
what long bone fractures can be significant? - ANSWER -hemorrhage from all long
bone fractures can be significant, and femoral fractures often result in significant blood
loss into the thigh
Red text
a properly applied tourniquet must include arterial inflow... what happens if you only
occlude venous system? - ANSWER -increase hemorrhage and result in a swollen
cyanotic extremity
the risks of tourniquet use increase over time... if it must remain in place for a prolonged
period to save a life, what choice is made? - ANSWER -choice of life over limb is made
what do you do if a fracture is associated with an open hemorrhaging wound? -
ANSWER -realign and splint it while a second person applies direct pressure to the
open wound
in patients with amputated extremities... who is not a candidate for replantation? -
ANSWER -pt with multiple injuries who require intensive resuscitation and or
emergency surgery for extremity or other injuries
red text
in patients who may be a potential for replantation of amputated extremity, how do you
initially manage the wound? - ANSWER -thoroughly wash the amputated part with
isotonic solution (ringers lactate) and wrap it in moist, sterile gauze... then wrap it in
moistened steril towel, place in plastic bag and transport with pt in an insulated cooling
chest with crushed ice
*be careful not to freeze it though
people with bilateral femur fractures vs unilateral femur fractures - ANSWER -they are
at significantly greater risk for significant blood loss, severe associated injuries,
pulmonary complications, multiple organ failure, and death
What can crush syndrome lead to? - ANSWER -aka traumatic rhabdomyolysis
, *if left untreated, can lead to acute renal failure and shock
*muscular insult is a combo of direct muscle injury, muscle ischemia, and cell death with
release of myoglobin
what is indicative of rhabdomyolysis when myoglobin levels arent available? - ANSWER
-dark amber colored urine + serum creatine kinase of 10,000 U/L
What can rhabdomyolysis lead to? - ANSWER -metabolic acidosis
hyperkalemia
hypocalcemia
DIC
what is the management of rhabdomyolysis? - ANSWER -early & aggressive IV fluids
during resuscitation is critical to protecting kidneys and prevent renal failure
what is the goal of initial fracture immobilization? - ANSWER -realign injured extremity
in as close to anatomic position as possible and prevent excessive motion at fracture
site
what are the 3 goals when assessing the extremities? - ANSWER -1. id life threatening
injuries (primary survey)
2. id limb threatening injuries (secondary survey)
3. conduct systematic review to avoid missing other MSK injuries
what do you always consider any open wound with an associated fx on a limb until
proven otherwise? - ANSWER -open fracture
what is abnormal motion through a joint segment indicative of? - ANSWER -tendon or
ligamentous rupture
for the circulatory evaluation, palpate the distal pulses in each extremity and assess
capillary refill of the digits... what do you do if hypotension limits digital exam of pulse? -
ANSWER -use doppler probe to detect blood flow
what joint may dislocated and reduce spontaneously and not present with any gross
external or radiographic anomalies until physical exam of the joint shows instability? -
ANSWER -knee dislocations
*ankle brachial index of <0.9 indicates abnormal arterial flow secondary to injury or
peripheral vascular dz
*red text
what is the only reason to forgo x-ray before treating dislocation or fracture? - ANSWER
-presence of vascular compromise or impending skin breakdown
*commonly seen with fracture dislocations of the ankle
