2024 ATLS Module 8 - Musculoskeletal Trauma Latest Questions With Complete Grade A Answers
- 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
- 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
- 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 1 / 2
with release of myoglobin
- what is indicative of rhabdomyolysis when myoglobin levels arent avail- able?
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:
- id life threatening injuries (primary survey)
- id limb threatening injuries (secondary survey)
- 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
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