ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UP, Exams of Nursing

Download ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UP and more Exams Nursing in PDF only on Docsity! ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Chapter objectives - CORRECT ANSWERS 1. Explain the significance of MSK injuries in a patient with multiple injuries. 2. Outline the priorities of the primary survey and resuscitation of patients with extremity injuries, quickly separating the potentially life-threatening injuries from those that are less urgent. 3. Identify the adjuncts needed in the immediate treatment of life- threatening extremity hemorrhage. 4. Describe key elements of the secondary survey of patients with MSK trauma, including the H&P exam. 5. Explain the principles of the initial management of limb- threatening MSK injuries. 6. Describe the appropriate assessment and initial management of patients with contusions, lacerations, joint and ligament injuries, and fractures. 7. Describe the principles of proper immobilization of patients with MSK injuries. ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Are MSK injuries life-threatening? - CORRECT ANSWERS Infrequently immediately. Often appear dramatic. Look for associated thoracic and abdominal injuries. Associated injuries: long bone fractures above and below diaphragm - CORRECT ANSWERS Increased risk for internal torso injury. Fat embolism - CORRECT ANSWERS blood tinged sputum r/t inflammations. Increase ESR, respiratory alkalosis. Hypocalcemia, increased serum lipids. Uncommon but highly lethal complication of long-bone fractures. Priorities of MSK care - CORRECT ANSWERS Control hemorrhage Potentially life-threatening: major arterial hemorrhage, bilateral femur fractures, crush syndrome. Appropriate splinting of fractures can decrease bleeding by reducing motion and enhancing tamponade of muscle and fascia. ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Can lead to metabolic acidosis, hyperkalemia, hypocalcemia, and DIC. Management: Early and aggressive fluid resuscitation, alkalinization of urine with bicarb, osmotic diuresis Adjuncts to primary: fracture immobilization and x-ray exam if fracture suspected cause of shock - CORRECT ANSWERS Realign, remove gross contamination, weight based dose of Abx ASAP. Splint in position found if not able to realign. Resuscitation efforts take priority over splinting. Secondary Survey: MOI - CORRECT ANSWERS Crash: driver or passenger inside or ejected seatbelt or airbag Distance thrown, landing conditions Exterior damaged? Interior damaged? Fall: Distance ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING How landed Crushed by object? Weight, site, suration Explosion? Distance, magnitude MVP: Height of bumper Patient age and size Environment Assessment of secondary survey - CORRECT ANSWERS Open fracture in contaminated environment Temperature extremes? Broken glass on scene? Bacterial contamination e.g., dirt, animal feces, fresh or salt water Prehospital observations and care - CORRECT ANSWERS Time of injury Position found Bleeding or pooling of blood and estimated amount ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Bone or fracture ends exposed Open wounds in proximity to obvious or suspected fractures Obvious deformity or dislocation Crush mechanism CMS in all extremities Delays in extrication Changes in CMS en route or after immobilization Reduction of fractures or dislocations Dressings and splints applied Time of tourniquet placement Physical exam MSK - CORRECT ANSWERS Primary: Identify life- threatening injuries Secondary: identify limb-threatening injuries Systematic review to avoid missing any other injuries Look and ask: color and perfusion, wounds, deformity (angulation or shortening); swelling, bruising Extremities with swelling in region of major muscle groups may indicate a crush injury with an impending compartment syndrome ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Loss of sensation in a stocking or glove distribution is an early sign of vascular impairment. In patients with normal BP, an arterial injury can be indicated by pulse discrepancies, coolness, pallor, paresthesia, and even motor function abnormalities. ABI < 0.9 indicates abnormal arterial flow secondary to injury or PVD X-ray - CORRECT ANSWERS TTP + deformity likely fracture Joint effusion, abnormal joint tenderness, and joint deformity indicate a joint injury or dislocation. Only reason to forgo x-ray exam is presence of vascular compromise or impending skin breakdown. Commonly seen with fracture/dislocations of the ankle. Limb-threatening injuries: open fracture - CORRECT ANSWERS Open fracture or joint injury Degree of soft-tissue injury proportional to energy applied Assessment: presence should be promptly determined. Open wound on the same limb segment as an associated fracture - do not probe wound ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING If an open wound exists on or near a joint, it should be assumed injury connects with or enters the joint. Intraarticular gas on a CT is highly sensitive and specific for identifying open joint injury. Management: Treat all open fractures with IV abx using weight-based dosing. Delay beyond 3 hours r/t increased risk of infection. Remove gross contamination and cover with moist sterile dressing. Tetanus prophylaxis Operative intervention Limb-threatening injuries: Vascular injuries - CORRECT ANSWERS Hx of blunt, crush, twisting, or penetrating injury or dislocation to an extremity - suspect if vascular insufficiency present. Assessment: Limb may initially appear viable because extremities often have some collateral circulation that provides adequate flow. ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Non-occlusive vascular injury (e.g, intimal tear) can cause coolness and prolonged cap refill in distal part of extremity, as well as diminished peripheral pulses and abnormal ABI. Sometimes will have complete lack of blood flow. Management: Crucial to recognize and emergently treat acutely avascular extremity. Muscle necrosis begins if lack of blood flow > 6 hours. Nerves may be more sensitive. If associated with fracture - gently realign and splint. Excessive pain after splint application must be investigated. CT angio may be used if no delay in Tx, only indicated after consult with surgeon. Compartment syndrome - CORRECT ANSWERS Occurs when increased pressure within a myofascial compartment causes ischemia and subsequent necrosis. Bleeding into compartment or swelling after revascularization of an ischemic extremity. Decrease in compartment size (constrictive dressing.) Skin acts as restricting layer in certain circumstances. ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Myoglobinuria may result if delay. Neurological injury secondary to fracture or dislocation - CORRECT ANSWERS Assessment: Deformity of extremity, assess nerve function with voluntary motor function and sensation. Muscle testing must include palpation of contracting muscle. Progression of neurologic findings is indicative of continued nerve compression. Management: Reduce and splint Contusions and lacerations - CORRECT ANSWERS Rule out vascular and/or neurologic injuries Lacerations require debridement and closure If below fascia - may need operative intervention. Contusions: usually pain, localized swelling, tenderness Tx by limiting fxn and applying cold packs ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Crush and internal degloving: subtle, suspected by mechanism Soft tissue avulsion can shear skin from deep fascia, allowing for significant accumulation of blood in resulting cavity (Morel-Lavallée lesion) Skin may be sheared from blood supply and undergo necrosis over a few days. Overlying abrasions or bruised skin - clues to more severe degree of muscle damage and potential compartment or crush syndromes. Tetanus risk - CORRECT ANSWERS Increased with wounds > 6 hours old, contused or abraded, more than 1cm in depth, from high- velocity missiles, d/t burns or cold, and significantly contaminated; particularly wounds with denervated or ischemic tissue Joint and ligament injuries - CORRECT ANSWERS Patient usually reports abnormal stress to joint TTP throughout affected joint. Hemarthrosis usually present unless joint capsule is disrupted and bleeding diffuses into soft tissues. Passive ligament testing reveals instability. Some small avulsion fractures from ligamentous insertions or origins may be present radiographically ATLS CHAPTER 8: MUSCULOSKELETAL TRAUMA QUESTIONS AND ANSWERS ALL ANSWERS CORRECT LATEST UPDATE 2022/2023 RATED A+,BEST FOR NURSING Management: Immobilize Knee dislocations often resolve spontaneously - place limb at risk for NV injury. Fractures - CORRECT ANSWERS break in continuity of bone cortex Abnormal motion, soft-tissue injury, bony crepitus, and pain. Open or closed. Assessment: Pain, swelling, deformity, tenderness, crepitus, abnormal motion. Evaluation for crepitus and abnormal motion are painful and may increase soft-tissue damage. To exclude occult dislocation and concomitant injury, x-ray films must include joints above and below suspected fracture site. Valgus vs varus - CORRECT ANSWERS Varus - lateral opening/strain Valgus - medial opening/strain Hip flexed 30 degrees and unflexed - apply pressure/feel for opening