PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Musculoskeletal Trauma 1 — Questions and Answers
Question 1: Which of the following is the earliest and most reliable sign of developing compartment syndrome in a fractured extremity?
- Pulselessness distal to the fracture site
- Pain that is disproportionate to the injury and worsened with passive stretch (Correct answer)
- Paralysis of the affected limb
- Pallor and mottling of the skin
Correct answer: Pain that is disproportionate to the injury and worsened with passive stretch
Pain out of proportion to the injury — especially pain worsened by passively stretching the muscles in the compartment — is the earliest and most sensitive indicator of compartment syndrome, preceding the '6 P's' late findings such as pulselessness and paralysis.
Question 2: When managing an open (compound) fracture in the prehospital setting, what is the correct treatment of the wound before splinting?
- Pack the wound tightly with dry gauze and apply a circumferential pressure wrap
- Cover the wound with a moist sterile dressing and do not attempt to push exposed bone back into the wound (Correct answer)
- Irrigate the wound thoroughly with sterile saline before applying a dressing
- Apply a tourniquet proximal to the wound regardless of bleeding severity
Correct answer: Cover the wound with a moist sterile dressing and do not attempt to push exposed bone back into the wound
Open fractures should be covered with a moist sterile dressing to prevent further contamination and tissue desiccation. Exposed bone should never be pushed back into the wound in the field, as this risks driving contamination deeper into the tissue.
Question 3: A patient involved in a high-speed MVC is found with a suspected pelvic fracture. What is the maximum estimated internal blood loss possible from an unstable pelvic ring disruption?
- Up to 500 mL
- Up to 1,000 mL
- Up to 2,000 mL
- More than 2,000 mL — potentially life-threatening hemorrhage (Correct answer)
Correct answer: More than 2,000 mL — potentially life-threatening hemorrhage
An unstable pelvic ring fracture can result in hemorrhage exceeding 2,000–3,000 mL due to injury to the pelvic venous plexus and nearby arterial structures, making it one of the most lethal musculoskeletal injuries. Early pelvic binder application is critical.
Question 4: In which situation should a prehospital provider NOT attempt to realign a deformed extremity fracture before splinting?
- When the patient reports significant pain with the deformity
- When pulses are absent distal to the fracture and transport time is less than 10 minutes
- When a joint is involved and any attempt at realignment produces resistance or causes severe pain (Correct answer)
- When the fracture is in the midshaft of the radius
Correct answer: When a joint is involved and any attempt at realignment produces resistance or causes severe pain
Fractures involving joints (dislocations) should not be forcibly realigned in the field. Resistance or severe pain during an attempt signals that reduction could cause additional neurovascular damage. Splint in the position found and transport immediately.
Question 5: What is the correct prehospital approach when a long bone fracture is associated with an absent distal pulse?
- Splint in the position of deformity and do not manipulate the limb
- Apply a traction splint immediately to restore circulation
- Gently realign the limb toward anatomical position once, reassess pulses, then splint (Correct answer)
- Apply a tourniquet and arrange air transport
Correct answer: Gently realign the limb toward anatomical position once, reassess pulses, then splint
When a distal pulse is absent due to a long bone fracture, a single gentle attempt to realign the limb toward anatomical position is indicated to relieve vascular compromise. Pulses should be reassessed immediately after; if still absent, expedite transport to a trauma center.
Question 6: Which patient presentation is an absolute contraindication to the use of a traction splint?
- Mid-shaft femur fracture with severe pain and shortening
- Suspected femur fracture with an associated hip or knee injury (Correct answer)
- Femur fracture with a 2 cm wound over the thigh
- Bilateral femur fractures in a hemodynamically unstable patient
Correct answer: Suspected femur fracture with an associated hip or knee injury
A traction splint is contraindicated when there is a concurrent injury to the hip or knee on the same extremity, as applying traction could worsen joint disruption, injure the acetabulum, or cause additional neurovascular damage. The device is designed specifically for isolated mid-shaft femur fractures.
PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Musculoskeletal Trauma 1
Which of the following is the earliest and most reliable sign of developing compartment syndrome in a fractured extremity?