PHTLS - Prehospital Trauma Life Support Musculoskeletal Trauma Questions and Answers

Question 1

A 46-year-old pedestrian was struck by a vehicle and presents with instability and crepitus on gentle palpation of the pelvis.
The patient is tachycardic and hypotensive.
What is the MOST critical prehospital intervention for managing this patient's suspected injury?

Accepted Answer

Application of a commercial pelvic binder or improvised sheet sling.

Answer

Rapid infusion of two liters of crystalloid fluid.

Answer

Application of bilateral traction splints to the lower extremities.

Answer

Log rolling the patient onto a long spine board for immobilization.

Question 2

Which of the following is considered the most reliable and earliest sign of developing compartment syndrome in a conscious patient with a closed tibial fracture?

Accepted Answer

Pain that is out of proportion to the injury and unrelieved by standard measures.

Answer

Pallor of the foot distal to the injury.

Answer

Absence of a pedal pulse.

Answer

Paresthesia or a 'pins and needles' sensation in the toes.

Question 3

A 24-year-old has an obviously deformed, closed fracture of the right forearm after a fall. According to PHTLS principles, which assessment is mandatory immediately before AND after applying a rigid splint?

Accepted Answer

Pulse, motor function, and sensation (PMS) distal to the injury.

Answer

Blood pressure in the affected arm.

Answer

Capillary refill time in the nail beds of both hands.

Answer

Range of motion of the wrist and elbow.

Question 4

Application of a traction splint is indicated for an isolated, mid-shaft femur fracture. In which of the following situations is a traction splint contraindicated?

Accepted Answer

The patient also has a suspected fracture of the ipsilateral tibia.

Answer

The patient has an open femur fracture with minimal bleeding.

Answer

The patient is unconscious with a GCS of 7.

Answer

The patient is hypotensive and tachycardic.

Question 5

You are managing a 38-year-old patient with a traumatic amputation of their left hand. After controlling hemorrhage, you recover the amputated part. What is the proper procedure for preserving the part for potential re-plantation?

Accepted Answer

Wrap the hand in saline-moistened gauze, place it in a sealed plastic bag, and place the bag in a cooler with ice.

Answer

Place the hand directly into a container of ice water to keep it cold.

Answer

Wrap the hand in a dry sterile dressing, place it in a plastic bag, and give it to the flight crew.

Answer

Clean the part thoroughly with betadine before wrapping it for transport.

Question 6

You are treating a patient with a severe open fracture of the tibia, with a 2-inch bone end protruding through the skin. After controlling major hemorrhage, what is the most appropriate management for the wound itself?

Accepted Answer

Cover the wound and exposed bone with a sterile, saline-moistened dressing.

Answer

Attempt to gently push the bone end back under the skin to prevent drying.

Answer

Vigorously irrigate the wound with sterile saline to remove all visible debris.

Answer

Apply a tourniquet proximal to the wound to prevent infection.