PHTLS - Prehospital Trauma Life Support Musculoskeletal Trauma 2 — Questions and Answers
Question 1: What is the primary goal of splinting extremity fractures in the prehospital setting?
- To reduce the fracture to anatomic alignment
- To prevent further injury, reduce pain, and minimize hemorrhage (Correct answer)
- To provide definitive fracture treatment in the field
- To improve cosmetic appearance of the injured limb
Correct answer: To prevent further injury, reduce pain, and minimize hemorrhage
Splinting prevents further soft tissue and neurovascular injury, reduces pain by limiting movement, and helps control hemorrhage.
PHTLS identifies multiple benefits of proper splinting: prevention of further injury to muscles, nerves, and blood vessels; pain reduction by limiting movement at the fracture site; and hemorrhage reduction. Splinting is NOT intended to achieve anatomic reduction. The general principle is to splint in the position found.
Question 2: A patient has a closed femur fracture. How much blood can be lost internally from this single injury?
- 100-200 mL
- 500-750 mL
- 1,000-1,500 mL (Correct answer)
- 50-100 mL
Correct answer: 1,000-1,500 mL
A closed femur fracture can result in 1,000-1,500 mL or more of blood loss into the thigh compartment.
The thigh contains the largest muscle group in the body with extensive blood supply. This blood loss may not be externally visible, making it a significant source of occult hemorrhage. Traction splinting helps reduce blood loss by approximating bone ends and reducing compartment volume.
Question 3: When is a traction splint indicated in prehospital trauma care?
- For all lower extremity fractures
- For isolated midshaft femur fractures without hip or knee involvement (Correct answer)
- For open fractures with exposed bone
- For suspected pelvic fractures
Correct answer: For isolated midshaft femur fractures without hip or knee involvement
Traction splints are specifically indicated for isolated midshaft femur fractures, applying longitudinal traction to reduce muscle spasm and realign bone fragments.
Contraindications include fractures near the hip or knee joint, pelvic fractures, knee injuries on the same leg, and ankle/foot injuries preventing traction strap application. For bilateral femur fractures, individual traction splints are applied to each leg.
Question 4: What neurovascular assessment should be performed before and after splinting an extremity fracture?
- Blood pressure measurement in the affected extremity
- Assessment of pulse, sensation, and motor function distal to the injury (Correct answer)
- ECG monitoring of the affected limb
- Temperature comparison between both extremities
Correct answer: Assessment of pulse, sensation, and motor function distal to the injury
Distal pulse, sensation, and motor function must be assessed before and after splinting to detect any neurovascular compromise.
The neurovascular assessment (Pulse, Motor function, Sensation) is fundamental in PHTLS. If PMS is abnormal after splinting, the splint must be adjusted. Progressive loss of PMS during transport suggests evolving compartment syndrome or vascular compromise.
Question 5: How should an open fracture with exposed bone be managed in the prehospital setting?
- Push the bone back into the wound and splint
- Control hemorrhage, apply moist sterile dressing over the wound, and splint (Correct answer)
- Apply a tourniquet above and below the fracture site
- Irrigate the wound extensively with saline in the field
Correct answer: Control hemorrhage, apply moist sterile dressing over the wound, and splint
Open fractures require hemorrhage control, covering with a moist sterile dressing to prevent further contamination and drying, and immobilization with a splint.
PHTLS management includes: control hemorrhage with direct pressure; cover exposed bone with sterile dressings moistened with normal saline; splint without pushing bone back into the wound. Extensive field irrigation is not recommended as it delays transport.
Question 6: A trauma patient has a deformed ankle with no palpable dorsalis pedis pulse. What should the prehospital provider do?
- Immediately apply a traction splint
- Attempt gentle realignment to restore distal circulation, then splint (Correct answer)
- Transport without any intervention
- Apply a tourniquet above the knee
Correct answer: Attempt gentle realignment to restore distal circulation, then splint
When a deformed extremity has absent distal pulses, gentle realignment with inline traction may restore blood flow.
The displaced bone or joint may be compressing or kinking the artery. Gentle inline traction to realign the extremity often restores distal circulation. If the pulse does not return after one gentle attempt, splint in position and transport urgently.
PHTLS - Prehospital Trauma Life Support Musculoskeletal Trauma 2
What is the primary goal of splinting extremity fractures in the prehospital setting?