TCRN Musculoskeletal and Wound Care Flashcards

A patient with a closed tibial fracture after a motorcycle crash requires escalating doses of opioid analgesia. Which early clinical finding is most indicative of developing acute compartment syndrome?

Answer: Pain that is out of proportion to the injury

Pain out of proportion to the injury, especially pain with passive stretching of the muscles in the affected compartment, is the earliest and most sensitive sign of acute compartment syndrome. Pulselessness, paralysis, and pallor are all considered very late and ominous signs, indicating significant vascular compromise and nerve damage have already occurred.

A patient arrives with a grossly contaminated Grade III open femur fracture. After controlling hemorrhage and ensuring hemodynamic stability, which intervention is the highest priority to prevent osteomyelitis?

Answer: Administering broad-spectrum intravenous antibiotics

Prompt administration of broad-spectrum intravenous antibiotics is a time-sensitive priority in managing open fractures to prevent infection, such as osteomyelitis. While covering the wound and surgical debridement are also critical steps, initiating systemic antibiotic therapy as soon as possible (ideally within 1-3 hours of injury) has been shown to significantly reduce infection rates. Wound cultures are typically obtained after initial irrigation.

A patient is extricated from a structural collapse with severe crush injuries to both lower extremities. The trauma nurse should anticipate which hallmark laboratory finding and prioritize which intervention to prevent acute kidney injury?

Answer: Elevated creatinine kinase (CK); aggressive intravenous fluid resuscitation

The hallmark laboratory finding for rhabdomyolysis is a markedly elevated creatinine kinase (CK) level, often greater than 5 times the upper limit of normal. The breakdown of muscle releases myoglobin, which is nephrotoxic. The primary intervention to prevent acute kidney injury is aggressive intravenous fluid resuscitation to maintain high urine output and flush the myoglobin through the renal tubules. While electrolyte abnormalities like hyperkalemia occur, treating the underlying cause with fluids is the priority.

A 22-year-old involved in a skiing accident has an isolated, closed femur fracture. Forty-eight hours after the injury, the patient becomes acutely confused, develops respiratory distress, and has a petechial rash across the chest and axillae. These findings are most characteristic of which complication?

Answer: Fat Embolism Syndrome (FES)

This patient is exhibiting the classic triad of Fat Embolism Syndrome (FES): neurologic changes (confusion), respiratory insufficiency (respiratory distress), and a pathognomonic petechial rash. FES typically occurs 24-72 hours after a long bone or pelvic fracture. The other options do not present with this specific combination of symptoms.

A patient presents with a deep, contaminated puncture wound from a farm implement. Their tetanus immunization history is unknown. According to current guidelines, what is the most appropriate prophylaxis?

Answer: Tdap vaccine and Tetanus Immune Globulin (TIG)

For a patient with a contaminated, tetanus-prone wound and an unknown or incomplete (<3 doses) vaccination history, guidelines recommend administering both the Tdap vaccine for active immunity and Tetanus Immune Globulin (TIG) for immediate passive immunity. They should be given in separate syringes at different anatomical sites.

A patient with a traumatic knee dislocation undergoes successful closed reduction in the emergency department. Distal pulses are strong and palpable post-reduction. What is the most critical next assessment to rule out a limb-threatening injury?

Answer: Measuring an Ankle-Brachial Index (ABI)

Knee dislocations have a high incidence of popliteal artery injury, which can occur even with palpable distal pulses due to an intimal tear. The standard of care is to measure the Ankle-Brachial Index (ABI). An ABI of less than 0.9 warrants further vascular imaging, such as a CT angiogram. While post-reduction x-rays are necessary, assessing for vascular injury is the most critical priority to prevent limb loss.