TNCC Musculoskeletal Trauma 3 — Questions and Answers
Question 1: Which assessment finding distinguishes a complete spinal cord injury from an incomplete spinal cord injury?
- Presence of spinal shock
- Loss of sacral sensation and motor function (Correct answer)
- Level of the injury
- Absence of deep tendon reflexes
Correct answer: Loss of sacral sensation and motor function
In a complete spinal cord injury, there is complete loss of motor and sensory function below the injury level, including the sacral segments (S4–S5), evidenced by no perianal sensation or voluntary anal contraction.
Question 2: A nurse suspects a scaphoid fracture in a patient who fell on an outstretched hand. Which assessment finding is most specific for this injury?
- Swelling at the anatomical snuffbox
- Tenderness over the anatomical snuffbox (Correct answer)
- Inability to make a fist
- Ecchymosis at the dorsum of the wrist
Correct answer: Tenderness over the anatomical snuffbox
Anatomical snuffbox tenderness is the hallmark finding for scaphoid fractures, which may not be visible on initial radiographs.
Question 3: When applying traction splinting for a femur fracture, which condition is an absolute contraindication?
- Open femur fracture with wound
- Coexisting hip or knee injury (Correct answer)
- Suspected pelvis fracture
- Vascular compromise distal to fracture
Correct answer: Coexisting hip or knee injury
Hip or knee injuries are absolute contraindications to traction splinting because applying traction can displace those injuries and cause additional damage.
Question 4: A patient with a calcaneal fracture after falling from a height should be assessed for which associated injury due to the axial loading mechanism?
- Lumbar spine compression fracture (Correct answer)
- Tibial plateau fracture
- Distal radius fracture
- Hip dislocation
Correct answer: Lumbar spine compression fracture
Calcaneal fractures from axial loading forces frequently transmit energy up the axial skeleton, causing lumbar spine fractures in up to 10% of cases.
Question 5: During a primary survey, a patient has an actively bleeding extremity wound with a tourniquet already applied. The tourniquet is not controlling bleeding. What is the next intervention?
- Remove the tourniquet and apply direct pressure
- Apply a second tourniquet proximal to the first (Correct answer)
- Apply hemostatic dressing under the tourniquet
- Elevate the extremity above the heart
Correct answer: Apply a second tourniquet proximal to the first
Applying a second tourniquet proximal to the first is the recommended intervention when a single tourniquet fails to control hemorrhage from a proximal extremity wound.
Question 6: A patient with a posterior hip dislocation will typically present with the affected extremity in which position?
- Extended, abducted, and externally rotated
- Flexed, adducted, and internally rotated (Correct answer)
- Extended, adducted, and internally rotated
- Flexed, abducted, and externally rotated
Correct answer: Flexed, adducted, and internally rotated
Posterior hip dislocation (90% of dislocations) presents with the hip flexed, adducted, and internally rotated due to posterior displacement of the femoral head.
Question 7: When caring for a patient with suspected long bone fractures and significant blood loss, which IV fluid strategy is currently recommended in trauma resuscitation?
- Large volumes of normal saline to restore circulating volume
- Balanced blood product ratio (1:1:1 PRBC:FFP:Platelets) (Correct answer)
- Hypertonic saline as primary resuscitation fluid
- Colloid solutions to maintain oncotic pressure
Correct answer: Balanced blood product ratio (1:1:1 PRBC:FFP:Platelets)
Damage control resuscitation using a balanced ratio of packed red blood cells, fresh frozen plasma, and platelets (1:1:1) minimizes coagulopathy and improves outcomes in hemorrhagic shock.
TNCC Musculoskeletal Trauma 3
Which assessment finding distinguishes a complete spinal cord injury from an incomplete spinal cord injury?