ATLS Module 8 - Musculoskeletal Trauma Exam Questions and Answers | Latest Update 2026 | Guaranteed Pass

ATLS Module 8 - Musculoskeletal Trauma Exam Questions and Answers | Latest Update 2026 | Guaranteed Pass what are potentially life threatening extremity injuries? - answer-major arterial hemorrhage, bilateral femoral fractures, crush syndrome what long bone fractures can be significant? - answer-hemorrhage from all long bone fractures can be significant, and femoral fractures often result in significant blood loss into the thigh Red text a properly applied tourniquet must include arterial inflow... what happens if you only occlude venous system? - answer-increase hemorrhage and result in a swollen cyanotic extremity the risks of tourniquet use increase over time... if it must remain in place for a prolonged period to save a life, what choice is made? - answer-choice of life over limb is made what do you do if a fracture is associated with an open hemorrhaging wound? - answer-realign and splint it while a second person applies direct pressure to the open wound in patients with amputated extremities... who is not a candidate for replantation? - answer-pt with multiple injuries who require intensive resuscitation and or emergency surgery for extremity or other injuries red text in patients who may be a potential for replantation of amputated extremity, how do you initially manage the wound? - answer-thoroughly wash the amputated part with isotonic solution (ringers lactate) andwrap it in moist, sterile gauze... then wrap it in moistened steril towel, place in plastic bag and transport with pt in an insulated cooling chest with crushed ice *be careful not to freeze it though people with bilateral femur fractures vs unilateral femur fractures - answer-they are at significantly greater risk for significant blood loss, severe associated injuries, pulmonary complications, multiple organ failure, and death What can crush syndrome lead to? - answer-aka traumatic rhabdomyolysis *if left untreated, can lead to acute renal failure and shock *muscular insult is a combo of direct muscle injury, muscle ischemia, and cell death with release of myoglobin what is indicative of rhabdomyolysis when myoglobin levels arent available? - answer-dark amber colored urine + serum creatine kinase of 10,000 U/L What can rhabdomyolysis lead to? - answer-metabolic acidosis hyperkalemia hypocalcemia DIC what is the management of rhabdomyolysis? - answer-early & aggressive IV fluids during resuscitation is critical to protecting kidneys and prevent renal failure what is the goal of initial fracture immobilization? - answer-realign injured extremity in as close to anatomic position as possible and prevent excessive motion at fracture site what are the 3 goals when assessing the extremities? - answer-1. id life threatening injuries (primary survey) 2. id limb threatening injuries (secondary survey) 3. conduct systematic review to avoid missing other MSK injurieswhat do you always consider any open wound with an associated fx on a limb until proven otherwise? - answer-open fracture what is abnormal motion through a joint segment indicative of? - answer-tendon or ligamentous rupture for the circulatory evaluation, palpate the distal pulses in each extremity and assess capillary refill of the digits... what do you do if hypotension limits digital exam of pulse? - answer-use doppler probe to detect blood flow what joint may dislocated and reduce spontaneously and not present with any gross external or radiographic anomalies until physical exam of the joint shows instability? - answer-knee dislocations *ankle brachial index of 0.9 indicates abnormal arterial flow secondary to injury or peripheral vascular dz *red text what is the only reason to forgo x-ray before treating dislocation or fracture? - answer-presence of vascular compromise or impending skin breakdown *commonly seen with fracture dislocations of the ankle what do you do if delay in obtaining x-rays is unavoidable with a fracture/dislocation? - answerimmediately reduce or realign the extremity to reestablish arterial blood flow and reduce pressure on skin what CT finding is highly specific and sensitive for identifying an open joint injury? - answer-presence of intraarticular gas on the affected extremity how do you treat all patients with open fractures? - answer-start IV antibiotics using weight based dosing ASAP *first generation cephalosporins *delay of tx 3 hours is related to increased risk of infectino when does muscle necrosis begin? - answer-When there is a lack of arterial blood flow for more than 6 hourshow do you manage a fracture deformity? - answer-gently pull limb out to length, realigning the fracture, and splinting into the injured extremity *this often restores blood flow to an ischemic extremity when the artery is kinked by shortening and deformity of the fracture site compartment syndrome can occur when there is an increase in the compartment content (bleeding/swelling) or decrease in compartment size (constrictive dressing)... it can occur wherever muscle is contained within a closed fascial space... what do you have to remember about the skin? - answer-skin can act as a restricting layer in certain circumstances red text what are the common areas for compartment syndrome? - answer-lower leg, forearm, foot, hand, gluteal region, thigh what injuries are high risk for compartment syndrome? - answer--tibia & forearm fx -injuries immobilized in tight dressings or casts -severe crush injury to muscle -localized, prolonged external pressure to extremity -increased capillary permeability secondary to reperfusion of ischemic muscle -burns -excessive exercise when measuring intracompartmental pressure, what pressures suggest decreased capillary blood flow? - answer-30mm Hg *remember, lower systemic pressure, lower the compartment pressure that causes a compartment syndrome *RED text: compartment syndrome is a clinical dx... pressure measurements are only an adjunct to aid dxwhat might occur if you delay a fasciotomy in the tx of compartment syndrome? - answer-other than neuromuscular damage... there is a risk of myoglobinuria which may decrease renal function *if compartment syndrome is suspected, immediately obtain surgical consultation what are the risk factors for tetanus? - answer-6 hours old contused or abraded 1cm deep wounds from high velocity missiles due to burns or cold significantly contaminated... particularly wounds with denervated or ischemic tissues when taking x-rays, how do you exclude occult dislocation and concomitant injury? - answer-include joints above and below suspected fracture site how do you manage fractures? - answer-immobilization including the joint above and below fx *after splinting, reassess neurologic and vascular status of extremity how are femoral fractures temporarily immobilized? - answer-traction splints... force is applied distally at the ankle. Proximally the post is pushed into the gluteal crease to apply pressure to buttocks, perineum, and groin when immobilized a knee injury... you dont want to immobilize in complete extension.. how is it done? - answer-~10 degrees of flexion to reduce tension on neurovascular structures when should you not apply traction for femoral fractures? - answer-presence of concomitant tibia/fibula fracture due to risk of neurovascular injury how much blood loss would you expect from a femur fracture and tibial fractures? - answer-femur fx = up to 2 L tibial fx = up to 1.5 Lwhat is the best way to control hemorrhage from femur and tibial shaft fractures? - answer-fracture immobilization *it will minimize blood loss and further soft tissue damage *also, facilitate pain control in hemodynamically unstable patients