ITLS - International Trauma Life Support Extremity Trauma Management Questions and Answers 1 — Questions and Answers
Question 1: A construction worker has a partial amputation of the lower leg with massive, pulsatile bleeding that is not controlled by direct pressure. According to ITLS guidelines, what is the most appropriate immediate action?
- Apply a hemostatic dressing deep into the wound.
- Apply a tourniquet high and tight on the thigh. (Correct answer)
- Elevate the limb above the heart and apply pressure to the femoral artery.
- Immediately package the patient for transport without further intervention.
Correct answer: Apply a tourniquet high and tight on the thigh.
For catastrophic extremity hemorrhage that is not controlled by direct pressure, the immediate application of a tourniquet is the priority intervention. The initial placement should be 'high and tight' on the affected limb to ensure arterial compression.
Question 2: What is the most critical assessment that must be performed both before and after applying a splint to a fractured extremity?
- Measuring the length of the extremity.
- Asking the patient to rate their pain on a scale of 1-10.
- Photographing the injury for hospital documentation.
- Assessing for pulses, motor function, and sensation distal to the injury. (Correct answer)
Correct answer: Assessing for pulses, motor function, and sensation distal to the injury.
Assessing distal pulses, motor function, and sensation (PMS or CMS) is critical both before and after splinting. The initial assessment establishes a baseline of the patient's neurovascular status. The assessment after splint application ensures that the splint has not compromised circulation or nerve function to the limb.
Question 3: A patient has a traumatic amputation of their hand at the wrist. The patient is stable and bleeding is controlled. Which of the following describes the correct management of the amputated part?
- Place the hand directly in a container of ice to ensure maximum cooling.
- Wrap the hand in saline-moistened gauze, seal it in a plastic bag, and place the bag in a container of ice and water. (Correct answer)
- Submerge the hand in a container of sterile saline to prevent dehydration.
- Give the hand to a family member to transport to the hospital separately.
Correct answer: Wrap the hand in saline-moistened gauze, seal it in a plastic bag, and place the bag in a container of ice and water.
The proper method to preserve an amputated part for potential replantation is to wrap it in saline-moistened sterile gauze, place it in a sealed, waterproof bag, and then cool the bag in a container with ice and water. This prevents the tissue from freezing (direct ice contact) or becoming macerated (direct water contact).
Question 4: A patient involved in a high-impact collision is hemodynamically unstable with a suspected pelvic fracture. What is the primary purpose of applying a pelvic binder?
- To provide definitive anatomical reduction of the pelvic bones.
- To splint associated femur fractures.
- To reduce the volume of the pelvic cavity and provide tamponade for venous bleeding. (Correct answer)
- To completely eliminate the need for fluid resuscitation.
Correct answer: To reduce the volume of the pelvic cavity and provide tamponade for venous bleeding.
The primary purpose of a pelvic binder is to apply circumferential pressure to an unstable pelvis. This 'closes the book' on the pelvic ring, which reduces the potential space within the pelvis, thereby limiting the volume of hemorrhage and helping to tamponade the low-pressure venous bleeding that is the primary source of blood loss in most pelvic fractures.
Question 5: A patient with a severe crush injury to the forearm complains of pain that is out of proportion to the visible injury. The forearm is tense, swollen, and the patient reports 'pins and needles' in their hand. These findings are most suggestive of which limb-threatening condition?
- Acute compartment syndrome. (Correct answer)
- A simple contusion with expected swelling.
- Complete transection of the radial nerve.
- Arterial occlusion from a brachial artery laceration.
Correct answer: Acute compartment syndrome.
The classic signs and symptoms of acute compartment syndrome include pain out of proportion to the injury, a tense or 'woody' feeling compartment, and neurological deficits such as paresthesia (pins and needles). This is a surgical emergency caused by swelling within a closed fascial space, which compromises circulation and nerve function.
Question 6: Which of the following is a key contraindication for the application of a traction splint?
- A painful, swollen, and deformed mid-shaft femur.
- An open fracture of the mid-shaft femur.
- A suspected pelvic fracture. (Correct answer)
- A patient who is tachycardic from blood loss.
Correct answer: A suspected pelvic fracture.
A traction splint should not be used if there is a suspected injury to the hip or pelvis. Applying traction could cause movement and further damage to an unstable pelvic fracture, potentially worsening hemorrhage. Other contraindications include injuries to the knee or lower leg on the same side.
ITLS - International Trauma Life Support Extremity Trauma Management Questions and Answers 1
A construction worker has a partial amputation of the lower leg with massive, pulsatile bleeding that is not controlled by direct pressure.
According to ITLS guidelines, what is the most appropriate immediate action?