Scenarios: Spinal Motion Restriction and Orthopedic Immobilization

An 82-year-old slipped on a kitchen floor and landed on her hip. On arrival at 14:20, she is alert and oriented to person, place, and time, denies neck or back pain, and moves all four extremities on command. Palpation reveals no midline tenderness along the cervical or thoracic spine, but she reports sharp pain at the right hip and an obvious shortening of the right leg. She takes no blood thinners and reports no numbness or tingling.

A conscious patient has an isolated hip fracture, no midline spinal tenderness, no neurological deficits, and no intoxication. Under a selective spinal motion restriction protocol that excludes isolated extremity fractures as qualifying distracting injuries, which action is most appropriate?

• Apply a rigid collar and secure to a long backboard

• Withhold spinal immobilization and transport with routine positioning

• Defer spinal assessment until hospital arrival

• Apply a vacuum mattress for full spinal precautions

Answer explanation

When all clearance criteria are met and the protocol does not classify an isolated hip fracture as a qualifying distracting injury, selective clearance allows transport without immobilization. A rigid collar and backboard are unnecessary when no spinal indicators are present.

Tags

Blooms Level: Apply

Given the shortened right leg and isolated hip pain noted on exam, which immobilization choice is most appropriate for transport?

• A long rigid board splint taped from ankle to waist

• A bipolar traction device applied to the affected leg

• Padding between the legs and securing both legs together on the stretcher

• An air splint inflated around the hip and upper thigh

Answer explanation

Suspected hip fractures are immobilized by padding and securing the patient on the stretcher; traction is for mid-shaft femur fractures, not hip injuries, and air or board splints do not stabilize the hip joint.

Tags

Blooms Level: Apply

List two assessments that should be performed and documented on the injured leg before moving the patient to the stretcher.

Tags

Blooms Level: Apply

A 17-year-old soccer player was struck by a car at low speed and is lying in the street. He is alert, complains of severe pain in the middle of his right thigh, and the thigh is visibly deformed and swollen with no broken skin. The crew checks the right foot and finds a strong pedal pulse, warm skin, normal sensation, and the patient can wiggle his toes. Vital signs are stable, and there are no other injuries noted on the rapid exam.

Based on the location and appearance of the thigh injury, which device is indicated for this patient?

• A vacuum mattress wrapped around the entire lower body

• A bipolar traction device applied to the affected leg

• An inflatable air splint placed over the thigh

• A padded board splint extending from hip to knee

Answer explanation

An isolated, closed mid-shaft femur fracture with intact distal circulation is the classic indication for a traction device. Board and air splints cannot counter the strong muscle pull of the thigh.

Tags

Blooms Level: Apply

After the device is applied and tension set, which finding from the initial foot exam should be rechecked first?

• Capillary refill at the fingertips

• Skin color of the opposite leg

• Blood pressure in both arms

• Pedal pulse, warmth, and toe movement

Answer explanation

Circulation, motor, and sensory function distal to any splint must be reassessed after application and compared to the pre-splint baseline taken at the foot.

Tags

Blooms Level: Apply

Name one finding that, if discovered after tension is applied, would require the crew to stop and adjust the device.

Tags

Blooms Level: Analyze