NREMT Paramedic Cognitive ExamTraumaMedium
A 50-year-old male is entrapped in a vehicle after a head-on collision. He is complaining of severe pain to his left lower extremity. On assessment, his left femur appears severely deformed and shortened. Distal pulses are absent in the left foot. What is the MOST appropriate immediate action after ensuring scene safety and ABCs?
- AAdminister high-flow oxygen and transport rapidly without intervention
- BAttempt to apply a traction splint immediately
- CManually stabilize the extremity and apply gentle manual traction
- DCover the deformity with a sterile dressing and await extrication
Show answer & explanationAnswer & explanation
Correct answer: C. Manually stabilize the extremity and apply gentle manual traction
Absent distal pulses indicate a potential vascular compromise. Before definitive splinting or extrication, gentle manual traction should be applied to realign the extremity sufficiently to restore pulses and prevent further neurovascular damage. This takes precedence over immediate traction splint application if pulses are absent.
Why the other options are wrong
- A. Rapid transport is important, but addressing limb-threatening vascular compromise takes precedence over immediate transport without intervention.
- B. Applying a traction splint without first attempting to restore pulses via manual traction could exacerbate vascular injury or delay vital blood flow.
- D. Covering the deformity is part of basic wound care but does not address the limb-threatening vascular compromise indicated by absent pulses.
Fracture Management with Absent Pulses
For severely angulated long bone fractures with absent distal pulses, gentle manual traction to realign the limb and restore perfusion is the immediate priority after ABCs.
- Absent pulses indicate a limb-threatening emergency.
- Manual traction can often restore pulses by relieving pressure on vessels.
- If pulses are restored, then proceed with definitive splinting.
Memory trick: Fracture Fix: Assess, Traction, Splint, Reassess