NREMT Paramedic Cognitive ExamTraumaMedium
A 60-year-old male presents with severe pain and deformity to his right lower leg after falling from a roof. The bone is protruding through the skin, and there is active bleeding. Distal pulses are present but weak, and the foot is cool to the touch. Which of the following is the MOST appropriate initial management step AFTER addressing life threats?
- AControl bleeding with direct pressure and cover the wound with a sterile dressing.
- BApply a traction splint to the injured leg.
- CAdminister pain medication and prepare for rapid transport.
- DAttempt to reduce the fracture by pushing the bone back into the skin.
Show answer & explanationAnswer & explanation
Correct answer: A. Control bleeding with direct pressure and cover the wound with a sterile dressing.
This is an open fracture with active bleeding. While immediate reduction might seem appealing, the priority for an open fracture with active bleeding (after life threats) is to control the hemorrhage and protect the exposed bone from contamination. Direct pressure and a sterile dressing accomplish this. Reduction should generally be attempted only after bleeding is controlled and often requires specific medical direction or in a controlled environment.
Why the other options are wrong
- B. Traction splints are used for isolated mid-shaft femur fractures and are not indicated for open lower leg fractures, especially with protruding bone.
- C. Pain medication and rapid transport are important, but controlling the hemorrhage and protecting the open wound are more immediate priorities for this specific injury.
- D. Attempting to push exposed bone back into the skin without proper sterilization and pain control risks infection and further injury.
Open Fracture Management
Emergency care for a fracture where the skin is broken, exposing the bone to the environment.
- Control bleeding first.
- Cover exposed bone with sterile dressing.
- Do not attempt to push bone back in.
- Immobilize the fracture.
Memory trick: Broken Bone Out, Bleeding Out, Better Bind!