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 Fracture  
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Author14 Posts
  #1

A 37-year-old male is brought to the emergency room immediately after being smashed in a hydraulic press at a local factory. The man is alert and oriented. Despite 10mg of IV morphine given by the paramedics, he is crying with pain. His vital signs are, PR: 110/min; BP: 110/70mm of Hg; RR: 18/min. Apparently, his left humeral shaft is fractured and the left arm is severely deformed being bent medially 90 degrees. Left radial artery pulse sensation and muscle strength in the left forearm are decreased compared to the right side. His right leg is shortened and externally rotated. Deformity of the right thigh is noted. Pedal pulses are symmetric. He has pain in the left anterior chest on antero-posterior sternal compression, but breath sounds are normal. The rest of his physical exam appears normal. The paramedics have placed 2 peripheral intravenous lines and immobilized the fractured limbs. What is the most appropriate next step in management of this patient?

A. X-ray of the left arm, right leg and chest
B. Repeat 10mg morphine
C. Induction of general anesthesia for operative reduction of the fractures
D. Gentle traction of the left forearm to attempt alignment of the fragments of the humerus
E. Gentle traction of the right leg to attempt alignment of the fragments of the femur


  #2

It should be D as to restore normal anotomy and decrease pain.
If unable to do that because of nerve,vessel then surgery


  #3

yes, this forum is dead.


  #4

d...



  #5

what is the answer?


  #6

A??


  #7

the Q seems to be asked twice in the forum. check the other one it has good discussion.


  #8

d


  #9

can any1 answer this plzz


  #10

i went with d...

but whers the right answer and expl ppl?cant find it in the forum?....

plz can nebody put a link here ?


  #11

A? drfax, please post the correct answer and explanation


  #12

iv morphine...pt is crying in pain ....
traction ll cause more pain...so b4 doing traction at least gv sm analgesia....
breathin is normal so v can post pone cxr..


  #13

Answer is d it
i have confirmed it from u world
the explanation is
gentle traction to attempt alignment of fragments of a fractured long bone is imp to prevent further vascular and neuro damage. This patients u limb neuro deficit is happening and l limb pulses are intact. Hope this helps



  #14

dhyaan wrote:
Answer is d it
i have confirmed it from u world
the explanation is
gentle traction to attempt alignment of fragments of a fractured long bone is imp to prevent further vascular and neuro damage. This patients u limb neuro deficit is happening and l limb pulses are intact. Hope this helps


Your right its D but .. i just want to point out it says pulse is decrease in UE.. usmle loves humeral frx and its association with brachial artery and subsequent compartment syndrome and volkman contracture.





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