Quiz-280-Section Two

A paramedic is performing a neurovascular assessment on a patient with an acute anterior shoulder dislocation. Which specific motor function test best isolates the deltoid muscle to accurately assess axillary nerve integrity in the presence of pain and muscle guarding?

Axillary Nerve Assessment Technique

Resisted wrist extension and finger extension.

Active thumb opposition against the index finger.

Active abduction of the arm against gravity in the first 0–30° arc.

Active finger abduction using the first dorsal interosseous muscle.

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During the pre-reduction assessment of an elderly patient with an anterior shoulder dislocation, the paramedic notes that the distal radial pulse is present and strong. Which statement correctly describes the clinical implication of this finding regarding vascular injury?

Vascular Injury Assessment Limitations

A palpable radial pulse definitively excludes axillary artery injury due to collateral flow limitations.

A normal pulse does not exclude proximal vascular compromise because collateral circulation may maintain distal perfusion.

The presence of a pulse confirms that the reduction can proceed without further vascular documentation.

A strong radial pulse indicates that the axillary vein is also intact and requires no further assessment.

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Which of the following clinical findings represents an absolute contraindication to attempting closed reduction of a shoulder dislocation in the pre-hospital setting?

Absolute Contraindications to Field Reduction

Patient age greater than 65 years with osteoporosis.

First-time dislocation in a young athletic patient.

Suspected periarticular fracture with palpable bony crepitus.

Presence of an isolated axillary nerve sensory deficit.

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A patient with a severe shoulder dislocation is anxious and initially refuses reduction, stating they do not want to be touched. The paramedic has provided analgesia and explains the risks of delay, including prolonged pain and potential soft tissue damage. The patient then states, "I understand I might get worse, but I still don't want you to pull my arm." How should the paramedic proceed?

Consent and Capacity in Painful Emergencies

Proceed with reduction under implied consent because the injury is painful and distressing.

Document the refusal as invalid due to the patient's anxiety and transport for sedation-only care.

Respect the patient's refusal as valid if capacity is intact, document the discussion, and transport for further care.

Attempt to reduce the shoulder quickly before the patient changes their mind to prevent permanent nerve damage.

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Which factor strongly favours transporting a patient with a shoulder dislocation to an emergency department for reduction rather than attempting reduction on-scene?

Strategic Decision Making: Scene vs. ED Reduction

The patient is a 28-year-old with a confirmed recurrent anterior dislocation and low transport time.

The patient is experiencing significant pain but is hemodynamically stable and cooperative.

There is uncertainty regarding a concomitant fracture-dislocation based on the mechanism and exam.

The patient has a history of rotator cuff surgery but presents with a clear anterior dislocation pattern.

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