Muscle Skeletal
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • Great for military. I plan to use with 86th CSH for educating medics.
    Are you sure you want to
    Your message goes here
  • To many pages!
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
10,385
On Slideshare
10,151
From Embeds
234
Number of Embeds
13

Actions

Shares
Downloads
398
Comments
2
Likes
4

Embeds 234

http://www.narenthorn.or.th 135
http://www.technowledgeable.com 43
http://emergencyteam.net 24
http://www.slideshare.net 22
http://blackboard.nicoletcollege.edu 2
https://nclc.blackboard.com 1
https://bblearn.tri-c.edu 1
https://lipscomb.blackboard.com 1
http://209.85.173.113 1
http://74.125.95.100 1
http://74.125.93.104 1
http://66.102.9.104 1
https://wctc.blackboard.com 1

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Musculoskeletal Trauma SSgt Jeffery C. Pintler Washington Air National Guard
  • 2. Incidence/Mortality/Morbidity
    • Occur in 70-80% of all multi-trauma patients
    • Blunt or Penetrating
    • Upper extremity rarely life-threatening
      • may result in long-term impairment
    • Lower extremity associated with more severe injuries
      • possibility of significant blood loss
      • femur, pelvic injuries may pose life-threat
  • 3. Incidence/Mortality/Morbidity
    • Problem is not just the bone injury
      • Other injuries caused by the injured bone
        • Soft tissue
        • Vascular
        • Nervous system
        • Decreased function
  • 4. Musculoskeletal System Function
    • Scaffolding/Support
    • Protection of vital organs
    • Movement
    • Production of Red Blood Cells
    • Storage of minerals
  • 5. Musculoskeletal Structures
    • Skin
    • Muscles
    • Bones
    • Tendons
    • Ligaments
    • Cartilage
  • 6. Muscular System
  • 7. Skeletal System
  • 8. Musculoskeletal Structures - Skin
    • Holds all structures together
    • Barrier function
    • Protects underlying structures
    • Subcutaneous tissue
  • 9. Musculoskeletal Structures - Muscle
    • Three types of muscle cells
    • Voluntary (Skeletal)
      • Conscious control
    • Smooth (Bronchi, GI tract, blood vessels)
      • Unconscious control
    • Cardiac
      • Contracts rhythmically on its own
  • 10. Musculoskeletal Structures
    • Tendons
      • Bands of connective tissue binding muscles to bones
    • Cartilage
      • Connective tissue covering the ends of bones
      • Needed for joint movement
    • Ligaments
      • Connective tissue supporting joints
      • Attach bone ends to each other
  • 11. Types of Joints
    • Ball/Socket
      • Shoulder/Hip
    • Hinge
      • Elbow/Knees/Fingers/TMJ
    • Pivot
      • Between radius and ulna
    • Gliding
      • Bones of wrist
  • 12. Fracture
    • Break in continuity of bone
    • Closed
      • Overlying skin intact
    • Open
      • Wound extends from body surface to fracture site
      • Produced either by bones or object that caused Fx
      • Danger of infection
      • Bone end not necessarily visible
  • 13. Common fractures
  • 14. Fracture Descriptions
    • Open vs Closed
    • X-Ray descriptions
      • greenstick
      • oblique
      • transverse
      • comminuted
      • spiral
      • impacted
      • epiphyseal
  • 15. Complications associated with Fractures
    • Hemorrhage
      • Possible loss within first 2 hours
        • Tib/Fib - 500 ml
        • Femur - 500 ml
        • Pelvis - 2000 ml
    • Interruption of Blood Supply
      • Compression on artery
        • decreased distal pulse
      • Decreased venous return
  • 16. Complications associated with Fractures
    • Disability
      • Diminished sensory or motor function
        • inadequate perfusion
        • direct nerve injury
    • Specific Injuries
      • Dislocation
      • Amputation/Avulsion
      • Crush Injury (soft tissue trauma discussion)
  • 17. Musculoskeletal Assessment
    • Initial Assessment
      • ABCDs
      • Life threats managed first
      • Don’t overlook life/limb threatening musculoskeletal trauma
      • Don’t be distracted by “gross” but non-life/limb threatening musculoskeletal injury
  • 18. Musculoskeletal Assessment
    • The six “P”s of musculoskeletal assessment
      • Pain
        • on palpation
        • on movement
        • constant
      • Pallor - pale skin or poor cap refill
      • Paresthesia - “pins and needles” sensation
      • Pulses - diminished or absent
      • Paralysis
      • Pressure
  • 19. Musculoskeletal Assessment
    • Palpation and Inspection
      • Swelling/Ecchymosis
        • Hemorrhage/Fluid at site of trauma
      • Deformity/Shortening of limb
        • Compare to other extremity if norm is questioned
      • Guarding/Disability
        • Presence of movement does not rule out fracture
  • 20. Musculoskeletal Assessment
    • Palpation and Inspection
      • Tenderness
        • Use two point fixation of limb with palpation with other hand.
        • Tenderness tends to localize over injury site.
      • Crepitus
        • Grating sensation
        • Produced by bones rubbing against each other.
        • Do not attempt to elicit.
  • 21. Musculoskeletal Assessment
    • Palpation and Inspection
      • Distal to injury, assess:
        • skin color
        • skin temperature
        • sensation
        • motor function
      • If uncertain, compare extremities
      • When in doubt splint!
  • 22. Musculoskeletal Assessment
    • Initial Assessment
      • ABCDs
      • Life threats managed first
      • Don’t overlook life/limb threatening musculoskeletal trauma
      • Don’t be distracted by “gross” but non-life/limb threatening musculoskeletal injury
  • 23. Management - General
    • Immobilization Objectives
      • Prevent further damage to nerves/blood vessels
      • Decrease bleeding, edema
      • Avoid creating an open Fracture
      • Decrease pain
      • Early immobilization of long bone fractures critical in preventing fat embolism
  • 24. Management - General
    • Principles of Fracture Management
      • Splint joint above, below
      • Splint bone ends
      • Loosely cover open fracture sites
      • Neurovascular assessment
        • before and after splinting
      • Gentle in-line traction of long bone
        • maintain normal alignment if possible
        • reduction of angulated fracture site
  • 25. Management - General
    • Principles of Fracture Management (cont)
      • Position of function
      • Pain management
    • Body Splinting
      • In urgent patient, entire body is stabilized by using a long board
      • Lower extremity fractures can be splinted as one to the long board
    • Long Board
      • Splints every bone and joint
      • No loss of time
      • Focus on critical conditions
  • 26. Dislocations
    • Displacement of bone end from articulating surface at joint
    • Pain or pressure is most common symptom
    • Principal sign is deformity
    • May experience loss of motion of joint
  • 27. Dislocations
    • Nerves, blood vessels pass very close to bone. Pressure on these structures can occur
    • Checking distally essential
      • Pulse presence
      • Pulse strength
      • Sensation
  • 28. Sprains
    • Stretching. tearing of ligaments surrounding joint
    • Occur when joint is twisted beyond normal range of motion
    • Most common = Ankle
  • 29. Sprain Management
    • Characteristics
      • Pain
      • Tenderness
      • Swelling
      • Discoloration
    • Typically does not manifest deformity
    • Ice, compression, elevation, immobilize
    • When in doubt, splint
    • Consider analgesia
  • 30. Strains
    • Tearing, stretching of musculo/tendonous unit.
    • Spasm, pain on active movement
    • Usually no deformity, swelling
    • Pain present on active movement
    • Avoid active movement, weight bearing
  • 31. Traumatic Amputation
    • First priority - ABC’s
      • Bleeding from stump usually not a problem
    • Next priority is to save limb
    Traumatic Amputation Management
    • Control Bleeding
    • Elevate
    • Apply direct pressure to stump
    • Avoid tourniquet except as last resort
  • 32. Tourniquet applied to an arm amputation
  • 33. Tourniquet applied to a leg amputation
  • 34. Traumatic Amputation - Limb Management
    • Place in saline moist gauze
    • Place in plastic bag
    • Place bag on ice
    • Do not
      • Warm amputated part
      • Place part in water
      • Place directly on ice
      • Use dry ice
  • 35. Sling and swathes applied to humerus fracture
  • 36. Applying a cravat sling
  • 37. Splint applied to a fractured elbow
  • 38. Swathes applied to a fractured elbow
  • 39. Splint applied to a fractured forearm
  • 40. Sling and swath applied to a fractured forearm
  • 41. Splint applied to a fractured wrist
  • 42. Improvised jacket sling
  • 43. Pelvic Fracture
    • Direct or indirect force
    • Pelvic ring tends to break in two places
    • Bone fragments can cause damage
      • Major vessels
      • Urinary bladder
      • Rectum resulting in contamination
      • Nerves (Lumbrosacral plexus or sciatic)
  • 44. Pelvic Fx Management
    • Treat as potential critical trauma patient
    • Comfortable position if possible
    • Splint = Minimize movement
      • Scoop stretcher
      • Body to long board
      • MAST for splint
    • Replace volume prn
      • Possible 4000cc blood loss
      • 2 IV of LR
  • 45. Military Anti-Shock Trousers Pneumatic Anti-Shock Garment
  • 46. Femur Fracture
    • Femoral Neck (Hip)
      • Most common in mid to late 60’s age group.
      • Leg tends to rotate outward
        • looks like anterior hip dislocation
      • Minimal blood loss tends to occur due to joint capsule
    • Management
      • NO traction splint
      • long board, scoop or MAST
  • 47. Femur Fracture
    • Mid-Shaft
      • Result from torsion in very young or old
      • High speed deceleration with impact
        • Hypovolemic shock
        • Fat Embolism
      • Early immobilization with traction splint will help prevent
      • 1000 to 2000 cc blood loss
  • 48. Femur Fracture - Management
    • Assess for traction splint contraindications
    • May use PASG, secure to long board
      • Secure to opposite extremity and then to long board (premise for the Sager splint)
    • Assess for :
      • Soft tissue, vascular, or nerve injury
      • Assess for hypovolemia
  • 49. Femur Fracture - Management
    • Traction Splints
      • Used on mid-shaft femur fractures
      • Do not use if suspected fracture involves
        • proximal or distal 1/3 of femur
        • pelvis
        • hip (or hip dislocation)
        • knee (or knee dislocation)
        • ankle (or ankle dislocation)
  • 50. Lower Extremity Fracture
    • Patellar
      • Due to direct impact
    • Tibia/Fibula
      • High potential for:
        • Open fracture
        • Hemorrhage
        • Infection
    • Calcaneal
      • Results from falls (foot landing)
      • High incidence of lumbar sacral compression
  • 51. Management - Lower Extremity Fracture
    • Patellar, Tibia/Fibula, and Calcaneal
      • Assess for neurovascular impairment
      • Realign long bones
      • Splinting possibilities
        • board splint or cardboard splint
        • vacuum splint
        • pillow
  • 52. Splint applied to an upper leg fracture
  • 53. Splint applied to a fractured knee
  • 54. Uninjured leg used as a splint
  • 55. Hemorrhage Management
    • Direct Pressure
      • Most effective method
      • Pressure bandage
    • Elevation
      • Combination with direct pressure
    • Pressure Point
      • Brachial, Femoral, Carotid
    • Tourniquet
      • last resort
      • rarely required
  • 56. Applying and securing a field dressing
  • 57. Applying manual pressure
  • 58. Pressure points for control of arterial bleeding
  • 59. Tourniquet
    • Last resort, but do not wait too long.
    • Use flat wide material
    • BP cuff
    • Close to the wound as possible
    • Do not remove
    • Leave in plain view
    • Note time applied and clearly communicate during transfer of care
  • 60. Application of a tourniquet to stop bleeding
  • 61. References
    • Field Manual 8-230 U.S. Army 2003
    • Combat Lifesaver Instructor Manual U.S. Army 2003