Musculoskeletal Injuries


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Musculoskeletal Injuries

  1. 1. Chapter Musculoskeletal Injuries Twenty-Three
  2. 2. Chapter <ul><li>Major bones and regions of the musculoskeletal system </li></ul><ul><li>How to identify open and closed extremity injuries </li></ul><ul><li>Purposes and general procedures for splinting </li></ul><ul><li>How to splint injured extremities </li></ul>Twenty-Three CORE CONCEPTS
  3. 3. Skeletal System: Torso
  4. 4. Pelvis and Lower Extremities
  5. 5. Upper Extremities
  6. 6. Ball-and-Socket Joint Hinge Joint
  7. 7. <ul><li>Gives the body shape. </li></ul><ul><li>Protects internal organs. </li></ul><ul><li>Provides for body movement. </li></ul>Musculoskeletal System
  8. 8. <ul><li>Attaches to the bones. </li></ul><ul><li>Forms the major muscle mass of </li></ul><ul><li>the body. </li></ul><ul><li>Is responsible for movement. </li></ul><ul><li>Is under conscious control. </li></ul>Voluntary (Skeletal) Muscle
  10. 10. Mechanisms of Injury
  11. 11. Types of Musculoskeletal Injuries
  12. 12. Patient ASSESSMENT Musculoskeletal Injuries Signs and Symptoms <ul><li>Pain and tenderness </li></ul><ul><li>Deformity or angulation </li></ul><ul><li>Grating (crepitus) </li></ul><ul><li>Swelling </li></ul>(Continued)
  13. 13. Patient ASSESSMENT Musculoskeletal Injuries Signs and Symptoms <ul><li>Bruising (discoloration) </li></ul><ul><li>Exposed bone ends </li></ul><ul><li>Joint locked in position </li></ul><ul><li>Nerve/blood vessel compromise </li></ul>
  14. 14. Patient CARE Musculoskeletal Injuries Emergency Care Steps <ul><li>Use body substance isolation. </li></ul><ul><li>Administer oxygen if indicated. </li></ul><ul><li>After control of life threats, </li></ul>splint injuries. <ul><li>Apply cold pack/elevate. </li></ul>
  15. 15. <ul><li>Bone fragments </li></ul><ul><li>Bone ends </li></ul><ul><li>Angulated joints </li></ul>Prevent Motion of (Continued) Splinting: Purposes
  16. 16. Minimize Complications Splinting: Purposes <ul><li>Damage to muscles, </li></ul>nerves, blood vessels <ul><li>Conversion of closed </li></ul>injury to open injury <ul><li>Restriction of blood flow </li></ul><ul><li>Excessive bleeding </li></ul><ul><li>Pain/paralysis </li></ul>
  17. 17. <ul><li>Assess distal movement, </li></ul>sensation, circulation before/after application. <ul><li>Immobilize joints above/ </li></ul>below injury. (Continued) Splinting: General Rules
  18. 18. <ul><li>Remove or cut away clothing. </li></ul><ul><li>Cover open wounds with </li></ul>sterile dressings. <ul><li>Do not replace protruding </li></ul>bone ends. <ul><li>Pad splint. </li></ul>(Continued) Splinting: General Rules
  19. 19. Tell new EMT-Bs to always immobilize a stable patient in the spot where he or she is found. However, the actual extremity will need to be moved into a “splintable” position, which is straight enough to fit on a padded board. As the saying goes, “immobilize them where they lie not as they lie.” P RECEPTOR P EARL
  20. 20. <ul><li>Align with gentle traction if: </li></ul><ul><li>Severe deformity </li></ul><ul><li>Cyanotic distal extremity </li></ul><ul><li>Pulseless distal extremity </li></ul>(Continued) Splinting: General Rules
  21. 21. <ul><li>Splint patient before moving. </li></ul><ul><li>When in doubt, splint. </li></ul><ul><li>If signs of shock, align in </li></ul>normal anatomical position and transport. Splinting: General Rules
  22. 22. Types of Splints
  23. 23. Hazards of Improper Splinting (Continued) Splinting <ul><li>Compression of nerves, </li></ul><ul><li>Delayed transport of life- </li></ul>tissues, and blood vessels threatened patient
  24. 24. Hazards of Improper Splinting Splinting <ul><li>Reduced distal circulation </li></ul><ul><li>Aggravation of initial injury </li></ul>(from tight splint) <ul><li>Cause/worsen injury </li></ul>(from excessive motion)
  25. 25. Assess distal pulse, motor function, and sensation (PMS). Stabilize extremity manually. Long-Bone Splinting
  26. 26. Make sure splint extends several inches beyond joints above/below injury.
  27. 27. Apply splint. Immobilize joints above/below injury. Secure entire extremity to splint.
  28. 28. Secure foot or hand in position of function.
  29. 29. Reassess distal PMS.
  30. 30. Joint Immobilization Stabilize injured area manually.
  31. 31. Assess distal PMS .
  32. 32. Immobilize injury site and bones above/below.
  33. 33. Reassess distal PMS.
  34. 34. If distal extremity is cyanotic or pulseless, align with gentle traction.
  35. 35. Pelvic Injury <ul><li>Pelvic fracture </li></ul><ul><li>Hip dislocation </li></ul><ul><li>Maintain strong suspicion of spinal injury. </li></ul>
  36. 36. Treatment of Pelvic Injury <ul><li>Minimize motion of injured area. </li></ul><ul><li>Assess distal PMS. </li></ul><ul><li>Attempt to straighten lower extremities into anatomical position. </li></ul><ul><li>Pad between extremities with blanket. </li></ul>
  37. 37. Treatment of Pelvic Injury <ul><li>Apply PASG if patient is hypotensive. </li></ul><ul><li>Place patient on spine board. (Use caution with log-roll!) </li></ul><ul><li>Reassess distal PMS. </li></ul><ul><li>Care for shock. </li></ul><ul><li>Transport. </li></ul>(Continued)
  38. 38. Treatment of Pelvic Injury <ul><li>Pelvic wrap is an option. </li></ul><ul><li>Perform patient assessment. </li></ul><ul><li>Treat for shock. </li></ul><ul><li>When correctly placed, sheet will appear lower than iliac “wings.” </li></ul>
  39. 39. Pelvic Wrap Prepare backboard.
  40. 40. Pelvic Wrap Logroll patient & bring sheets around patient.
  41. 41. Pelvic Wrap Secure sheets without over-compressing.
  42. 42. Use traction splint to immobilize a painful, swollen, or deformed thigh with no joint or lower leg pain. Traction Splinting
  43. 43. Contraindications Traction Splinting <ul><li>Knee or nearby area </li></ul><ul><li>Hip (proximal femur) </li></ul><ul><li>Pelvis </li></ul><ul><li>Injury to </li></ul><ul><li>Partial amputation or </li></ul>avulsion of lower leg (where traction might complete amputation)
  44. 44. Stabilize leg manually. Assess distal PMS. Direct application of manual traction. Traction Splinting
  45. 45. Adjust splint length and position. Apply proximal securing device.
  46. 46. Apply distal securing device. Apply mechanical traction.
  47. 47. Position/fasten support straps. Reevaluate proximal/distal securing devices. Reassess distal PMS.
  48. 48. Secure patient and splint to long board.
  49. 49. Tell new EMT-Bs to remember: when a bone breaks, it bleeds. Therefore, a patient with multiple breaks can easily be in shock from significant blood loss. In the first 2 hours of an uncomplicated simple fracture of the tibia and fibula, a patient can lose a pint of blood. A fractured femur can cause a 2-pint blood loss. A pelvic fracture can cause a 3-to 4-pint loss. P RECEPTOR P EARL
  50. 50. 1. List signs and symptoms of musculoskeletal injuries. 2. Name the bones in the arms and legs. 3. Explain how to splint a fractured femur. 4. Explain what is meant by “position of function.” R EVIEW QUESTIONS