Musculoskeletal Care
Skeletal System <ul><li>14% total body weight </li></ul><ul><li>Function </li></ul><ul><ul><li>Shape, Movement, Storage  <...
 
Axial Skeleton Skull  <ul><li>Skull </li></ul><ul><ul><li>22 bones </li></ul></ul><ul><ul><li>Cranium + Face </li></ul></u...
 
Axial Skeletal Vertebral Column  <ul><li>Function </li></ul><ul><ul><li>Support </li></ul></ul><ul><li>Components  </li></...
Axial Skeletal  Thoracic Cage <ul><li>Function </li></ul><ul><ul><li>Protection of thoracic cavity </li></ul></ul><ul><ul>...
Appendicular Skeleton Upper Extremities  <ul><li>Clavicle </li></ul><ul><li>Scapula </li></ul><ul><li>Acromion (Tip of sho...
Appendicular Skeleton Lower Extremities <ul><li>Greater Trochanter (head of femur) </li></ul><ul><li>Acetabulum (socket of...
Appendicular Skeleton Pelvis <ul><li>Function </li></ul><ul><ul><li>Support and protection </li></ul></ul><ul><li>Componen...
Joints <ul><li>Definition </li></ul><ul><ul><li>2 or more bones connecting to bones </li></ul></ul><ul><li>Types </li></ul...
Types of Force <ul><li>Direct </li></ul><ul><ul><li>Energy applied directly to an area </li></ul></ul><ul><ul><li>GSW shat...
Types of Fractures <ul><li>Fracture </li></ul><ul><ul><li>A break in the continuity of a bone </li></ul></ul><ul><li>Compl...
Open Fractures
Closed Fractures
Injuries to Ligaments Tendons <ul><li>Sprains </li></ul><ul><ul><li>Injuries to ligaments </li></ul></ul><ul><ul><li>Usual...
Musculoskeletal Care Assessment <ul><li>BSI/Scene Safety </li></ul><ul><ul><li>Determine MOI </li></ul></ul><ul><ul><ul><l...
Bone/Joint Injuries S/S <ul><li>Deformity </li></ul><ul><li>Angulation </li></ul><ul><li>Pain and tenderness </li></ul><ul...
Bone/Joint Injuries Blood Loss <ul><li>Bleeding </li></ul><ul><ul><li>CAN BE LIFETHREATING COMPLICATION! </li></ul></ul><u...
Bone/Joint Injuries Vascular Injuries <ul><li>Vascular Injuries  </li></ul><ul><ul><li>Injuries to blood vessels  </li></u...
Bone/Joint Injuries Peripheral Nerve Injuries <ul><li>Peripheral Nerve Injuries  </li></ul><ul><ul><li>Injured more often ...
Bone/Joint Injuries Internal Organ Injuries <ul><li>Injuries to Internal Organs </li></ul><ul><ul><li>Forces transmitted t...
Bone/Joint Injuries Care <ul><li>BSI </li></ul><ul><li>O2 </li></ul><ul><li>Splinting </li></ul><ul><ul><li>After life thr...
Bone/Joint Injuries Splinting <ul><li>Reasons </li></ul><ul><ul><li>Prevents motion of: </li></ul></ul><ul><ul><ul><li>Bon...
Splint Types <ul><li>Sling and Swathe  </li></ul><ul><ul><li>Sling- Triangular bandage supporting weight of injured arm  <...
General Rules of Splinting <ul><li>Assess PMS distal to injury: </li></ul><ul><ul><li>Prior to </li></ul></ul><ul><ul><li>...
Splinting Precautions  <ul><li>Compression of: </li></ul><ul><ul><li>-Nerve – Tissues - Vessels </li></ul></ul><ul><li>Del...
Long Bone Splinting <ul><li>Splints: </li></ul><ul><ul><li>Rigid splint, Air Splint, Sling and Swathe, Long Board Splint  ...
Measure Apply/Secure Immobilize Joint Above and Below injury
Splinting of Joints <ul><li>BSI </li></ul><ul><li>Manual stabilization </li></ul><ul><li>Assess PMS </li></ul><ul><li>If d...
Traction Splinting <ul><li>Indication: </li></ul><ul><ul><li>Painful, swollen, deformed  mid-thigh </li></ul></ul><ul><ul>...
Traction Splinting <ul><ul><li>BSI </li></ul></ul><ul><ul><li>Manual stabilization </li></ul></ul><ul><ul><li>Assess PMS <...
Manual Stabilization  Manual Traction Apply ankle hitch. Continue manual traction Place splint under injured leg Apply isc...
Position straps: 2 above knee, 2 below knee Reassess PMS
That does it… REMEMBER: ASSESS PMS BEFORE/AFTER IMMOBILIZATION
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26)Musculoskeletal Care

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26)Musculoskeletal Care

  1. 1. Musculoskeletal Care
  2. 2. Skeletal System <ul><li>14% total body weight </li></ul><ul><li>Function </li></ul><ul><ul><li>Shape, Movement, Storage </li></ul></ul><ul><ul><li>(Calcium, Phosphorus, Iron) </li></ul></ul><ul><ul><li>Protection of organs </li></ul></ul><ul><ul><li>Blood cell production </li></ul></ul><ul><ul><li>Endocrine Regularion </li></ul></ul><ul><li>Components </li></ul><ul><ul><li>Bones </li></ul></ul><ul><ul><ul><li>Mineralized osseous tissue </li></ul></ul></ul><ul><ul><li>Cartilage </li></ul></ul><ul><ul><ul><li>Soft connective tissue/Collagen </li></ul></ul></ul><ul><ul><ul><li>Flexible support </li></ul></ul></ul><ul><ul><li>Tendons </li></ul></ul><ul><ul><ul><li>Attach muscle to bone </li></ul></ul></ul><ul><ul><ul><li>Collagen, Elastin, Proteogylcans </li></ul></ul></ul><ul><ul><li>Ligaments </li></ul></ul><ul><ul><ul><li>Attach bone to bone </li></ul></ul></ul><ul><ul><ul><li>Collagen </li></ul></ul></ul><ul><li>Axial Skeleton </li></ul><ul><ul><li>Skull, vertebral column, thoracic cage </li></ul></ul><ul><li>Appendicular Skeleton </li></ul><ul><ul><li>Upper limbs, pelvic girdle, lower limbs </li></ul></ul>
  3. 4. Axial Skeleton Skull <ul><li>Skull </li></ul><ul><ul><li>22 bones </li></ul></ul><ul><ul><li>Cranium + Face </li></ul></ul><ul><ul><li>Encases brain </li></ul></ul><ul><ul><li>Brain + CSF + Vessels </li></ul></ul><ul><ul><ul><li>Little space </li></ul></ul></ul><ul><li>Facial Bones </li></ul><ul><ul><li>Orbits </li></ul></ul><ul><ul><ul><li>Eyes </li></ul></ul></ul><ul><ul><li>Nasal Bones </li></ul></ul><ul><ul><li>Maxilla </li></ul></ul><ul><ul><ul><li>Upper Jaw </li></ul></ul></ul><ul><ul><li>Zygomatics </li></ul></ul><ul><ul><ul><li>Cheekbones </li></ul></ul></ul><ul><ul><li>Mandible </li></ul></ul><ul><ul><ul><li>Lower Jaw </li></ul></ul></ul>
  4. 6. Axial Skeletal Vertebral Column <ul><li>Function </li></ul><ul><ul><li>Support </li></ul></ul><ul><li>Components </li></ul><ul><ul><li>33 Vertebrae </li></ul></ul><ul><ul><li>Intervertebral disks </li></ul></ul><ul><li>Divisions of Vertebrae </li></ul><ul><ul><li>Cervical (C-) = 7 Neck </li></ul></ul><ul><ul><ul><li>C1 = Atlas </li></ul></ul></ul><ul><ul><ul><li>C2 = Axis </li></ul></ul></ul><ul><ul><li>Thoracic (T-)= 12 Chest </li></ul></ul><ul><ul><li>Lumbar (L-)= 5 Lower Back </li></ul></ul><ul><ul><li>Sacral (S-)= 5 Back of pelvis (fused) </li></ul></ul><ul><ul><li>Coccyx (C-)= 4 Tailbone (fused) </li></ul></ul>
  5. 7. Axial Skeletal Thoracic Cage <ul><li>Function </li></ul><ul><ul><li>Protection of thoracic cavity </li></ul></ul><ul><ul><li>Supports shoulder girdle </li></ul></ul><ul><li>Components </li></ul><ul><ul><li>12 pairs of ribs </li></ul></ul><ul><ul><ul><li>1-10 attach to sternum </li></ul></ul></ul><ul><ul><ul><li>11-12 “float” </li></ul></ul></ul><ul><ul><li>Sternum </li></ul></ul><ul><ul><ul><li>Manubrium </li></ul></ul></ul><ul><ul><ul><li>Body </li></ul></ul></ul><ul><ul><ul><li>Xiphoid process </li></ul></ul></ul><ul><ul><li>Costal cartilage </li></ul></ul><ul><ul><ul><li>Connect ribs to sternum </li></ul></ul></ul><ul><ul><li>Thoracic vertebrae (12) </li></ul></ul>
  6. 8. Appendicular Skeleton Upper Extremities <ul><li>Clavicle </li></ul><ul><li>Scapula </li></ul><ul><li>Acromion (Tip of shoulder) </li></ul><ul><li>Humerus </li></ul><ul><li>Olecranon (elbow) </li></ul><ul><li>Radius </li></ul><ul><li>Ulna </li></ul><ul><li>Carpals (wrist) </li></ul><ul><li>Metacarpals (hands) </li></ul><ul><li>Phalanges (fingers) </li></ul>
  7. 9. Appendicular Skeleton Lower Extremities <ul><li>Greater Trochanter (head of femur) </li></ul><ul><li>Acetabulum (socket of hip) </li></ul><ul><li>Femur (thigh) </li></ul><ul><li>Patella (knee) </li></ul><ul><li>Tibia (shin) </li></ul><ul><li>Fibula (lower leg) </li></ul><ul><li>Medial/Lateral malleolus (ankle) </li></ul><ul><li>Tarsals and metatarsals (foot) </li></ul><ul><li>Calcaneus (heel) </li></ul><ul><li>Phalanges (toes) </li></ul>
  8. 10. Appendicular Skeleton Pelvis <ul><li>Function </li></ul><ul><ul><li>Support and protection </li></ul></ul><ul><li>Components </li></ul><ul><ul><li>Ilium </li></ul></ul><ul><ul><ul><li>Wings </li></ul></ul></ul><ul><ul><li>Pubis </li></ul></ul><ul><ul><ul><li>Anterior portion </li></ul></ul></ul><ul><ul><li>Ischium </li></ul></ul><ul><ul><ul><li>Inferior portion </li></ul></ul></ul><ul><ul><li>Sacrum </li></ul></ul><ul><ul><li>Coccyx </li></ul></ul>
  9. 11. Joints <ul><li>Definition </li></ul><ul><ul><li>2 or more bones connecting to bones </li></ul></ul><ul><li>Types </li></ul><ul><ul><li>Ball and socket </li></ul></ul><ul><ul><ul><li>Hip/Shoulder </li></ul></ul></ul><ul><ul><ul><li>Wide Range of motion </li></ul></ul></ul><ul><ul><li>Hinge </li></ul></ul><ul><ul><ul><li>Elbow/knee </li></ul></ul></ul><ul><ul><ul><li>Motion in 1 plane </li></ul></ul></ul><ul><ul><ul><li>Flexion and extension only </li></ul></ul></ul>
  10. 12. Types of Force <ul><li>Direct </li></ul><ul><ul><li>Energy applied directly to an area </li></ul></ul><ul><ul><li>GSW shattering bone </li></ul></ul><ul><ul><li>Falling person landing on feet </li></ul></ul><ul><ul><li>Sports injuries </li></ul></ul><ul><li>Indirect </li></ul><ul><ul><li>Force transmitted along axes of bone </li></ul></ul><ul><ul><li>Injury at a location other than point of impact </li></ul></ul><ul><ul><ul><li>i.e. Person falling on outstretched hand </li></ul></ul></ul><ul><li>Twisting </li></ul><ul><ul><li>Twisting force transmitted along axes of bone </li></ul></ul><ul><ul><ul><li>i.e. A scatter who plants skates in the middle of turn </li></ul></ul></ul>
  11. 13. Types of Fractures <ul><li>Fracture </li></ul><ul><ul><li>A break in the continuity of a bone </li></ul></ul><ul><li>Complete </li></ul><ul><ul><li>Two bone ends widely separated </li></ul></ul><ul><li>Incomplete </li></ul><ul><ul><li>Hairline crack along the bone </li></ul></ul><ul><li>Open </li></ul><ul><ul><li>Breakage of skin at the fracture site </li></ul></ul><ul><ul><li>Exposed to the outside environment </li></ul></ul><ul><li>Closed </li></ul><ul><ul><li>No break of the skin over the fracture site </li></ul></ul><ul><ul><li>No environmental exposure </li></ul></ul>
  12. 14. Open Fractures
  13. 15. Closed Fractures
  14. 16. Injuries to Ligaments Tendons <ul><li>Sprains </li></ul><ul><ul><li>Injuries to ligaments </li></ul></ul><ul><ul><li>Usually due to stretching forces </li></ul></ul><ul><li>Strains </li></ul><ul><ul><li>Injuries to: </li></ul></ul><ul><ul><ul><li>Muscle </li></ul></ul></ul><ul><ul><ul><li>Tendons </li></ul></ul></ul><ul><ul><ul><li>“ You can tend a strain” </li></ul></ul></ul><ul><ul><li>Usually due to stretching forces </li></ul></ul><ul><li>Dislocation </li></ul><ul><ul><li>Displacement of a bone in joint from its normal position </li></ul></ul><ul><ul><li>Stretching/tearing of joint ligaments must also occur </li></ul></ul>
  15. 17. Musculoskeletal Care Assessment <ul><li>BSI/Scene Safety </li></ul><ul><ul><li>Determine MOI </li></ul></ul><ul><ul><ul><li>Lap belt injuries- Possible abd complications </li></ul></ul></ul><ul><ul><ul><li>Starburst – Possible head trauma </li></ul></ul></ul><ul><ul><ul><li>Etc. </li></ul></ul></ul><ul><li>Initial assessment </li></ul><ul><ul><li>ABC’s </li></ul></ul><ul><ul><li>Major bleeds/Life threats </li></ul></ul><ul><ul><li>C-Spine </li></ul></ul><ul><li>Focused Hx/Px </li></ul><ul><ul><li>More info on MOI </li></ul></ul><ul><ul><li>Events prior to accident </li></ul></ul><ul><ul><ul><li>Seatbelts worn </li></ul></ul></ul><ul><ul><ul><li>Airbags deployed </li></ul></ul></ul><ul><ul><ul><li>Did pt trip and fall </li></ul></ul></ul><ul><ul><ul><li>Did pt become dizzy/ALOC and fall </li></ul></ul></ul><ul><ul><ul><li>Etc. </li></ul></ul></ul><ul><ul><li>DCAP-BTLS </li></ul></ul><ul><li>Vitals </li></ul><ul><li>On-going assessment </li></ul>Seatbelt Injury
  16. 18. Bone/Joint Injuries S/S <ul><li>Deformity </li></ul><ul><li>Angulation </li></ul><ul><li>Pain and tenderness </li></ul><ul><ul><li>Sometimes referred distal/proximal to injury </li></ul></ul><ul><ul><ul><li>i.e. Hip fx- pain in knee </li></ul></ul></ul><ul><li>Crepitus </li></ul><ul><ul><li>Bone ends rubbing against each other </li></ul></ul><ul><li>Swelling </li></ul><ul><ul><li>Fluid/blood loss </li></ul></ul><ul><li>Discoloration/Bruising </li></ul><ul><li>Exposed bone ends </li></ul><ul><li>Joint locked into position </li></ul><ul><ul><li>Possible dislocation </li></ul></ul><ul><li>Loss of use </li></ul><ul><ul><li>Do not force movement against pt complaints </li></ul></ul>
  17. 19. Bone/Joint Injuries Blood Loss <ul><li>Bleeding </li></ul><ul><ul><li>CAN BE LIFETHREATING COMPLICATION! </li></ul></ul><ul><ul><li>Radius or Ulna - 250-500 ml </li></ul></ul><ul><ul><li>Humerus - 500-759 ml </li></ul></ul><ul><ul><li>Pelvis - 1500-3000 ml </li></ul></ul><ul><ul><li>Femur - 1000-2000 ml </li></ul></ul><ul><ul><li>Tibia and fibula - 500-1000 ml </li></ul></ul>
  18. 20. Bone/Joint Injuries Vascular Injuries <ul><li>Vascular Injuries </li></ul><ul><ul><li>Injuries to blood vessels </li></ul></ul><ul><ul><li>Pinching, tearing, spasms, compression, occlusion by clots </li></ul></ul><ul><ul><li>Loss of distal blood flow </li></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><ul><li>Distal Pulses </li></ul></ul></ul><ul><ul><ul><li>Skin color/temp </li></ul></ul></ul><ul><ul><ul><li>Capillary refill time </li></ul></ul></ul><ul><ul><ul><li>Pain </li></ul></ul></ul><ul><ul><ul><li>Numbness, Tingling, Prickling, </li></ul></ul></ul><ul><ul><ul><li>Sensory loss </li></ul></ul></ul><ul><ul><ul><li>Paralysis distal to injury </li></ul></ul></ul>
  19. 21. Bone/Joint Injuries Peripheral Nerve Injuries <ul><li>Peripheral Nerve Injuries </li></ul><ul><ul><li>Injured more often than arteries </li></ul></ul><ul><ul><li>Tearing, Pinching, Stretch, Compression, of a nerve </li></ul></ul><ul><ul><li>S/S </li></ul></ul><ul><ul><ul><li>Numbness </li></ul></ul></ul><ul><ul><ul><li>Pain </li></ul></ul></ul><ul><ul><ul><li>Abnormal sensation </li></ul></ul></ul><ul><ul><ul><li>Loss of motor ability </li></ul></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><ul><li>P ulse </li></ul></ul></ul><ul><ul><ul><li>M otor </li></ul></ul></ul><ul><ul><ul><li>S ensation </li></ul></ul></ul>
  20. 22. Bone/Joint Injuries Internal Organ Injuries <ul><li>Injuries to Internal Organs </li></ul><ul><ul><li>Forces transmitted to underlying organs </li></ul></ul><ul><li>Thorax </li></ul><ul><ul><li>Flail segment </li></ul></ul><ul><ul><li>Hemothorax </li></ul></ul><ul><ul><li>Pneumothorax </li></ul></ul><ul><ul><ul><li>Open </li></ul></ul></ul><ul><ul><ul><li>Closed </li></ul></ul></ul><ul><ul><ul><li>Tension </li></ul></ul></ul><ul><ul><li>Traumatic asphyxia </li></ul></ul><ul><ul><li>Rupture of: </li></ul></ul><ul><ul><ul><li>Spleen </li></ul></ul></ul><ul><ul><ul><li>Liver </li></ul></ul></ul><ul><li>Pelvis </li></ul><ul><ul><li>Bladder </li></ul></ul><ul><ul><li>Urethra </li></ul></ul><ul><ul><li>Rectum </li></ul></ul><ul><ul><li>Lower intestine </li></ul></ul><ul><ul><li>Reproductive organs </li></ul></ul>
  21. 23. Bone/Joint Injuries Care <ul><li>BSI </li></ul><ul><li>O2 </li></ul><ul><li>Splinting </li></ul><ul><ul><li>After life threats have been treated </li></ul></ul><ul><li>Cold pack </li></ul><ul><ul><li>Reduces swelling in: </li></ul></ul><ul><ul><li>Painful </li></ul></ul><ul><ul><li>Swollen </li></ul></ul><ul><ul><li>Deformed </li></ul></ul><ul><li>Elevation of extremity </li></ul>
  22. 24. Bone/Joint Injuries Splinting <ul><li>Reasons </li></ul><ul><ul><li>Prevents motion of: </li></ul></ul><ul><ul><ul><li>Bone fragments </li></ul></ul></ul><ul><ul><ul><li>Bone ends </li></ul></ul></ul><ul><ul><ul><li>Angulated bones </li></ul></ul></ul><ul><ul><li>Minimizes: </li></ul></ul><ul><ul><ul><li>Damage to –muscles – nerves – blood vessels </li></ul></ul></ul><ul><ul><ul><li>Conversion of closed fx to open fx </li></ul></ul></ul><ul><ul><ul><li>Compression of blood vessels due to bone ends </li></ul></ul></ul><ul><ul><ul><li>Excessive bleeding </li></ul></ul></ul><ul><ul><ul><li>Pain with movement </li></ul></ul></ul><ul><ul><ul><li>Paralysis of extremity due to spinal injury </li></ul></ul></ul>
  23. 25. Splint Types <ul><li>Sling and Swathe </li></ul><ul><ul><li>Sling- Triangular bandage supporting weight of injured arm </li></ul></ul><ul><ul><li>Swathe – Triangular bandage binding upper arm to chest wall </li></ul></ul><ul><li>Rigid Splints </li></ul><ul><ul><li>Rigid material often padded </li></ul></ul><ul><ul><li>Applied to both sides of injury </li></ul></ul><ul><ul><li>Secured with roller bandages or cravats </li></ul></ul><ul><li>Traction Splints </li></ul><ul><ul><li>Metal frame with pulley system </li></ul></ul><ul><ul><li>Apply traction to lower extremity fx </li></ul></ul><ul><ul><li>Used for femur fx </li></ul></ul><ul><li>Pneumatic Splints (Air, Vacuum) </li></ul><ul><ul><li>Plastic splints filled with air </li></ul></ul><ul><ul><li>Circumferential support </li></ul></ul><ul><li>Improvised Splints </li></ul><ul><ul><li>Blankets, magazines, cardboard, notebooks, pillows, etc… </li></ul></ul><ul><li>Pneumatic Anti Shock Garment </li></ul><ul><ul><li>Air splint for lower extremity/pelvis fx </li></ul></ul>
  24. 26. General Rules of Splinting <ul><li>Assess PMS distal to injury: </li></ul><ul><ul><li>Prior to </li></ul></ul><ul><ul><li>After splinting </li></ul></ul><ul><li>Immobilize the joint </li></ul><ul><ul><li>Above and Below injury </li></ul></ul><ul><li>Remove clothing </li></ul><ul><li>Cover open wounds </li></ul><ul><ul><li>Sterile dressings </li></ul></ul><ul><li>Splint joint injuries in position found UNLESS: </li></ul><ul><li>If severe deformity or cyanosis : </li></ul><ul><ul><li>Align with gentle traction before splinting </li></ul></ul><ul><ul><li>If resistance is met or pt complains of increased pain – Splint in position </li></ul></ul><ul><li>Do not intentionally replace protruding bone ends </li></ul><ul><ul><li>Cover with moistened sterile dressing </li></ul></ul><ul><ul><li>Cover with dry sterile dressing </li></ul></ul><ul><li>Pad each splint </li></ul><ul><ul><li>Prevents further pain </li></ul></ul><ul><li>Splint the injury </li></ul><ul><ul><li>When in doubt… </li></ul></ul><ul><ul><li>When feasible and no life threats </li></ul></ul><ul><li>If pt in shock: </li></ul><ul><ul><li>Align in normal anatomical position </li></ul></ul><ul><ul><li>TRANSPORT </li></ul></ul><ul><ul><li>Total body immobilization= Long Back Board (LBB) </li></ul></ul>
  25. 27. Splinting Precautions <ul><li>Compression of: </li></ul><ul><ul><li>-Nerve – Tissues - Vessels </li></ul></ul><ul><li>Delay of transport </li></ul><ul><ul><li>Critical pt = LBB </li></ul></ul><ul><li>Reduction of distal circulation </li></ul><ul><ul><li>If applied too tight </li></ul></ul><ul><li>Aggravation of: (if too loose) </li></ul><ul><ul><li>Bone/joint injury </li></ul></ul><ul><ul><li>Nerves </li></ul></ul><ul><ul><li>Vessels </li></ul></ul><ul><ul><li>Tissue </li></ul></ul>
  26. 28. Long Bone Splinting <ul><li>Splints: </li></ul><ul><ul><li>Rigid splint, Air Splint, Sling and Swathe, Long Board Splint </li></ul></ul><ul><li>Locations: </li></ul><ul><ul><li>Arms and Legs </li></ul></ul><ul><li>BSI </li></ul><ul><li>Apply manual stabilization </li></ul><ul><li>Assess PMS </li></ul><ul><li>If severe deformity or cyanosis: </li></ul><ul><ul><li>Align with gentle traction before splinting </li></ul></ul><ul><li>Measure splint </li></ul><ul><li>Immobilize 1 joint above and 1 joint below </li></ul><ul><ul><li>Secure ENTIRE injured extremity </li></ul></ul><ul><li>Immobilize hand/foot in position of function </li></ul><ul><li>Reassess PMS </li></ul>
  27. 29. Measure Apply/Secure Immobilize Joint Above and Below injury
  28. 30. Splinting of Joints <ul><li>BSI </li></ul><ul><li>Manual stabilization </li></ul><ul><li>Assess PMS </li></ul><ul><li>If distal extremity lacks pulse or is cyanotic </li></ul><ul><ul><li>Align with gentle traction if no resistance </li></ul></ul><ul><li>Immobilize site of injury </li></ul><ul><li>Immobilize bone above and below injury </li></ul><ul><li>Reassess PMS </li></ul>
  29. 31. Traction Splinting <ul><li>Indication: </li></ul><ul><ul><li>Painful, swollen, deformed mid-thigh </li></ul></ul><ul><ul><li>No joint or lower leg injury </li></ul></ul><ul><li>Contraindication: </li></ul><ul><ul><li>Injury close to the knee </li></ul></ul><ul><ul><li>Injury to the knee </li></ul></ul><ul><ul><li>Injury to hip </li></ul></ul><ul><ul><li>Injured pelvis </li></ul></ul><ul><ul><li>Partial amputation </li></ul></ul><ul><ul><ul><li>Avulsion with bone separation </li></ul></ul></ul><ul><ul><ul><li>Distal limb is connected by a margin of tissue </li></ul></ul></ul><ul><ul><ul><li>Traction would risk separation </li></ul></ul></ul><ul><ul><li>Lower leg/ankle injury </li></ul></ul>
  30. 32. Traction Splinting <ul><ul><li>BSI </li></ul></ul><ul><ul><li>Manual stabilization </li></ul></ul><ul><ul><li>Assess PMS </li></ul></ul><ul><ul><li>Apply ankle hitch – (Ankle) = Distal immobilization </li></ul></ul><ul><ul><li>Apply manual traction </li></ul></ul><ul><ul><li>Adjust splint length to length of uninjured leg </li></ul></ul><ul><ul><li>Position splint under injured leg </li></ul></ul><ul><ul><li>Apply ischial strap –(Groin) = Proximal immobilization </li></ul></ul><ul><ul><li>Apply mechanical traction </li></ul></ul><ul><ul><li>Release manual traction </li></ul></ul><ul><ul><li>Position/secure straps </li></ul></ul><ul><ul><ul><li>2 Above the knee </li></ul></ul></ul><ul><ul><ul><li>2 Below the knee </li></ul></ul></ul><ul><ul><ul><li>DO NOT PLACE DIRECTLY OVER SITE OF INJURY </li></ul></ul></ul><ul><ul><li>Reassess ischial strap and ankle hitch </li></ul></ul><ul><ul><li>Reassess PMS </li></ul></ul><ul><ul><li>Secure torso to LBB </li></ul></ul><ul><ul><ul><li>Immobilized hip </li></ul></ul></ul><ul><ul><li>Secure splint to LBB </li></ul></ul><ul><ul><ul><li>Prevents movement of splint </li></ul></ul></ul>
  31. 33. Manual Stabilization Manual Traction Apply ankle hitch. Continue manual traction Place splint under injured leg Apply ischial strap Apply mechanical traction Release manual traction
  32. 34. Position straps: 2 above knee, 2 below knee Reassess PMS
  33. 35. That does it… REMEMBER: ASSESS PMS BEFORE/AFTER IMMOBILIZATION
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