Alexander ch29 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 29
Nontraumatic
Musculoskeletal and
Soft-Tissue Disorders

• Applies fundamental knowledge to provide basic
and selected advanced emergency care and
transportation based on assessment findings for
an acutely ill patient.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Obtain a relevant history from patients presenting with
nontraumatic musculoskeletal disorders.
3. Describe the pathophysiology of, and concerns for,
patients with osteoporosis.
4. List etiologies of nontraumatic back, neck, muscle, and
joint pain.
5. Explain considerations in assessing and managing
patients with nontraumatic musculoskeletal complaints.
Objectives (1 of 2)

6. Describe the pathophysiology of arthritis, including
osteoarthritis, septic arthritis, rheumatoid arthritis,
and gout.
7. List various etiologies of myalgia (muscle pain).
8. Describe the pathophysiology, progression, and needs
of patients with muscular dystrophy.
9. Describe the pathophysiology and management of
rhabdomyolysis.
10.Discuss various types of soft-tissue infection and
inflammation, such as cellulitis, gangrene, and
necrotizing fasciitis.
Objectives (2 of 2)

• Muscle aches, weakness, rashes, changes in
skin color, other musculoskeletal and soft-tissue
complaints can be signs and symptoms of other
health problems.
• Most nontraumatic musculoskeletal and
soft-tissue disorders do not pose immediately
life-threatening problems.
Introduction

Think About It
• What complications would Luis and Colin predict
from the patient’s history?
• What special considerations must Luis and Colin
take into account when packaging and
transporting this patient?
• In addition to vital signs, what are other things
Luis and Colin must consider in the continuing
assessment of this patient during transport?

Anatomy and Physiology Review (1 of 5)
• Skin
– Protects body from the environment, from fluid loss,
and from infection
– Regulates temperature
– Synthesizes and stores nutrients, such as vitamin D
– Provides sensory input from the environment
– Excretes wastes and secretes body substances

• More than 600 skeletal muscles in body
composed of muscle cells or muscle fibers.
– Ability to move
– Maintain position and posture
– Support soft tissues
– Regulate temperature through heat production
– Provide shape and protection

• Skeletal muscle movement controlled at
neuromuscular junction by neurotransmitter
acetylcholine (ACh).
• Muscle cells contain myoglobin.
– Binds to iron, which binds to oxygen
– Found only within muscle cells

• Skeletal system: bone, cartilage, tendons,
ligaments
– Leverage, to allow movement in response to muscle
contraction
– Support
– Protection
– Calcium and phosphorus storage
– Blood cell production

Figure 29-1
The knee joint.

• Joint
• Ligaments
• Tendons
• Bursae

General Assessment and Management
• Complaints: pain, weakness, swelling, redness,
rash, loss of use
– List of patient’s medications useful
– Check for decubitus ulcers.
– Localized or due to problem with another body system

Skin and Soft-Tissue Disorders (1 of 4)
• Skin and soft-tissue disorders infectious or
noninfectious
• Gangrene
– Result of untreated infection
• Necrotizing fasciitis
– Rapidly spreading infection caused by group A
hemolytic streptococci

Figure 29-2
Cellulitis. (© Edward T. Dickinson, MD)

Figure 29-3
A decubitus ulcer. (© SPL/Science Source)

• Cellulitis
– Infection of skin and subcutaneous tissues; signs of
inflammation: redness, swelling, warmth, pain
• Decubitus ulcers (bedsores or pressure sores)
– Individual remains in one position for long periods
of time

• Chronic, nonhealing wounds can occur in:
– Diabetics
– Immunocompromised patients
– Patients taking corticosteroids
– Patients who are hypoxic, are malnourished, have
poor peripheral circulation

• Rare skin conditions:
– Toxic epidermal necrolysis (TEN)
– Stevens-Johnson syndrome (SJS)
– Erythema multiforme (EM)
• Toxins lead to detachment of the epidermis and
mucous membranes.
• In those conditions, blisters form and progress
until large sheets of epidermis detach.

Figure 29-4
Osteoarthritis of the hands.

Joint Disorders (1 of 2)
• Arthritis: inflammation of a joint
– Osteoarthritis or degenerative joint disease (DJD):
articular cartilage damaged and breaks down
– Pain, warmth, tenderness, stiffness, swelling; severe
cases involve malalignment and deformity of joint
– Hands, spine, weightbearing joints (knee and hip) but
can occur in any joint

Joint Disorders (2 of 2)
• Ankylosing spondylosis
– Bones that form joints become fused
• Gout
– Form of arthritis from uric acid crystals being deposited
in joint, often in foot
• Bursitis
– Inflammation of synovial fluid–filled sacs that protect
tissues adjacent to joints

Figure 29-6
(A) Normal spongy bone.

Figure 29-6 (continued)
(B) Spongy bone in osteoporosis.

Bone Disorders
• Osteopenia
– Decrease in bone mass, occurs with aging
• Osteoporosis
– When decrease has pathologic consequences
• Kyphosis
– Abnormal curvature of spine that gives “hunchback”
appearance
• Bone cancers (osteosarcoma; Ewing’s sarcoma)
common in children and young adults

Muscular Disorders (1 of 3)
• Muscular dystrophies: genetic diseases result in
abnormalities of structural and functional muscle
proteins, progressive muscle degeneration and
weakness
– Duchenne’s muscular dystrophy: males and onset
between 3 and 7 years of age
– Death often by early 20s due to respiratory failure

• Rhabdomyolysis: breakdown of skeletal muscle
from traumatic and nontraumatic causes
– Results in release of myoglobin, which can enter blood
– Myoglobin toxic to epithelium of renal tubules and can
cause acute renal failure
– Hyperkalemia may occur, which can result in cardiac
dysrhythmia.

• Fibromyalgia
– Chronic inflammatory disease of the musculoskeletal
system
– Signs and symptoms include multiple tender points,
poor sleep, muscle stiffness, and muscle pain that have
no other explanation.
– Commonly associated with chronic fatigue syndrome.

Figure 29-8
A herniated disc placing pressure on a spinal nerve.

Figure 29-9
Scoliosis. (Princess Margaret Rose Orthopaedic Hospital/Science Source)

Neck and Back Disorders
• Lumbar strain and disc problems are common
causes of low back pain.
• Slipped disc or herniated disc
– Disc material forced out of disc space
• Sciatica
– Sciatic nerve compressed and resulting in pain that
radiates pain radiates through buttocks and down leg
• Scoliosis
– Abnormal lateral curvature of spine

Chapter Summary
• Nontraumatic musculoskeletal and soft-tissue
complaints can have many underlying causes.
• Consider systemic causes and localized
problems.
• Obtain list of patient’s medications.
• Understand mechanisms and consequences of
specific disorders.

Alexander ch29 lecture

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