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