This document discusses the musculoskeletal system and emergencies. It covers the anatomy and functions of the musculoskeletal system including muscles, ligaments, tendons and bones. It describes different types of musculoskeletal injuries like sprains, strains, dislocations, fractures and provides treatment guidelines for splinting and immobilizing injured extremities. The document emphasizes the importance of assessing distal circulation and function before and after splinting and provides tips on proper splinting techniques and potential hazards of improper splinting.

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Musculoskeletal
System
& Emergencies

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Functions of the Musculoskeletal
System
 Gives the body shape
 Protects internal organs
 Provides for movement
 Consists of more than 600 muscles

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Anatomy
 Muscles - provide movement &
generate heat.
 Ligaments - connect bone to bone
injury = sprain
 Tendons - connect bone to muscle
injury = strain
 Bones - protection & shape

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The Skeletal System
 Gives form to the body
 Protects vital organs
 Consists of 206 bones
 Acts as a framework for attachment of muscles
 Designed to permit motion of the body

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The Skull

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The Neck

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The Spinal Column

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The Thorax

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The Pelvis

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The Lower Extremity
 Hip
 Thigh
 Knee
 Leg
 Ankle
 Foot

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The Upper Extremity
 Shoulder girdle
 Arm
 Elbow
 Forearm
 Wrist
 Hand

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Joints

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Types of Muscle (1 of 2)
 Skeletal (voluntary) muscle
 Attached to the bones of the body
 Smooth (involuntary) muscle
 Carry out the automatic muscular functions of
the body

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Types of Muscle (2 of 2)
 Cardiac muscle
 Involuntary muscle
 Has own blood supply and electrical system
 Can tolerate interruptions of blood supply for
only very short periods

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Injuries
 Sprain
 Strain
 Dislocation
 Closed fracture
 Open fracture

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Sprains & Strains
 Sprain
 Joint injury with tearing of ligaments
 Strain
 Stretching or tearing of a muscle

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S/S
 Pain
 Edema and Ecchymosis
 Joint instability
 Treatment: - immobilize, ice, & elevate
if possible

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Dislocation
 A disruption of a joint, in which the bone
ends are no longer in contact and the
supporting ligaments are torn

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S/S of a Dislocation
 Marked deformity
 Edema
 Pain
 Tenderness on palpation
 Complete loss of joint function
 Distal numbness
 Treatment - immobilize, ice, elevate if
possible.

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Fractures
 Closed fracture
 does not break the
skin
 Open fracture
 External wound
 Nondisplaced
fracture
 Simple crack
 Displaced fracture
 deformity

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Closed fracture
 Signs & symptoms
 Pain
 Edema
 Possible deformity
 Contusion
 Loss of motion
 false motion
 Crepitus
 Guarding
 Treatment - immobilize, ice, elevate if possible.

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Open fracture
 Signs & symptoms
 Pain
 Deformity
 Break in skin and/or exposed bone
 Treatment - dressing, immobilize, ice, &
elevate if possible

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Old terminology
 Simple & compound

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Types of Fractures
 Green stick
 Spiral
 Transverse
 Comminuted
 Pathologic
 Epiphyseal

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complications of fx
 blood vessel & nerve damage
 Fat embolus
 disability or deformity

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Bleeding (internal)
 Bones have a blood supply!
 Fractures bleed internally -
 Femur - 1 liter
 Pelvis - 1 liter
 Tibia - 500 cc

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Other considerations
 What is beneath fracture site?
 open fracture
 Joint involved?

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Tips & other stuff
 Angulation or angulated extremity
 Depressed skull fracture
 Basilar skull fracture
 Flail Chest

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Hip Injury
 Hip Fracture – classic presentation
 Shortened, externally rotated
 Hip Dislocation
 Usually flexed and internally rotated
 Requires significant force

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TX
 draw-sheet method
 Make NO attempt to straighten leg
 Support with rolled blankets
 Prevent hip movement

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Assessment of injured extremities
 PMSC
 Pulse
 Movement
 Sensation
 Capillary refill
Cold, blue, pulseless extremity has circulation
problem

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ALWAYS CHECK DISTAL
FUNCTION BEFORE &
AFTER SPLINTING !!!!!
AND DOCUMENT WHAT YOU
FOUND !!

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Splinting
 Why we splint...
 relieve pain
 reduce tissue/vessel damage during
movement

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Types of splints
 Self splinting
 Pillows, blankets, & items of clothing
 Sling & swath
 Rigid
 B-splints
 Sam splints
 vacuum
 Traction

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Traction splints
 Closed, mid-shaft femur fracture without
hip, knee, or ankle injury.

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General Principles of
Splinting (1 of 2)
 Remove clothing area
 PMSC (pulse, movement,
sensation, cap refill)
 Dress all wounds
 Do not move the patient before
splinting

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General Principles of
Splinting (2 of 2)
 Immobilize the joints
 Pad rigid splints
 Maintain manual immobilization.
 Realign angulations PRN
 When in doubt, splint
 Reassess PMSC
 Immobilize all suspected spinal injuries in
a neutral in-line position*
*pain, resistance, crepitus

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Hazards of Improper Splinting
 Further damage
 Delay in transport
 Reduction of distal circulation
 Aggravation of the injury
 Injury to tissue, nerves, blood
vessels, or muscle

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Realignment issues
 NEVER REALIGN A JOINT
 NEVER REALIGN A INJURY WITH GOOD
DISTAL FUNCTION
 Only pulseless, longbone fractures

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Basic Realignment Steps
 Have all equipment ready & in place
 Explain procedure to patient
 In 1 move, with gentle traction, align
extremity (goal is anatomical position)
 Use the least amount of force necessary.
 If resistance is met or pain increases, splint in
deformed position.
 Reassess distal function

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Remember
 No matter how bad the fracture our
priorities are the ABC’s

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Questions and
Answers
???