chapter 28 lo - jones & bartlett...
TRANSCRIPT
9/10/2012
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Musculoskeletal Trauma
Lesson Goal
Recognize and manage patients with musculoskeletal trauma
Lesson Objectives
Describe function of muscular system
Describe composition of muscular system
Describe, compare, and contrast different injuries to muscular system
Describe function of skeletal system
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Lesson Objectives
Describe composition of skeletal system: Head
Spinal column
Thorax
Upper and lower extremities
Describe structures within a joint
Compare and contrast different types of joints
Lesson Objectives
Distinguish between open & closed skeletal injuries
Define splinting
List reasons for splinting
List rules for splinting
Lesson Objectives
Explain splinting procedures
Explain complications of splinting
Explain situations in which splinting on scene is not acceptable and why
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Introduction
EMS commonly called to assess and manage musculoskeletal injuries
EMTs need to understand functions of musculoskeletal system, musculoskeletal injuries, and care of musculoskeletal injuries
Muscular System
Functions Provide shape
Protection
Motion
Move blood through body
Move food through digestive tract
Types of Muscles
Voluntary Under conscious control
Involuntary Automatic
Function without thought
Skeletal Striated
Voluntary
Cardiac Striated
Involuntary
Smooth Nonstriated
Involuntary
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Types of Muscles
Muscle groups work together under control of nervous system
Movement is produced when muscles contract & shorten
Skeletal muscles—contained within fascia
Injuries to the Muscular System
Types of injuries Strain Sprain Laceration Contusion Crushing injury Avulsion Puncture
Swelling may impede circulation
Injuries to the Muscular System
Assessment of a muscular injury yields a painful, swollen extremity
6 Ps Pain
Pallor
Pulses
Paresthesia
Paralysis
Pressure/puffiness
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Forces that Produce Injury
Direct
Indirect
Twisting
Treatment of Muscular Injuries
Similar to treatment of other soft tissue injuries
Splint
Functions of Skeletal System
Support & protect
Made of calcium & living tissue
Rich blood supply
Marrow cavity Yellow marrow Red marrow
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Skeletal System
Classification of Bones
Long Humerus, femur
Short Carpals, tarsals
Flat Ribs, sternum
Irregular Vertebrae, facial bones
Skull
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Spine
Spinal column (vertebral column) 7 Cervical
12 Thoracic
5 Lumbar
1 Sacrum (5 sacral)
1 Coccyx (4 or 5 coccygeal )
Thorax
Upper Extremity
Pectoral girdle Clavicles Scapulae
Arm Humerus Radius Ulna
Wrist 8 carpals (2 rows of 4)
Hand 5 Metacarpals 14 Phalanges
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Lower Extremity
Ligaments, Cartilage & Joints
Ligaments connect bone to bone
Cartilage covers bone ends
Bones come together at joints Fibrous—little or no movement
Cartilaginous—some movement
Synovial—allow different types of motion
Synovial Joints
Joint capsule contains synovial fluid
Types Plane or gliding
Saddle
Hinge
Pivot
Ball & socket
Ellipsoidal
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Injuries to Skeletal System
Can involve joints &/or bones
May be open or closed
Sign & symptoms: Swelling
Pain
Deformity
Crepitus
Musculoskeletal Injuries
X-rays—used to determine type of injury Fracture
Dislocation
Musculoskeletal Injuries
Fracture
Dislocation
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Assessment
6 Ps Pain/tenderness
Pallor or skin color
Pulses
Paresthesia
Paralysis
Pressure/puffiness
Management
When in doubt, splint
Importance of splinting Reduces pain
Controls bleeding
Prevents further injury
Splinting never takes precedence over ABCs!
Objectives of Splinting
Stabilize injury to prevent movement
Prevent further injury by stabilizing bone ends
Provide some pain relief by stabilization
Restore or maintain circulation to extremity
Provide padding during transport
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Rules of Splinting
If it is painful, swollen, or deformed, splint it
Completely immobilize injury & surrounding area Bones
• From joint above to joint below
Joints• From bone above to bone
below
In Preparation for Splinting
Support injured area
Remove clothing & jewelry
Assess distal pulse, motor & sensory function
In Preparation for Splinting
Apply gentle, inline traction if Pulses are absent
Distal extremity is cyanotic
Gross deformity is present
Do not reinsert protruding bone ends
Cover open wounds with sterile dressings
Pad splint
Maintain position of function
Splint before moving patient
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Types of Splints
Rigid board
Ladder
Traction
Air
Vacuum
Formable
Anatomic
Sling and swathe
Rigid Board Splint
Skill 28-1: Rigid Splint
1. Check distal pulses; stabilize extremity above and below fracture site before manipulating extremity
2. Apply rigid splints on at least 2 sides of extremity
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Skill 28-1: Rigid Splint
3. Wrap splints securely to extremity, moving distal to proximal
4. Recheck distal pulses after applying splints
Skill 28-1: Rigid Splint
Video Clip coming soon
Ladder Splint
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Traction Splint
Skill 28-2: Traction Splint
1. Check distal pulses while supporting injured extremity
2. Attach ankle strap and apply manual traction, then check distal pulse
Skill 28-2: Traction Splint
3. Adjust traction splint to proper length using uninjured extremity as guide
4. Slide splint under injured extremity and fasten strap at top of splint; recheck distal pulse
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Skill 28-2: Traction Splint
5. Attach traction device to ankle strap; ratchet up traction until device takes traction away from EMT applying manual traction
6. Recheck distal pulse after traction is turned over to device
Skill 28-2: Traction Splint
7. Attach leg straps to secure leg in splint
Skill 28-2: Traction Splint
Video Clip coming soon
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Skill 28-2: Traction Splint
Video Clip coming soon
Air Splint
Vacuum Splint
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Skill 28-3: Vacuum Splint
1. Lay splint on flat area, smooth out until plastic beads are evenly distributed. Remove some air from splint so sides do not collapse when splint is shaped
2. Place splint underneath extremity and bend it into a U-shape around extremity, fasten Velcro fasteners. Form each major curve around any bend in extremity so that extremity is held completely in place
Skill 28-3: Vacuum Splint
3. Use pump to remove remaining air, leaving splint rigid
4. Check distal circulation on extremity
Skill 28-3: Vacuum Splint
Video Clip coming soon
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Pillow Splint
Formable Splint Application
Video Clip coming soon
Anatomic Splint
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Sling and Swathe
Skill 28-4: Sling and Swathe
1. Check distal pulse and sensation, then apply sling
2. Wrap upper arm to chest without restricting breathing
Skill 28-4: Sling and Swathe
3. Recheck distal pulse and sensation after securing sling
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Reassessment
Reassessment after splinting is essential
Recheck distal: Pulse
Sensation
Motor function
Multisystem Trauma
Skeletal trauma may be obvious & distracting, but may not be the most serious injury
Assess patient for potential life threats
Manage life threats first
Use anatomic splinting if patient is in “load & go” situation
Summary
Musculoskeletal system has many important functions & is commonly injured
Injuries present with pain, swelling, deformity
After the ABCs, assess the “6 Ps”
Manage with splinting, elevation, & cold
Reassess after splinting
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