chapter 30 - musculoskeletal trauma - ronald gagne 30... · musculoskeletal injuries. slide 18 ......

Chapter 30 - Musculoskeletal_Trauma

1

Copyright ©2012 by Pearson Education, Inc.

All rights reserved.

Emergency Care, Twelfth Edition

Limmer • O’Keefe • Dickinson

Introduction to Emergency Medical Care

1





OBJECTIVES

30.1 Define key terms introduced in this chapter. Slides 11–12, 19–20, 22–23, 37

30.2 Describe the anatomy of elements of the musculoskeletal system. Slides 11–16

30.3 Associate mechanisms of injury with the potential for musculoskeletal injuries. Slide 18

continued





OBJECTIVES

30.4 Describe the four types of musculoskeletal injury (fracture, dislocation, sprain, and strain) and define

open and closed extremity injuries. Slides 19–21

30.5 Discuss the assessment of musculoskeletal injuries, including compartment syndrome. Slides 22–24

continued


2





OBJECTIVES

30.6 Discuss the general care of musculoskeletal injuries. Slides 26–27

30.7 Discuss specific considerations for splinting. Slides 28–37

continued





OBJECTIVES

30.8 Discuss considerations in the assessment and management of specific types of injuries, including

shoulder girdle injuries, pelvic injuries, hip dislocation, hip fracture, femoral shaft fracture, knee

injury, tibia or fibula injury, ankle or foot injury. Slides 39–52





MULTIMEDIA

• Slide 53 Hip Fractures Video

• Slide 54 Immobilizing a Long Bone Video


3





CORE CONCEPTS

• Understanding bones, muscles, and other

elements of the musculoskeletal system

• Understanding general guidelines for emergency care of musculoskeletal

injuries

continued





CORE CONCEPTS

• Purposes and general procedures for

splinting

• Assessment and care of specific injuries to the upper and lower extremities





Topics

• Musculoskeletal System

• General Guidelines for Emergency Care

• Emergency Care of Specific Injuries


4





Musculoskeletal System





Components of Musculoskeletal System

• Bones

• Joints

• Muscles

• Cartilage

• Ligaments

• Tendons





Physiology of Musculoskeletal System

• Bones: framework

• Joints: bending

• Muscles: movement

• Cartilage: flexibility

• Ligaments: connect bone to bone

• Tendons: connect muscle to bone


5





Bones

• Formed of dense

connective tissues

• Vascular and susceptible to

bleeding on injury





Shapes of Bones

• Irregular

• Long

• Short

• Flat





Self-Healing Nature of Bone

• Break causes soft tissue swelling and a

blood clot in the fracture area

• Interruption of blood supply causes the bone section to die

• Cells further from fracture divide rapidly

forming tissue that heals the fracture and

develops into new bone


6





Muscles, Cartilage,

Ligaments, and Tendons





General Guidelines for Emergency Care





Mechanisms of Musculoskeletal Injury

• Direct force

• Indirect force

• Twisting

(rotational) force


7





Injury to Bones and Connective Tissue

• Fracture: any break in a bone (open or

closed)

– Comminuted—broken in several places

– Greenstick—incomplete break

– Angulated—bent at angle

• Dislocation: “coming apart” of a joint

continued





continued


• Sprain: stretching and tearing of ligaments

• Strain: overstretching of muscle






• Not all injuries can

be confirmed as a

fracture in the field

• Splinting an

extremity with a

suspected fracture

helps prevent

blood loss from

bone tissues


8





Assessment:Musculoskeletal Injuries

• Rapidly identify and treat life-threatening

conditions

• Be alert for injuries besides grotesque wound

• Pain and tenderness

• Deformity and angulation

continued





Assessment:Musculoskeletal Injuries

• Grating (crepitus)

• Swelling

• Bruising

• Exposed bone ends

• Nerve/blood vessel compromise (decreased CMS)

• Compartment syndrome





Six P’s of Assessment

• Pain or tenderness

• Pallor (pale skin)

• Parasthesia (pins and needles)

• Pulses diminished or absent

• Paralysis

• Pressure


9





Think About It

• Do my patient’s musculoskeletal injuries

add up to serious multiple trauma?

• Does my patient have circulation, sensation, and motor function distal to the

suspected fracture or dislocation?





Treatment:Musculoskeletal Injuries

• Take standard

precautions

• Perform primary assessment

• Take spinal

precautions, if

necessary

continued





Treatment:Musculoskeletal Injuries

• Splint any

suspected

extremity fractures

after treating life-

threatening conditions

• Cover open

wounds with sterile

dressings


10





Advantages of Splinting

• Minimizes movement of disrupted joints

and broken bone ends

• Prevents additional injury to soft tissues (nerves, arteries, veins, muscles)

• Decreases pain

• Minimizes blood loss

• Can prevent a closed fracture from

becoming an open fracture





Principles of Splinting

• Care for life-threatening problems first

• Expose injury site

• Assess distal CSM

• Align long-bone injuries to anatomical

position

• Do not push protruding bones back into

place

continued





Principles of Splinting

• Immobilize both injury site and adjacent

joints

• Choose splinting method based on severity of condition and priority decision

• Apply splint before moving patient to

stretcher

• Pad voids


11





Realigning Deformed Extremity

• Assists in restoring

effective circulation to

extremity and to fit it

to splint

• If not realigned, splint

may be ineffective,

causing increased

pain and possible

further injury

continued





Realigning Deformed Extremity

• If not realigned, increased chance of

nerves, arteries, and veins being

compromised

• Increased pain is only momentary





Hazards of Splinting

• “Splinting patient to death”—splinting

before life-threatening conditions

addressed

• Not ensuring ABC’s

• Too tight—compresses soft tissues

• Too loose—allows too much movement

• Splinting in deformed position


12





Treatment:Splinting Long Bone and Joints

• Select splint

appropriate to

injury

• Standard

precautions

• Manually stabilize

injury site

continued





continued

Treatment:Splinting Long Bone and Joints

• Assess circulation,

sensation, and

motor function

• Realign injury if

deformed or if

distal extremity is

cyanotic or

pulseless





Treatment: Splinting Long Bone and Joints

• Measure or adjust

splint; move it into

position

• Apply and secure

splint to immobilize

injury site, adjacent

joints

• Reassess CSM

distal to injury


13





Treatment: Traction Splint





Emergency Care of Specific Injuries





Shoulder Girdle Injuries

• Assessment

– Pain in shoulder

– Dropped shoulder

– Severe blow to

back over scapula

continued


14





Shoulder Girdle Injuries

• Treatment

– Assess distal CSM

– Use sling and

swathe

– Do not attempt to

straighten or

reduce

– Reassess distal

CSM





Forearm, Wrist, and Hand Injuries

• Signs

– Forearm: deformity and tenderness

– Wrist: deformity and tenderness

– Hand: deformity and pain; dislocated fingers





continued

Splinting Forearm, Wrist, and Hand Injuries

• Padded rigid splint

– From elbow past fingertips

– Roll of bandage placed in hand

– Sling and swathe


15





Splinting Forearm, Wrist, and Hand Injuries

• Soft splint

– Roll of bandage

placed in hand

– Tie forearm, wrist, and

hand into fold of one pillow or between two pillows

– Tape finger to adjacent uninjured finger





Pelvic Injuries

• Assessment

– Pain in pelvis, hips, or groin

– Pain when pressure applied

– Cannot lift legs

– Lateral rotation of foot

– Unexplained pressure in bladder

continued





Pelvic Injuries

• Treatment

– Move patient as little as possible

– Determine CSM distal to injury

– Straighten lower limbs to anatomical position

– Stabilize lower limbs

– Assume spinal injuries

– Treat for shock


16





Hip Dislocation/Fracture

• Assessment

– Anterior hip dislocation

– Posterior hip dislocation

• Rotation of leg and foot

– Pain and unable to stand

continued





Hip Dislocation/Fracture

• Treatment


– Move patient onto spine board

– Immobilize limb with

pillows and blankets

– Secure patient to

spine board

– Reassess distal CSM





Femoral Shaft Fracture

• Assessment

– Intense pain

– Possibly open

fracture

– Injured limb may be

shortened

• Treatment

– Control bleeding


– Apply traction splint

– Reassess distal

CSM

– Treat for shock


17





Knee Injury

• Assessment

– Pain and tenderness

– Swelling

– Deformity with swelling

• Treatment


– Immobilize in current position

– Reassess distal CSM





Tibia/Fibula Injury

• Assessment

– Pain and tenderness

– Swelling

– Possible deformity

• Treatment

– Air inflated splint

– Two-splint method

– Single splint with ankle hitch





Ankle/Foot Injury

• Assessment

– Pain

– Swelling

– Possible deformity

continued


18





Ankle/Foot Injury

• Treatment– Assess distal CSM

– Stabilize limb

– Lift limb

– Place cravats under ankle

– Lower limb into pillow

– Tie pillow around ankle

– Apply ice pack as needed





Hip Fractures Video

Click here to view a video on the subject of hip fractures.

Back to Directory





Immobilizing a Long Bone Video

Click here to view a view a video on the subject of splinting a

long bone injury.

Back to Directory


19





Chapter Review





Chapter Review

• Bones bleed. Fractures cause blood loss

within the bone.

• Splinting of long bone fractures involves immobilizing adjacent joints.

• Splinting protects the patient from further

injury.

continued





Chapter Review

• You may need to be creative while

splinting. There are many correct ways to

splint the same extremity.

• Injuries to bones and joints should be

splinted prior to moving the patient.

continued


20





Chapter Review

• If patient has multiple trauma or appears

to have shock do not waste time splinting

individual fractures. Place patient on long

spine board and secure limbs to board.

Splint individual fractures en route if time and priorities allow.





Remember

• Bones, joints, muscles, cartilage, tendons,

and ligaments make up the

musculoskeletal system.

• Bones provide the body with structure,

store metabolic materials, and produce red

blood. Joints are the places where bones

articulate to create movement.

continued





continued

Remember

• Fractures, dislocations, sprains, and

strains are musculoskeletal injuries that

are caused by direct force, indirect force,

and twisting force. Injuries should be

splinted prior to moving the patient.


21





Remember

• A closed extremity injury is one in which

the skin has not been broken. An open

extremity injury is one in which the skin

has been broken.

• Pelvic fractures and femoral shaft

fractures often indicate more severe

internal injuries.

continued





Remember

• EMTs must learn specific techniques for

immobilizing particular injuries but at the

same time must foster creativity while

applying the general rules of splinting.





Questions to Consider

• Have I fully addressed life threats and

maintained my priorities even in the

presence of a grossly deformed extremity?

• Does the patient have an injury that

requires splinting?

continued


22





Questions to Consider

• Does the patient have multiple fractures,

multiple trauma, or shock?

• Does the patient have adequate CSM distal to the musculoskeletal injury?

• Should I align the angulated extremity

fracture?





Critical Thinking

• Patients who suffer fractures can be in

extreme pain. Pain can cause anxiety and

elevated pulse rates. How could you

differentiate between a patient with a rapid

pulse and anxiety from pain versus a patient with rapid pulse and anxiety from

shock?





Please visit Resource Central on www.bradybooks.com to view

additional resources for this text.

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