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Musculoskeletal System
Temple College
EMS Professions
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Musculoskeletal System
Bones Muscles Cartilages Tendons Ligaments
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Skeleton
Support against gravity Movement Protection Production of blood cells Storage of calcium, phosphorus
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Skull
Cranium• Frontal• Parietal• Temporal• Occipital
Face• Mandible• Maxilla• Zygoma• Nasal bones
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Spinal Column
Cervical: 7 vertebrae Thoracic: 12 vertebrae Lumbar: 5 vertebrae Sacrum: 5 vertebrae (fused) Coccyx: 4 vertebrae (fused)
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Thorax
12 pairs of ribs Sternum Protects heart, lungs
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Pelvis
Bony ring Two innominate bones, each made of 3
fused bones• Ilium• Ischium• Pubis
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Lower Extremity
Femur (largest bone in body) Patella (knee cap) Tibia (shin bone) Fibula Tarsals Metatarsals Phalanges
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Upper Extremity Shoulder girdle
• Scapula• Clavicle
Humerus Radius Ulna Carpals Metacarpals Phalanges
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Muscles
Maintain posture, allow movement 3 types:
• Skeletal (Striated)• Smooth (Involuntary)• Cardiac
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Skeletal Muscles
Voluntary muscles Attach to bones by tendons that cross joints Shortening of muscle moves joint
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Smooth Muscles
Carry out involuntary movements Located in walls of:
• GI tract• GU tract• Respiratory tract• Blood vessels
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Cardiac Muscle
Found only in heart Automaticity Can initiate own contractions without
external stimulation
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Joints
Joining points of bones Bone-ends covered with cartilage Ligaments connect bone-to-bone Inner surface of joint capsule lined with
synovial membrane• Produces synovial fluid• Lubricates joint
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Extremity Trauma
Temple College
EMS Professions
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Fracture
Break in bone’s continuity
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Fracture Causes
Direct force Indirect force Twisting forces (torsion) Diseases of bones (pathological fractures)
• Osteoporosis• Tumors
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Open vs. Closed Fractures
Closed = skin over fracture site intact Open = break in skin over fracture site
• Bone ends do not have to be exposed• Small opening in skin communicating with
fracture site = open fx• Open fractures more serious due to external
blood loss, possible infection
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Fractures
One of the most important things we do in EMS is prevent closed
fractures from becoming open ones
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Fracture Types
Transverse: fracture is at 90o angle to shaft Oblique: fracture is at an angle other than
90o to shaft Spiral: fracture coils through shaft of bone
like a spring
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Fracture Types
Impacted: bone ends driven into each other Comminuted: bone broken into > 3 pieces
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Fracture Types
Greenstick• Shaft of bone not completely broken• Compressed on one side, splintered outward on
other• What group of patients does this type of
fracture occur in?
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Fracture Signs
Deformity Tenderness
• Usually point tenderness• Overlies fracture site
Inability to use limb• Reliable sign of significant injury if present• Reverse is not true
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Fracture Signs
Swelling, ecchymosis Exposed fragments Crepitus
• Grating of bone ends• May be heard or felt• Do NOT actively seek
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Dislocation
Displacement of bones from normal positions at joint
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Dislocation Signs
Deformity Swelling, ecchymosis about joint Pain/tenderness in joint Loss of motion usually perceived as
“locked” joint
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Sprains
Partial, temporary dislocations Result in tearing of ligaments Bone ends NOT displaced from normal
positions
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Sprain Signs
Tenderness Swelling, ecchymosis Inability to use extremity No deformity
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Sprains
Degree of joint dislocation at time of injury cannot be determined
during exam
Extensive damage to neural or vascular structures may have
occurred
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Strains
“Muscle pull” Injury to musculotendenous unit Pain on active motion Pain not present on passive motion
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Assessment
Perform initial (primary) assessment Locate, treat life-threats Assess for injuries of head, chest, abdomen,
pelvis Assess distal neurovascular function
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Assessment
With exception of pelvic, possibly femur fractures, orthopedic injuries are NOT life-threatening.
Do NOT let spectacular orthopedic injury distract you from ABCs
It’s the unobvious things that kill patients!
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Assessment
Evaluation must ALWAYS be done of distal neurovascular function.• Pulse• Skin color• Capillary refill• Sensation• Movement
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Management
Splinting• Prevents further movement at injury site
• Limits tissue damage, bleeding
• Eases pain
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Management
It is difficult to differentiate fractures, dislocations and sprains
When in doubt
SPLINT
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Principles of Splinting
Do NOT move patients before splinting unless patient is in danger
Remove clothes to allow inspection of limb Note, record distal neurovascular function
before, after splinting
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Principles of Splinting
Cover wounds with dry, sterile compression dressings
Fractures: splint joint above, below fracture Dislocations: splint bone above, below joint
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Principles of Splinting
Minimize movement Support injury until splinting completed Pad splint to avoid local pressure
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Principles of Splinting
Angulated fractures• Realign before splinting• If resistance, pain encountered stop, immobilize as is
Dislocations• Splint as is unless circulation compromised• Attempt to reposition once to restore pulse• If resistance, pain encountered stop, immobilize as is