Download - Musculoskeletal Sytem 3
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Division 3Trauma Emergencies
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 22Musculoskeletal Trauma
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Introduction to Musculoskeletal
Trauma
Anatomy and Physiology of the
Musculoskeletal System
Pathophysiology of the
Musculoskeletal System
Musculoskeletal Injury Assessment
Musculoskeletal Injury Management
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to Musculoskeletal
InjuriesMillions of Americans experience
annually
Multiple MOI
Falls, crashes, violence, etc.
Multi-system trauma
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the
Musculoskeletal System
Skeletal Tissue and Structure
Give the body its structural form
Protect vital organs Promote efficient movement despite the
forces of gravity
Store salts and other materials neededfor metabolism
Produce red blood cells
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal SystemBone Structure
Diaphysis EpiphysisEnd of a long bone
MetaphysisBetween epiphysis anddiaphysis
Growth plate Medullary canal
Contains bone marrow
PeriosteumFibrous covering of
diaphysis CartilageConnective tissue thatprovides a smootharticulation surface for otherbones
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of
the Musculoskeletal SystemJoint Structure Joint
Where bones interact
SynarthrosisA joint that does not permit movement
Diarthroses (synovial joints)Monaxial: hinge or pivot joints
Biaxial: gliding, sliding, or saddle joints
Triaxial: ball and socket joints Ligaments
Joint capsuleSynovial fluid
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Structure (1 of 2)
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Structure (2 of 2)
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the
Musculoskeletal System (1 of 3)
Skeletal Organization
206 bones
Axial skeletonHead, thorax, and spine
Appendicular skeleton
Upper extremities
Lower extremities
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bone Aging
Birth to adult (1820)
Transition from flexible to firm bone Adult to elderly (40+)
Reduction in collagen matrix and calcium salts
Diminution of bone strength
Spinal curvature
Anatomy and Physiology of the
Musculoskeletal System (2 of 3)
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the
Musculoskeletal System (3 of 3)
Types of Muscles
Smooth
Striated
Cardiac
Muscular Tissue and Structure
600 muscle groups
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Muscles
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal System
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Contusion
Compartment Syndrome
Penetrating Injury
Fatigue
Muscle Cramp
Muscle Spasm
Strain
Pathophysiology of the
Musculoskeletal System (1 of 5)
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System (2 of 5)Joint Injury
Sprain
Subluxation
Dislocation
Bone Injury
Open fracture
Closed fracture
Hairline fracture
Impacted fracture
Transverse
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System (3 of 5)
Pediatric Considerations
Flexible nature
Geriatric Considerations Osteoporosis
Pathological Fractures
Pathological diseases
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System (4 of 5)General Considerations with
Musculoskeletal Injuries
Neurological compromise
Decreased stability
Muscle spasm
Bone Repair Cycle
Osteocytes produce osteoblasts
Deposition of salts
Increasing strength of matrix
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System (5 of 5)
Inflammatory and DegenerativeConditions
Bursitis
Tendonitis
ArthritisOsteoarthritis
Degenerative
Rheumatoid arthritisChronic, systemic, progressive, debilitating
GoutInflammation of joints produced by accumulation of
uric acid crystals
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Assessment (1 of 2)Scene Size-up Clues to specific injuries.
Pelvic fractures or bilateral femur fractures areLoad and Go.
Control major bleeding. History may suggest other injuries.
Initial Assessment Categories of urgency
Life- and limb-threatening injuryLife-threatening injury and minor musculoskeletal injury
Non-life-threatening injuries but serious musculoskeletalinjuries
Non-life-threatening injuries and only isolated minormusculoskeletal injuries
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Assessment (2 of 2)
Rapid Trauma Assessment
Only press on pelvis if no clinical signs of injury
are present such as pain.
Focused H&P
6 Ps: Pain, Pallor, Paralysis, Paresthesia,
Pressure, Pulses
Detailed Physical ExamOngoing Assessment
Sports Injury Considerations
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Detailed Exam of Extremities
Deformity
Contusions
AbrasionsPenetrations
Burns
Tenderness
LacerationsSwelling
Also check PMS.
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management (1 of 2)General Principles
Protecting open wounds
Positioning the limb
Immobilizing the injury Checking neurovascular function
PulsePalpate
Utilize pulse oximetry
Motor
Sensation
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management (2 of 2)Splinting Devices Rigid splints
Formable splintsVacuum splints
Air splints Soft splints
Traction splints
Other splinting aidsCravats or Velcro splints
Fracture CareJoint Care
Muscular and Connective Tissue Care
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Care for Specific Fractures (1 of 4)
Pelvis
Scoop stretcher
Pelvic sling devicePASG as a reserve device only
Fluid resuscitation
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Care for Specific Fractures (2 of 4)
Femur Fractures
Traction splints
Contraindicated in hip/knee injuries PASG
High-force injury
High potential for shock
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Care for Specific Fractures (3 of 4)
Tibia-Fibula Fractures
Frequently open fractures.
Cover bone ends with moist dressing. Depending on level of fracture, use:
Rigid splint
Air splint
Pillow
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Care for Specific Fractures (4 of 4)
Clavicle
Most frequently fractured bone in the
body Transmitted to 1st and 2nd rib
Alert for lung injury
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Bledsoe et al.,Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
ManagementCare for Specific Joint Injuries
Hip
Knee
Ankle
Foot
Shoulder
Elbow
Wrist/Hand
Finger
Be alert for
neurological
compromise.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hip Fractures
Common in the elderly.
May be able to support weight.
Ability to walk does not rule out fracture.
Leg often externally rotated.
May refer pain to the knee.
Use other leg for splint.Use vacuum mattress if available.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hip Dislocation
Orthopedic emergency
Posterior dislocation most common
Hip flexed and leg rotated internallySevere pain on attempts to straighten
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hip Dislocation Management
Splint in most comfortable position.
Document sensation and pulse.
Prompt transport.Be alert for associated knee injuries or
fractures.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Knee Fracture or Dislocation
Orthopedic emergency
Frequently causes vascular injury
Dislocation associated with 50% rateof amputation of leg
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Knee Fracture or Dislocation
ManagementObvious dislocation without distal
pulse:
Apply gentle traction along the long axis
of the joint.
If gentle traction does not restore the
pulse:
Splint in place.
Prompt transport.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Foot or Hand Injury
Common industrial injury.
Often disabling.
Rarely life threatening.Splint foot with pillow.
Splint hand in position of function.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Shoulder Injury
AC Separation
Sling and swathe.
Shoulder Dislocation
Use pillow with sling and swathe.
Fracture
Use sling and swathe.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Elbow Injury
Fracture or dislocation may cause
neurovascular injury.
Splint in position found.
Transport promptly.
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Forearm/Wrist Injury
Rigid Splint
Keep hand in position of function.
Air Splint
May be hard to reassess circulation.
Pillow
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management
Soft and Connective Tissue Injuries
Tendon
Ligament Muscle
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Medications (1 of 4)
Nitrous Oxide 50% O2:50% N2O
Non-explosive
Effects dissipate in25 minutes
Easily diffused intoair-filled spaces inbody
DoseInhaled and selfadministered
Onset12 minutes
Diazepam Benzodiazepine
Antianxiety
Analgesic
Dose515 mg titrated
Onset1015 minutes
Duration1560 minutes
Counter agentFlumazenil
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Medications (2 of 4)
Morphine Sulfate
Opiate alkaloid.
Reduces vascular volume and cardiac
preload. Do not administer to hypovolemic
patients.
Dose:
2 mg IVP slow
Counter agent:Narcan
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Medications (3 of 4)
Meperidine
Demerol
Narcotic analgesic
Dose50100 mg
Counter agentNarcan
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Medications (4 of 4)
Sublimaze Fentanyl
Synthetic opioid
Equivalent to morphine
Dose2550 mg SIVP followed by an additional 25 mg asneeded
OnsetLess than a minute
Duration36 hours
ConsiderationsIf given too rapidly, chest wall rigidity may ensue,leading to respiratory compromise.
M l k l t l I j
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2006 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management
Other Injury Considerations
Pediatric musculoskeletal injury
Athletic musculoskeletal injury Patient refusals and referral
Psychological support
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Summary
Introduction to Musculoskeletal
Trauma
Anatomy and Physiology of the
Musculoskeletal System
Pathophysiology of the
Musculoskeletal System
Musculoskeletal Injury Assessment
Musculoskeletal Injury Management