musculoskeletal trauma. sections introduction to musculoskeletal trauma anatomy and physiology of...

Musculoskeletal Musculoskeletal TraumaTrauma

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Introduction to Musculoskeletal Trauma Anatomy and Physiology of the

Musculoskeletal System Pathophysiology of the Musculoskeletal

System Musculoskeletal Injury Assessment Musculoskeletal Injury Management

Introduction to Musculoskeletal Trauma Anatomy and Physiology of the

Musculoskeletal System Pathophysiology of the Musculoskeletal

System Musculoskeletal Injury Assessment Musculoskeletal Injury Management

Millions of Americans experience annually.

Multiple MOI Falls, Crashes, Violence, etc Multi-system trauma

Millions of Americans experience annually.

Multiple MOI Falls, Crashes, Violence, etc Multi-system trauma

Introduction to Introduction to Musculoskeletal Musculoskeletal

InjuriesInjuries

Skeletal Tissue & Structure Protects organs Allows for efficient movement Stores salts and other materials needed for

metabolism Produces RBC’s

Skeletal Tissue & Structure Protects organs Allows for efficient movement Stores salts and other materials needed for

metabolism Produces RBC’s

Anatomy & Physiology Anatomy & Physiology of the Musculoskeletal of the Musculoskeletal

SystemSystem

Musculoskeletal Musculoskeletal SystemSystem Bone Structure

Diaphysis Epiphysis

End of a long bone Metaphysis

Between epiphysis and diaphysis

Growth plate Medullary Canal

Contains bone marrow Periosteum

Fibrous covering of diaphysis Cartilage

Connective tissue that provides a smooth articulation surface for other bones.

Bone Structure Diaphysis Epiphysis

End of a long bone Metaphysis

Between epiphysis and diaphysis

Growth plate Medullary Canal

Contains bone marrow Periosteum

Fibrous covering of diaphysis Cartilage

Connective tissue that provides a smooth articulation surface for other bones.

Figure 7-1

Joint Structure Joint

Where bones interact

Synarthrosis A joint that does not permit movement

Diarthroses (Synovial Joints) Monaxial: hinge or pivot joints Biaxial: gliding, sliding, or saddle joints Triaxial: Ball & socket joints

Ligaments Joint Capsule

Synovial fluid

Joint Structure Joint

Where bones interact

Synarthrosis A joint that does not permit movement

Diarthroses (Synovial Joints) Monaxial: hinge or pivot joints Biaxial: gliding, sliding, or saddle joints Triaxial: Ball & socket joints

Ligaments Joint Capsule

Synovial fluid


SystemSystem

Skeletal Organization 206 Bones Axial Skeleton

Head, Thorax & Spine

Appendicular Skeleton Upper Extremities Lower Extremities

Skeletal Organization 206 Bones Axial Skeleton

Head, Thorax & Spine

Appendicular Skeleton Upper Extremities Lower Extremities


SystemSystem

Bone Aging Birth to Adult (18-20)

Transition from flexible to firm bone

Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature

Bone Aging Birth to Adult (18-20)

Transition from flexible to firm bone

Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature


SystemSystem

Muscular Tissue & Structure

600 muscle groups

Muscular Tissue & Structure

600 muscle groups

Anatomy & Anatomy & Physiology of Physiology of

the the MusculoskeleMusculoskele

tal Systemtal System

(continued)

Types of muscles Smooth Striated Cardiac

Types of muscles Smooth Striated Cardiac

Anatomy & Anatomy & Physiology of Physiology of

the the MusculoskeleMusculoskele

tal Systemtal System

Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain

Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain

Pathophysiology of Pathophysiology of the Musculoskeletal the Musculoskeletal

SystemSystem

Joint Injury Sprain Subluxation Dislocation

Bone Injury Open Fracture Closed Fracture Hairline Fracture Impacted Fracture

Joint Injury Sprain Subluxation Dislocation

Bone Injury Open Fracture Closed Fracture Hairline Fracture Impacted Fracture


SystemSystem

Pediatric Considerations Flexible nature

Geriatric Considerations Osteoporosis

Pathological Fractures Pathological diseases

Pediatric Considerations Flexible nature

Geriatric Considerations Osteoporosis

Pathological Fractures Pathological diseases


SystemSystem

General Considerations with musculoskeletal injuries

Neurological compromise Decreased stability Muscle spasm

Bone Repair Cycle Osteocytes produce osteoblasts Deposition of salts Increasing strength of matrix

General Considerations with musculoskeletal injuries

Neurological compromise Decreased stability Muscle spasm

Bone Repair Cycle Osteocytes produce osteoblasts Deposition of salts Increasing strength of matrix


SystemSystem

Inflammatory & Degenerative Conditions

Bursitis Tendinitis Arthritis

Osteoarthritis• Degenerative

Rheumatoid Arthritis• Chronic, systemic, progressive, debilitating

Gout• Inflammation of joints produced by accumulation of uric

acid crystals

Inflammatory & Degenerative Conditions

Bursitis Tendinitis Arthritis

Osteoarthritis• Degenerative

Rheumatoid Arthritis• Chronic, systemic, progressive, debilitating

Gout• Inflammation of joints produced by accumulation of uric

acid crystals


SystemSystem

Scene Size-up Initial Assessment

Categories of urgency Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal

injuries

Rapid Trauma Assessment Focused H&P

6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses

Detailed Physical Exam Ongoing Assessment Sports Injury Consideration

Scene Size-up Initial Assessment

Categories of urgency Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal

injuries

Rapid Trauma Assessment Focused H&P

6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses

Detailed Physical Exam Ongoing Assessment Sports Injury Consideration

Musculoskeletal Musculoskeletal Injury AssessmentInjury Assessment

General Principles Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function

General Principles Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function

Musculoskeletal Musculoskeletal Injury ManagementInjury Management

Splinting Devices Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids

Vacuum Splints Air Sprints Cravats or Velcro Splints

Fracture Care Joint Care Muscular & Connective Tissue Care

Splinting Devices Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids

Vacuum Splints Air Sprints Cravats or Velcro Splints

Fracture Care Joint Care Muscular & Connective Tissue Care


Care for Specific Fractures Pelvis

Scoop Stretcher PASG Fluid Resuscitation

Femur Traction Splints PASG Fracture versus hip dislocation

Care for Specific Fractures Pelvis

Scoop Stretcher PASG Fluid Resuscitation

Femur Traction Splints PASG Fracture versus hip dislocation


Care Specific Fractures Tibia/Fibula Clavicle

Most frequently fractured bone in the body Transmitted to 1st and 2nd rib Alert for lung injury

Humerus Radius/Ulna

Care Specific Fractures Tibia/Fibula Clavicle

Most frequently fractured bone in the body Transmitted to 1st and 2nd rib Alert for lung injury

Humerus Radius/Ulna


Care for Specific Joint Injuries Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger

Care for Specific Joint Injuries Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger


Joint Injuries

Alert for neurological Compromise

Soft & Connective Tissue Injuries Tendon Ligament Muscle

Soft & Connective Tissue Injuries Tendon Ligament Muscle


Nitrous Oxide 50% O2:50% N2O Non-explosive Effects dissipate in

2-5 minutes Easily diffused into

air filled spaces in body.

Dose Inhaled & self

administered

Onset 1-2 minutes

Nitrous Oxide 50% O2:50% N2O Non-explosive Effects dissipate in

2-5 minutes Easily diffused into

air filled spaces in body.

Dose Inhaled & self

administered

Onset 1-2 minutes

Musculoskeletal Injury Musculoskeletal Injury ManagementManagementMedicationsMedications

Diazepam Benzodiazepine Antianxiety Analgesic Dose

5-15 mg titrated

Onset 10-15 minutes

Duration 15-60 minutes

Counter Agent Flumazenil

Diazepam Benzodiazepine Antianxiety Analgesic Dose

5-15 mg titrated

Onset 10-15 minutes

Duration 15-60 minutes

Counter Agent Flumazenil

Morphine Sulfate Opiate alkaloid Reduces vascular volume and cardiac preload Do not administer to hypovolemic patients Dose

2mg IVP slow Counter Agent

Narcan

Morphine Sulfate Opiate alkaloid Reduces vascular volume and cardiac preload Do not administer to hypovolemic patients Dose

2mg IVP slow Counter Agent

Narcan


(continued)


Meperidine Demerol Narcotic Analgesic Dose

50-100 mg

Counter Agent Narcan

Meperidine Demerol Narcotic Analgesic Dose

50-100 mg

Counter Agent Narcan

Nalbuphine Nubain Narcotic Analgesic Equivalent to Morphine Dose

2-5 mg

Onset 2-3 minutes

Duration 3-6 hours

Nalbuphine Nubain Narcotic Analgesic Equivalent to Morphine Dose

2-5 mg

Onset 2-3 minutes

Duration 3-6 hours


Other Injury Consideration Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support

Other Injury Consideration Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support
