Chapter 28 Musculoskeletal Injuries

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Chapter 28Musculoskeletal Injuries
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U.S. DOT Objectives Directory

• U.S. DOT Objectives are covered and/or supported
  by the PowerPoint Slide Program and Notes for
  Emergency Care, 11th Ed. Please see the Chapter
  28 correlation below.
• KNOWLEDGE AND ATTITUDE
• 5-3.1 Describe the function of the muscular
  system. Slides 6, 11-13
• 5-3.2 Describe the function of the skeletal
  system. Slides 6-10
• 5-3.3 List the major bones or bone groupings of
  the spinal column, the thorax, the upper
  extremities, and the lower extremities. Slide 6
• 5-3.4 Differentiate between an open and a closed
  painful, swollen, or deformed extremity. Slide 19
• 5-3.5 State the reasons for splinting. Slides
  21-23
• 5-3.6 List the general rules of splinting. Slides
  25, 29
• 5-3.7 List the complications of splinting. Slide
  28
• 5-3.8 List the emergency medical care for a
  patient with a painful, swollen, deformed
  extremity. Slides 21-68

(cont.)
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U.S. DOT Objectives Directory

• KNOWLEDGE AND ATTITUDE
• 5-3.9 Explain the rationale for splinting at the
  scene versus load and go. Slides 21-22
• 5-3.10 Explain the rationale for immobilization
  of the painful, swollen, deformed extremity.
  Slides 21, 23, 25

(cont.)
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U.S. DOT Objectives Directory

• SKILLS
• 5-3.11 Demonstrate the emergency medical care of
  a patient with a painful, swollen, deformed
  extremity.
• 5-3.12 Demonstrate completing a prehospital care
  report for patients with musculoskeletal injuries.

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Anatomy and Physiology
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Virtual Tours

• Click here to view a virtual tour of the head and
  neck.
• Click here to view a virtual tour of the trunk
  and abdomen.
• Click here to view a virtual tour of the upper
  limbs.
• Click here to view a virtual tour of the lower
  limbs.

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Anatomy

• Dense connective tissue
• Provide bodys framework
• Support and protection
• Production of red blood cells
• Bones articulated into joints
• Classified
• Long
• Short
• Flat
• Irregular

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Physiology

• Bones provide framework.
• Joints allow for bending.
• Muscles allow for movement.
• Cartilage provides flexibility.
• Tendons connect muscle to bone.
• Ligaments connect bone to bone.

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Periosteum

• Strong, white, fibrous material
• Blood vessels and nerves pass through
• Obvious when bone exposed
• Impaled objects
• Do not remove

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Joints
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Muscles

• Skeletal
• Voluntary
• Gives body shape
• Connected to bones
• Tongue, pharynx
• Upper esophagus
• Smooth
• Involuntary
• Walls of organs
• Digestive
• Cardiac
• Walls of the heart

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Cartilage

• Connective tissue outside of the bone
  (epiphysis)
• Surface for articulation
• Smooth movement at joints
• Less rigid
• Forms flexible structures
• Septum of nose
• External ear
• Trachea
• Connections between ribs and sternum

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Tendons and Ligaments

• Tendons
• Bands of connective tissue
• Binds muscles to bones
• Power of movement
• Ligaments
• Connective tissue
• Supports joints
• Connects bone to bone

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Mechanisms of Injury
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Mechanisms of Injury

• Direct force
• MVC
• Crushed tissue
• Fractures
• Rotational forces
• Football, basketball
• Soccer
• Indirect force
• Falls from heights

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Types of Injuries

• Fracture
• Bones break
• Dislocation
• Joints come apart
• Sprain
• Stretching and tearing of ligaments
• Strain
• Overexertion of muscle

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Patient Assessment
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AssessmentMusculoskeletal

• Pain and tenderness
• Deformity or angulation
• Grating or crepitus
• Swelling
• Bruising
• Exposed bone ends
• Joints locked in position
• Nerve and blood vessel compromise

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Fractures
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Patient Care
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Patient CareInjuries
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Load and Go

• Initial assessment reveals unstable patient.
• Address ABCs.
• Use long spine board.
• Do not splint individual extremities.

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Splinting

• Immobilize adjacent joints and bone ends.
• Decreases pain and movement
• Prevents additional injuries

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Realignment

• Restores effective circulation
• Splint may be ineffective.
• Increased circulatory compromise
• Reduction in pain

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General RulesRealignment

• Grasp distal extremity for support
• Splint in position found
• Realign if extremity cyanotic or lacks pulse
• Manual traction
• Resistance
• Stop realignment and splint in position found.
• No resistance
• Maintain traction until splint applied.

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General RulesImmobilization
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Types of Splints
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Hazards of Splinting

• First address life-threatening conditions.
• Ensure airway, breathing, and circulation.
• Method dictated by severity of patient.
• Compression of nerves blood vessels and muscles
• Inappropriate splinting
• Cause further soft-tissue injury
• Cause open fracture to occur

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ProcedureSplinting
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TechniqueLower Extremity
(cont.)
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TechniqueLower Extremity
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TechniqueUpper Extremity
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Traction Splint

• Indications
• Painful, swollen
• Deformed thigh with no joint or lower leg pain
• Amount
• 10 of patients body weight
• Do not exceed 15 pounds

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GuidelinesTraction Splint
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Hare Traction Splint
(cont.)
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Hare Traction Splint
(cont.)
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Hare Traction Splint
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Sager Traction Splint
(cont.)
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Sager Traction Splint
Click here to view a video on the Sager traction
splint.
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Shoulder Girdle Injuries

• Pain in shoulder
• Dropped shoulder
• Consider fracture
• Check entire girdle

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Patient CareShoulder Girdle
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ProcedureSling and Swathe
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SignsLower Extremity Injuries

• Pain in pelvis, hips, groin, or back
• Painful reaction when pressure applied to iliac
  crest
• Inability to lift legs when supine
• Lateral rotation (outward)
• Unexplained pressure on bladder

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Patient CarePelvic Injuries
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Pelvic Wrap

• Pelvic deformity or instability
• Mechanism of injury indicates pelvic injury.
• Follow local protocols.

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ProcedurePelvic Wrap
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Pneumatic Anti-shock Garment

• PASG
• Suspected pelvic fracture
• Splints hip, femur, and multiple leg fractures

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Hip Dislocation
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Signs and SymptomsHip Dislocation

• Anterior
• Lower limb rotated outward
• Hip flexed
• Posterior
• Lower limb rotated inward
• Hip flexed
• Knee bent
• Foot may hang loose.

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Patient CareHip
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Signs and SymptomsHip Fracture

• Localized pain (sometimes in the knee)
• Sensitive to pressure laterally (greater
  trochanter)
• Discolored tissues
• Swelling
• Unable to move limb
• Unable to stand
• Foot rotated outward/inward
• Injured limb appear shorter

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Patient CareHip Fracture
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Femoral Shaft Fracture

• Pain
• Open fracture with deformity
• Closed fracture with deformity
• Injured limb shortened

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Patient CareFemoral Shaft Fracture
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Knee Injury

• Pain and tenderness
• Swelling
• Deformity with obvious swelling

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Patient CareKnee Injury
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Tibia or Fibula Injury

• Pain and tenderness
• Swelling
• Deformity

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Patient CareTibia or Fibula Injury
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Patient Assessment Ankle/Foot

• Pain
• Swelling
• Possible deformity

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Patient CareAnkle/Foot Injury
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SplintingFinger
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SplintingLong Bone
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Position of Function
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SplintingUpper Extremity
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Vacuum SplintUpper Extremity
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Reassessing PMS
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Vacuum SplintLower Extremity
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Reassessing PMS
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Review Questions

• Describe the basic anatomy of bone and its
  purposes.
• Identify the signs and symptoms of
  musculoskeletal injury.
• Describe basic emergency care for painful,
  swollen, or deformed extremities, including
  general guidelines for splinting long bones and
  joints.

(cont.)
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Review Questions

• Explain why angulated deformed injuries to the
  long bones should be realigned to anatomical
  position.
• List the basic principles of splinting.
• Describe the hazards of splinting.
• Describe the basic types of splints carried on
  ambulances.

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Street Scenes

• What priority would you assign to this patient?
  Why?
• How would you continue your assessment?

(cont.)
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Street Scenes

• What signs might you expect to find with a broken
  long bone?
• What are your major concerns with possible broken
  bones in the extremities?

(cont.)
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Street Scenes

• What interventions are appropriate for this
  patient?

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Sample Documentation