Nontraumatic Musculoskeletal and Soft-Tissue Disorders

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29
Nontraumatic Musculoskeletal and Soft-Tissue
Disorders
2
Advanced EMT Education Standard

• Applies fundamental knowledge to provide basic
  and selected advanced emergency care and
  transportation based on assessment findings for
  an acutely ill patient.

3
Objectives

1. Define key terms introduced in this chapter.
2. Obtain a relevant history from patients
   presenting with nontraumatic musculoskeletal
   disorders. 17-18
3. Describe the pathophysiology of, and concerns
   for, patients with osteoporosis. 30-32
4. List etiologies of nontraumatic back, neck,
   muscle, and joint pain. 16-18

4
Objectives

1. Explain considerations in assessing and managing
   patients with nontraumatic musculoskeletal
   complaints. 17-18
2. Describe the pathophysiology of arthritis,
   including osteoarthritis, septic arthritis,
   rheumatoid arthritis, and gout. 26-29
3. List various etiologies of myalgia. 36-37
4. Describe the pathophysiology, progression, and
   needs of patients with muscular dystrophy. 34

5
Objectives

1. Describe the pathophysiology and management of
   rhabdomyolysis. 35-36
2. Discuss various types of soft-tissue infection
   and inflammation, such as cellulitis, gangrene,
   and necrotizing fasciitis. 19-25

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Introduction

• Muscle aches, weakness, rashes, changes in skin
  color, other musculoskeletal and soft-tissue
  complaints can be signs and symptoms of other
  health problems.
• Most nontraumatic musculoskeletal and soft-tissue
  disorders do not pose immediately
  life-threatening problems.

7
Think About It

• What complications would Luis and Colin predict
  from the patients history?
• What special considerations must Luis and Colin
  take into account when packaging and transporting
  this patient?

8
Think About It

• In addition to vital signs, what are other things
  Luis and Colin must consider in the continuing
  assessment of this patient during transport?

9
Anatomy andPhysiology Review

• Skin is protective outer covering of body.
• What are the functions of the skin?
• What are the three layers of the skin?

10
Anatomy andPhysiology Review

• Skin exposed to UV radiation from sun synthesizes
  vitamin D3.
• Melanin production increases as sun exposure
  increases.
• Skin bluish cast (cyanosis) indication of
  hypoxia.
• Skin yellowish cast indication of liver failure
  excess bilirubin deposited in skin.

11
Anatomy andPhysiology Review

• More than 600 skeletal muscles in body composed
  of muscle cells or muscle fibers.
• Ability to move
• Maintain position and posture
• Support soft tissues
• Regulate temperature through heat production
• Provide shape and protection

12
Anatomy andPhysiology Review

• Skeletal muscle movement controlled at
  neuromuscular junction by neurotransmitter
  acetylcholine (ACh).
• Muscle cells contain myoglobin.
• Binds to iron, which binds to oxygen.
• Found only within muscle cells.

13
Anatomy andPhysiology Review

• Skeletal system bone, cartilage, tendons,
  ligaments
• Leverage, to allow movement in response to muscle
  contraction
• Support
• Protection
• Calcium and phosphorus storage
• Blood cell production

14
Anatomy andPhysiology Review

• Figure 29-1 Knee joint.

15
Anatomy andPhysiology Review

• Define each of the following terms.
• Joints
• Ligaments
• Tendons
• Bursae

16
Think About It

• With age, a number of skin changes occur. There
  are decreases in
• The number of skin macrophages
• Vitamin D production
• Oil production
• Size of elastin fibers and collagen production
• Circulation
• Perspiration

17
General Assessment and Management ofNontraumatic
Musculoskeletal and Soft-Tissue Disorders

• Complaints pain, weakness, swelling, redness,
  rash, loss of use.
• List of patients medications useful.
• Check for decubitus ulcers.
• Localized or due to problem with another body
  system.

18
Think About It

• A nontraumatic musculoskeletal patient may be
  noncritical, but is the complaint localized or
  due to a problem with another body system?
• A thorough assessment is necessary to make this
  determination.

19
Skin and Soft-Tissue Disorders

• Skin and soft-tissue disorders infectious or
  noninfectious.
• Gangrene result of untreated infection.
• Necrotizing fasciitis rapidly spreading
  infection caused by group A hemolytic
  streptococci.

20
Skin and Soft-Tissue Disorders

• Figure 29-2 Cellulitis.

21
Skin and Soft-Tissue Disorders

• Figure 29-3 Decubitus ulcer.

22
Skin and Soft-Tissue Disorders

• Cellulitis infection of skin and subcutaneous
  tissues signs of inflammation redness,
  swelling, warmth, pain.
• Decubitus ulcers (bedsores or pressure sores)
  individual remains in one position for long
  periods of time.

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Skin and Soft-Tissue Disorders

• Chronic, nonhealing wounds can occur in
• Diabetics
• Immunocompromised patients
• Patients taking corticosteroids
• Patients who are hypoxic, malnourished, have poor
  peripheral circulation

24
Skin and Soft-Tissue Disorders

• Rare skin conditions
• Toxic epidermal necrolysis (TEN)
• Stevens-Johnson syndrome (SJS)
• Erythema multiforme (EM)
• Toxins lead to detachment of the epidermis and
  mucous membranes.
• In those conditions, blisters form and progress
  until large sheets of epidermis detach.

25
Think About It

• Pressure caused by transportation on a long
  backboard, or even by a thin stretcher mattress,
  can lead to sore formation in just 2 hours.
• If prolonged transports are common, do not place
  patient on a long backboard unless it is
  indicated for spinal immobilization.

26
Joint Disorders

• Figure 29-4 Osteoarthritis of hands.

27
Joint Disorders

• Arthritis inflammation of a joint.
• Osteoarthritis or degenerative joint disease
  (DJD) articular cartilage damaged and breaks
  down.
• Pain, warmth, tenderness, stiffness, swelling
  severe cases, malalignment and deformity of
  joint.
• Hands, spine, weightbearing joints (knee and
  hip) can occur in any joint.

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Joint Disorders

• Ankylosing spondylosis bones that form joints
  become fused.
• Gout form of arthritis from uric acid crystals
  being deposited in joint, often in foot.
• Bursitis inflammation of synovial fluidfilled
  sacs that protect tissues adjacent to joints.

29
Think About It

• Osteoarthritis is most common form.
• Occurs from wear and tear on joints over time.
• More common in middle-aged and older adults.
• In osteoarthritis, or degenerative joint disease
  (DJD), the articular cartilage is damaged and
  breaks down.

30
Bone Disorders

• Figure 29-6a Normal spongy bone.

31
Bone Disorders

• Figure 29-6b Spongy bone in osteoporosis.

32
Bone Disorders

• Osteopenia decrease in bone mass, occurs with
  aging.
• Osteoporosis when decrease has pathologic
  consequences.
• Kyphosis abnormal curvature of spine that gives
  hunchback appearance.
• Bone cancers (osteosarcoma Ewings sarcoma)
  common in children and young adults.

33
Think About It

• Lymphomas and multiple myeloma are lymphatic
  cancers, but can affect the bones.
• Cancers from other sites, such as lung cancer,
  can metastasize to bone.
• Bone cancers cause weakness of the bones and bone
  pain, and can result in pathologic fractures.

34
Muscular Disorders

• Muscular dystrophies genetic diseases that
  result in abnormalities of structural and
  functional muscle proteins progressive muscle
  degeneration and weakness.
• Duchennes muscular dystrophy males and onset
  between 3 and 7 years of age.
• Death often by early 20s due to respiratory
  failure.

35
Muscular Disorders

• Rhabdomyolysis breakdown of skeletal muscle
  traumatic and nontraumatic causes.
• Results in release of myoglobin can enter blood.
• Myoglobin toxic to epithelium of renal tubules
  can result in acute renal failure.

36
Muscular Disorders

• Rhabdomyolysis breakdown of skeletal muscle
  traumatic and nontraumatic causes.
• Hyperkalemia may occur result in cardiac
  dysrhythmia.
• Fibromyalgia chronic inflammatory disease of
  musculoskeletal system.

37
Think About It

• Fibromyalgia chronic inflammatory disease of
  the musculoskeletal system.
• Signs and symptoms multiple tender points, poor
  sleep, muscle stiffness, and muscle pain that
  have no other explanation.
• Commonly associated with chronic fatigue syndrome.

38
Neck and Back Disorders

• Figure 29-8 Herniated disc placing pressure on
  spinal nerve.

39
Neck and Back Disorders

• Figure 29-9 Scoliosis.

40
Neck and Back Disorders

• Lumbar strain and disc problems common causes of
  low back pain.
• Slipped disc or herniated disc disc material
  forced out of disc space.
• Sciatica sciatic nerve compressed pain radiates
  through buttocks and down leg.
• Scoliosis abnormal lateral curvature of spine.

41
Think About It

• Has your thinking about the case study changed
  since the beginning of the chapter?

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Chapter Summary

• Nontraumatic musculoskeletal and soft-tissue
  complaints can have many underlying causes.
• Consider systemic causes and localized problems.
• Obtain list of patients medications.
• Understand mechanisms and consequences of
  specific disorders.