Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Musculoskeletal Injuries Revised: 11/2013

Transcription

1 Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Musculoskeletal Injuries Revised: 11/2013 (6 questions on trauma exam from this outline) Musculoskeletal Trauma DEFINITIONS Anatomic Positioning Standing erect, arms to side, palms up. Open Reduction use of surgery to place bones. Internal Fixation wires, pins, screws to place bones. Crepitus Bones grinding against each other. Like ribs and CPR. Cravats goes around an extremity. Sling goes around neck to hold up arm. Swathe goes around torso. SKELETAL SYSTEM Approximately 206 bones. Provides structure and protection. Ligaments support bone to bone. Tendons support muscle to bone.

2 Bones have a rich supply of blood, the larger the bone the more bleeding possible. The lining of the bone has the nerves (periosteum). This is why a fracture hurts. Young children are more flexible, injuries are more of a twisting motion. Problems associated with musculoskeletal Injuries Hemorrhage. Instability. Loss of tissue. Contamination. Interruption of blood supply. Nerve damage. Long term disability. BONE CLASSIFICATION Long bones humorous, femur. Short bones fingers, toes, wrist. Flat bones sternum, ribs, skull, scapula. Irregular or odd shaped bones vertebrae. MUSCULAR SYSTEM

3 Approximately 600 muscles. Support movement of the skeletal system. Point of origin doesn t move during contraction. Point if insertion the bone that moves during contraction. MUSCLES CELLS Skeletal muscle (voluntary or striated) found in skeletal movement. Involuntary muscle (smooth) control body organs. Vessels, GI Cardiac muscle (heart) sensitive to O2 levels and has automaticity. MECHANISM OF INJURY Direct force bat to body. Indirect force a fall and the wrist tries to catch the body. Twisting force football tackle that spins your body but the shoes are planted. FRACTURE INJURIES Open (compound) fracture skin is open. Closed (simple) fracture - skin is closed. Unstable bone moves freely.

4 Impacted jammed together. Angulated major curves. Dislocation frozen joint or locked joint. Greenstick - children bones flex like a greenstick. Spiral - twists around the bone. Transverse - Horizontal fx right across the bone. Oblique - Diagonal fx right through the bone. Comminuted - splintered into pieces fx. Growth plate (epiphyseal plate) fractures in children. Five types. If not treated may result in permanent angulations or deformity of bone. OPEN FRACTURES Most common open fractures are tibia and fibula. Most commonly fractured bone open or closed is the clavicle. Do not put back in, unless it goes in on its own. Traction splint are specifically designed for femur mid-shaft fx. CLOSED FRACTURES Hemorrhage into soft tissue.

5 Since skin is still closed Compartment Syndrome can take place. DISLOCATION Known as a frozen or locked joint. Possible nerve, vessel damage. 50% of dislocated knees and elbows have nerve damage. If knee or elbow try to splint as found. Spontaneously reduce or relocated popped back in. Subluxation is the pulling of the joint apart and goes back in. Luxation is a complete dislocation. STRAIN Tendon (muscle) pulled. Days to weeks to heal. Lifting something heavy. SPRAIN Ligament damage. Can take up to 8 months to heal. Twisted an ankle on a sidewalk.

6 I heard it pop. 3 degrees of sprains; 1st = no joint instability. 2nd = swelling and bruising but joint intact. 3rd = ligaments completely torn. Splint, ice for first 24 hours and x-ray. Bursitis Inflammation of bursa (small, fluid filled sac that acts as a cushion at pressure points. Knees, shoulders, and elbows most common. Results from pressure, friction, or slight injury to membranes surrounding joint. Care: Rest, ice and pain meds. Tendonitis Inflammation of a tendon. Often caused by injury. Pain, tenderness, sometimes restriction of movement. Nonsteroidal antiinflammatory most common treatment. Arthritis Inflammation of joint. Referred to as joint disease because many factor cause this. Pain, swelling, stiffness, and redness.

7 Rheumatoid arthritis - most severe. Autoimmune disorder. ASSESSMENT what to look for Swelling - indicates inflammation for protection and/or hemorrhage. Unusual color indicates contusion or hematoma. Purple, black, blue. Unusual position angulations, shorter than other side, false movement. Feel Bone ends grinding known as Crepitus. Loss of Nerve Supple PMS problems. Loss if Pulses distal cold and discolored. Capillary refill may be delayed if blood supple is affected. Pain Hurts with motion. Pain and Swelling is considered broken until x-ray. RULES FOR BASIC SPLINTING PMS checks before and after. Remove clothing in affected area. Open wounds dressed and bandaged before splinting. Open fractures with open site should use dry-sterile dressings. Do not put back in bones that have come out unless they went in on its own.

8 Pad the splints. No knots on the body to dig into tissue. Try to align the injured part into a more protective position if vulnerable. IF NO CREPITUS, MAJOR PAIN, OR FROZEN JOINT IS OBSERVED. Try to keep knees and elbows as found. If not contraindicated try to bring the elbow to a 90 degree position to the body and use a sling and swathe. If not contraindicated try to leave a little natural flex in the knee joint while splinting with rigid splints or air splints. Ice for first 24 hours minimum to reduce swelling. DCAP-BTLS During physical exam look for; D-deformity C-contusions A-abrasion P-punctures B-burns T-tenderness L-lacerations S-swelling HEMORRHAGE COMPLICATION After ABC control major bleeding. Follow four steps to control bleeding. Tib/Fib fx bleeds about 500mL, Femur fx bleeds about 1000mL, Pelvis bleeds about 2000mL - give or take depending on textbook.

9 Always an unstable pelvis is a priority over a femur on exams. If multiple life threatening injuries are present a fracture is not an immediate priority. Place on long back board if that bad. PASG is preferred for tib/fib bleeding control because it splints and provides direct pressure. PMS COMPLICATION If no distal PMS the EMT has one chance to gently align the extremity with gentle traction and splint when pulse returns. If still no pulse splint as is and transport. SPLINTS Hard like a board. Something you would not like across your face. Soft pillow. Something you would like across your face. Air (Pneumatic) splints like PASG but made for body parts. Traction used only on isolated mid shaft femur fractures with no other injury. Hip/pelvis Fracture splinting PASG as splint Long back board with padding. Leg/hip shorter than the other leg and rotated supports dislocation.