Musculoskeletal Sytem 3

7/29/2019 Musculoskeletal Sytem 3

1/45

Bledsoe et al.,Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Division 3Trauma Emergencies


2/45



Chapter 22Musculoskeletal Trauma


3/45



Topics

Introduction to Musculoskeletal

Trauma

Anatomy and Physiology of the

Musculoskeletal System

Pathophysiology of the


Musculoskeletal Injury Assessment

Musculoskeletal Injury Management


4/45




InjuriesMillions of Americans experience

annually

Multiple MOI

Falls, crashes, violence, etc.

Multi-system trauma


5/45





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


6/45



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


7/45



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


8/45



Joint Structure (1 of 2)


9/45



Joint Structure (2 of 2)


10/45




Musculoskeletal System (1 of 3)

Skeletal Organization

206 bones

Axial skeletonHead, thorax, and spine

Appendicular skeleton

Upper extremities

Lower extremities


11/45



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




12/45





Types of Muscles

Smooth

Striated

Cardiac

Muscular Tissue and Structure

600 muscle groups


13/45



Muscles


14/45





15/45



Muscular Injury

Contusion

Compartment Syndrome

Penetrating Injury

Fatigue

Muscle Cramp

Muscle Spasm

Strain




16/45




Musculoskeletal System (2 of 5)Joint Injury

Sprain

Subluxation

Dislocation

Bone Injury

Open fracture

Closed fracture

Hairline fracture

Impacted fracture

Transverse


17/45





Pediatric Considerations

Flexible nature

Geriatric Considerations Osteoporosis

Pathological Fractures

Pathological diseases


18/45




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


19/45





Inflammatory and DegenerativeConditions

Bursitis

Tendonitis

ArthritisOsteoarthritis

Degenerative

Rheumatoid arthritisChronic, systemic, progressive, debilitating

GoutInflammation of joints produced by accumulation of

uric acid crystals


20/45



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


21/45




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


22/45



Detailed Exam of Extremities

Deformity

Contusions

AbrasionsPenetrations

Burns

Tenderness

LacerationsSwelling

Also check PMS.


23/45




Management (1 of 2)General Principles

Protecting open wounds

Positioning the limb

Immobilizing the injury Checking neurovascular function

PulsePalpate

Utilize pulse oximetry

Motor

Sensation


24/45




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


25/45




Care for Specific Fractures (1 of 4)

Pelvis

Scoop stretcher

Pelvic sling devicePASG as a reserve device only

Fluid resuscitation


26/45





Femur Fractures

Traction splints

Contraindicated in hip/knee injuries PASG

High-force injury

High potential for shock


27/45





Tibia-Fibula Fractures

Frequently open fractures.

Cover bone ends with moist dressing. Depending on level of fracture, use:

Rigid splint

Air splint

Pillow


28/45





Clavicle

Most frequently fractured bone in the

body Transmitted to 1st and 2nd rib

Alert for lung injury


29/45




ManagementCare for Specific Joint Injuries

Hip

Knee

Ankle

Foot

Shoulder

Elbow

Wrist/Hand

Finger

Be alert for

neurological

compromise.


30/45



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.


31/45



Hip Dislocation

Orthopedic emergency

Posterior dislocation most common

Hip flexed and leg rotated internallySevere pain on attempts to straighten


32/45



Hip Dislocation Management

Splint in most comfortable position.

Document sensation and pulse.

Prompt transport.Be alert for associated knee injuries or

fractures.


33/45



Knee Fracture or Dislocation

Orthopedic emergency

Frequently causes vascular injury

Dislocation associated with 50% rateof amputation of leg


34/45



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.


35/45



Foot or Hand Injury

Common industrial injury.

Often disabling.

Rarely life threatening.Splint foot with pillow.

Splint hand in position of function.


36/45



Shoulder Injury

AC Separation

Sling and swathe.

Shoulder Dislocation

Use pillow with sling and swathe.

Fracture

Use sling and swathe.


37/45



Elbow Injury

Fracture or dislocation may cause

neurovascular injury.

Splint in position found.

Transport promptly.


38/45



Forearm/Wrist Injury

Rigid Splint

Keep hand in position of function.

Air Splint

May be hard to reassess circulation.

Pillow


39/45




Management

Soft and Connective Tissue Injuries

Tendon

Ligament Muscle


40/45




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


41/45





Morphine Sulfate

Opiate alkaloid.

Reduces vascular volume and cardiac

preload. Do not administer to hypovolemic

patients.

Dose:

2 mg IVP slow

Counter agent:Narcan


42/45





Meperidine

Demerol

Narcotic analgesic

Dose50100 mg

Counter agentNarcan


43/45





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


44/45




Management

Other Injury Considerations

Pediatric musculoskeletal injury

Athletic musculoskeletal injury Patient refusals and referral

Psychological support


45/45

Summary


Trauma





Musculoskeletal Injury Assessment


Musculoskeletal Sytem 3

Documents