Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Paramedic Care:Principles & Practice
Volume 5Trauma Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Introduction to Musculoskeletal TraumaAnatomy and Physiology of the Musculoskeletal SystemPathophysiology of the Musculoskeletal SystemMusculoskeletal Injury AssessmentMusculoskeletal Injury Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to Musculoskeletal Injuries
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to Musculoskeletal Injuries
In trauma, incidences of musculoskeletal injury are second in frequency only to soft-tissue injuries. – Millions of Americans sustain musculoskeletal
injuries each year. – Multiple MOI
Falls, crashes, violence, etc.Multi-system trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Prevention StrategiesApplication of modern vehicle and highway designs and safe driving practices – Use of restraints
Workplace safety standardsSports activities remain a significant cause of injury – Protective gear, improved equipment design, and
better conditioning of athletes has reduced injuriesHousehold accidents and falls – Use of good safety practices
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Skeletal Tissue and Structure– Gives the body its structural form– Protects vital organs– Promotes efficient movement despite the forces of
gravity– Stores salts and other materials needed for
metabolism– Produces red blood cells
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Bone Structure– Diaphysis– Epiphysis– Metaphysis
Growth plate– Medullary canal– Periosteum– Cartilage
Provides a smooth articulation surface for other bones
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Bone Classification– Bones are classified according to their general
shape Long
Humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals, and phalanges
ShortCarpals and tarsals
IrregularVertebrae, facial
FlatCranium, sternum, ribs, shoulder, and pelvis
SesamoidPatella
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Joint Structure– Three basic types of joints
SynarthrosesImmovable joints
AmphiarthosesVery limited movement
DiarthrosesSynovial jointsPermit free movement
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Diarthroses – Monaxial
jointsHinge jointsPivot joints
– Biaxial jointsCondyloid Ellipsoidal Saddle joints
– Triaxial jointsBall-and-socket
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Ligaments– Bands of connective
tissue that hold bones together at joints
Joint Capsule– Synovial capsule– Synovial fluid– Bursae
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Skeletal Organization– 206 bones– Axial skeleton
Head, thorax, and spine
– Appendicular skeleton
Upper extremitiesLower extremities
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bone Aging– Birth to adult (18–20)
Transition from flexible to firm bone– Adult to elderly (40+)
Reduction in collagen matrix and calcium saltsDiminution of bone strengthSpinal curvature
Anatomy and Physiology of the Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Types of Muscles– Smooth– Striated– Cardiac
Muscular Tissue and Structure– 600 muscle groups
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscles
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the Musculoskeletal System
Skeletal muscles attach to the bones at a minimum of two locations – Origin– Insertion
Opposition– Allows straightening of
muscles
TendonsMuscle tone
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The complex arrangement of connective, skeletal, vascular, nervous, and muscular tissue is endangered whenever significant kinetic forces are applied to the extremities.
Pathophysiology of the Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury– Results from direct blunt or penetrating trauma,
overexertion, or problems with oxygen supply during exertion
– Injuries include:Contusions Compartment syndromePenetrating injuriesFatigueCramps SpasmsStrains
Pathophysiology of the Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Contusion– Small blood vessels rupture with crushing forces– Blood will pool beneath or within tissue layers
Compartment Syndrome– Occurs in extremities– Contained by the fascia, this swelling increases
the pressure within the compartment – Deep and burning pain that appears out of
proportion to the apparent injury
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Penetrating injury– Deep lacerations may penetrate skin and
subcutaneous tissues Affects muscles belowContraction of the opposing muscle
Fatigue– Muscles reach their limit of performance – Cells become hypoxic– Strength diminishes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Muscle Cramping– A painful spasm of the muscle tissue – Due to accumulation of wastes
Electrolyte imbalances Lactic acid
Muscle Spasms– An intermittent (clonic) or continuous (tonic)
contraction– Spasm usually subsides with rest
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Strain– Occurs when muscle fibers are overstretched by
forces that exceed the strength of the fibers Tearing of muscle occurs
– Fibers are damaged without internal bleeding, edema, or discoloration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the Musculoskeletal System
Joint Injury– Sprain– Subluxation– Dislocation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Injury
Sprain– Tearing of a joint capsule’s connective tissues
Ligaments– Classified according to degree of tear
Subluxation– A partial displacement of a bone end from its
position within a joint capsule – Differs from the sprain in that it more significantly
reduces the joint’s integrity
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Injury
Dislocation– A complete
displacement of bone ends from their normal joint position
– Danger of entrapping, compressing, or tearing blood vessels and nerves
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the Musculoskeletal System
Bone Injury– Caused by extreme
compressional forces or significant lateral forces
Exceeds the tensile strength of a bone
May be open or closed
© Mark C. Ide
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Fractures
Types of Fractures– Hairline fracture– Impacted fracture– Transverse– Oblique– Comminuted– Spiral– Fatigue
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the Musculoskeletal System
Pediatric Considerations– Flexible nature
Greenstick fracture– Epiphyseal fracture
Geriatric Considerations– Osteoporosis
Pathological Fractures– Pathological diseases
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the Musculoskeletal System
General Considerations with Musculoskeletal Injuries– Neurological compromise– Decreased stability– Muscle spasm
Bone Repair Cycle– Osteocytes produce osteoblasts– Deposition of salts– Increasing strength of matrix
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the Musculoskeletal System
Inflammatory and Degenerative Conditions– Bursitis– Tendinitis– Arthritis
OsteoarthritisDegenerative
Rheumatoid arthritisChronic, systemic, progressive, debilitating
GoutInflammation of joints produced by accumulation of uric acid crystals
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Assessment
A patient with an isolated musculoskeletal injury will receive complete assessment and management at the scene. Look for indications of the severity of the trauma forces and the possibility that the forces also caused internal injuries.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Scene Size-up– Don the appropriate personal protective
equipment – Clues to specific injuries
MOI– History may suggest other injuries
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Initial Assessment– Categories of urgency
Life- and limb-threatening injuryLife-threatening injury and minor musculoskeletal injuryNon-life-threatening injuries but serious musculoskeletal injuriesNon-life-threatening injuries and only isolated minor musculoskeletal injuries
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Rapid Trauma Assessment– Performed on any patient with any sign, symptom,
or mechanism of injury that suggests serious injury
– Perform in a carefully ordered way Pay attention to pelvis and femur areas
May be significant blood loss
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Focused History and Physical Exam– Observe and inquire carefully for signs and
symptoms of fracture, dislocation, or other musculoskeletal injury in each limb with suspected injury
– 6 Ps: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
– Carefully evaluate the distal circulation, sensation, and motor function
– Identify all injuries, prioritize them, and establish the order of care for them
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Detailed Physical Exam– A search for the signs and symptoms of further
injury Head-to-toe
– Look specifically where you have not looked before and with enough care to identify any subtle indications of injury
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Ongoing Assessment– Focus
Serial measurement of the patient’s vital signs, level of consciousness, and the signs and symptoms of the major trauma affecting the patient
– Monitor distal sensation and pulses frequently
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Sports Injury Consideration– Assess the mechanism of injury – Determine whether there was a major kinetic force
involved – Downplaying of injuries– Specific and serious musculoskeletal injury
associated with sports is the sprainCommonly the knee
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
General Principles– Protecting open wounds– Positioning the limb
You should not attempt alignment of dislocations and serious injuries within 3 inches of a joint.
– Immobilizing the injury– Checking neurovascular function
Pulse, motor, sensation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
ManagementSplinting Devices– Rigid splints– Formable splints
Vacuum splintsAir splints
– Soft splints– Traction splints– Other splinting aids
Cravats or Velcro splints
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Fracture Care– Carefully immobilize the limb in the position found
unless there is a significant circulatory or nervous deficit.
– Ensure distal pulses, sensation, and motor function.
– If you identify any neurovascular deficit, attempt to correct the problem by gentle repositioning.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Joint Care– Assess for distal neurovascular function
If present, immobilize the joint in the position found If absent, consider moving the limb to reestablish it
Reduction
– Splint the limb in the position of function and transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Muscular and Connective Tissue Care– To manage muscle, tendon, and ligament injuries,
immobilize the region surrounding them – Provide gentle circumferential bandaging
Monitor distal circulation – Application of local cooling – Elevation and position of function
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific FracturesPelvis– Involves either the
iliac crest or the pelvic ring
Pelvic ring fractures are often serious, life-threatening events due to hemorrhage
– Pelvic sling devicePASG as a reserve device only
– Fluid resuscitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific FracturesFemur Fractures– High-force injury– High potential for
shock– Assessment
considerations– Traction splints
Do not use if suspected pelvic, knee, tibia, or foot injuries
– PASG
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Tibia-Fibula Fractures– Frequently open fractures– Cover bone ends with moist dressing– Depending on level of fracture, use:
Rigid splintAir splintPillow
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
ClavicleMost frequently fractured bone in the body
Has the potential to cause serious internal injury
Transmitted to 1st and 2nd ribBe alert for lung injuryImmobilize the affected limb in a sling and swathe against the chest
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Humerus– Difficult to immobilize at its proximal end
Most effective technique for splinting this fracture is to apply a sling and swathe
Radius/Ulna– Most commonly, fracture occurs at the distal end
of ulnaDisplaces in volar direction (toward palm)Colles’ fracture
– Splint forearm fractures with a short, padded rigid splint
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Hip– The hip may dislocate in two directions
AnteriorWith the foot turned outward and the head of the femur palpable in the inguinal area
PosteriorMost common Knee flexed and the foot rotated internally
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Hip Dislocation Management – Splint in most comfortable position– Document sensation and pulse– Prompt transport– Be alert for associated knee injuries or fractures
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Knee Fracture or Dislocation – Orthopedic
emergency– Frequently causes
vascular injury– Dislocation
associated with 50% rate of amputation of leg
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Knee Fracture or Dislocation– Obvious 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
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Foot or Hand Injury – Common industrial
injuries– Often disabling– Rarely life
threatening– Splint foot with
pillow– Splint hand in
position of function
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint InjuriesShoulder Injuries– Most commonly involves the proximal humerus,
lateral scapula, and distal clavicle– Shoulder Dislocation
Anterior dislocations displace the humoral head forward Posterior dislocations rotate the arm internally
The elbow and forearm held away from the chest Use pillow with sling and swathe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Elbow Injury – Fracture or
dislocation may cause neurovascular injury
– Splint in position found
– Transport promptly
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Wrist/Hand Injury– Noticeable deformity and significant pain reported
by the patient – Rigid Splint
Keep hand in “position of function”– Air Splint
May be hard to reassess circulation– Pillow
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Finger – Forces may displace the phalanges from their
joints May occur between the phalanges May occur between the proximal phalanx and the metacarpal
– Use tongue depressor to splint– Malleable splints
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Soft and Connective Tissue Injuries
Massive muscular contusions and hematomas may contribute to hypovolemia. Ligament and tendon injuries can endanger the future function of a limb. Treat these injuries as you would dislocations and immobilize the adjacent joints.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
MedicationsNitrous Oxide– 50% O2:50% N2O– Non-explosive– Effects dissipate in 2–5
minutes– Easily diffused into air-
filled spaces in body– Dose
Inhaled and self administered
– Onset1–2 minutes
Diazepam– Benzodiazepine– Antianxiety– Analgesic– Dose
5–15 mg titrated– Onset
10–15 minutes– Duration
15–60 minutes– Counteragent
Flumazenil
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
MedicationsMorphine Sulfate– Opiate alkaloid– Reduces vascular volume and cardiac preload– Do not administer to hypovolemic patients– Dose:
2mg IVP slow– Counteragent:
Narcan
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
MedicationsMeperidine– Demerol– Narcotic analgesic– Dose
50–100 mg– Counteragent
Narcan
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
MedicationsSublimaze– Fentanyl– Synthetic opioid– Equivalent to morphine– Dose
25–50 mg SIVP followed by an additional 25 mg as needed
– OnsetLess than a minute
– Duration3–6 hours
– ConsiderationsIf given too rapidly, chest wall rigidity may ensue, leading to respiratory compromise
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury Management
Other Injury Considerations– Pediatric musculoskeletal injury
Greenstick fractures and epiphyseal fractures – Athletic musculoskeletal injury
Injuries to the joints are common – Patient refusals and referral– Psychological support
Concerned attitude and a professional demeanor Communicating frequently and compassionately
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Introduction to Musculoskeletal TraumaAnatomy and Physiology of the Musculoskeletal SystemPathophysiology of the Musculoskeletal SystemMusculoskeletal Injury AssessmentMusculoskeletal Injury Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ