Musculoskeletal Trauma. Lesson Goal. Lesson Objectives 9/10/2012. Recognize and manage patients with musculoskeletal trauma
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1 Musculoskeletal Trauma Lesson Goal Recognize and manage patients with musculoskeletal trauma Lesson Objectives Describe function of muscular system Describe composition of muscular system Describe, compare, and contrast different injuries to muscular system Describe function of skeletal system 1
2 Lesson Objectives Describe composition of skeletal system: Head Spinal column Thorax Upper and lower extremities Describe structures within a joint Compare and contrast different types of joints Lesson Objectives Distinguish between open & closed skeletal injuries Define splinting List reasons for splinting List rules for splinting Lesson Objectives Explain splinting procedures Explain complications of splinting Explain situations in which splinting on scene is not acceptable and why 2
3 Introduction EMS commonly called to assess and manage musculoskeletal injuries EMTs need to understand functions of musculoskeletal system, musculoskeletal injuries, and care of musculoskeletal injuries Muscular System Functions Provide shape Protection Motion Move blood through body Move food through digestive tract Types of Muscles Voluntary Under conscious control Involuntary Automatic Function without thought Skeletal Striated Voluntary Cardiac Striated Involuntary Smooth Nonstriated Involuntary 3
4 Types of Muscles Muscle groups work together under control of nervous system Movement is produced when muscles contract & shorten Skeletal muscles contained within fascia Injuries to the Muscular System Types of injuries Strain Sprain Laceration Contusion Crushing injury Avulsion Puncture Swelling may impede circulation Injuries to the Muscular System Assessment of a muscular injury yields a painful, swollen extremity 6 Ps Pain Pallor Pulses Paresthesia Paralysis Pressure/puffiness 4
5 Direct Forces that Produce Injury Indirect Twisting Treatment of Muscular Injuries Similar to treatment of other soft tissue injuries Splint Functions of Skeletal System Support & protect Made of calcium & living tissue Rich blood supply Marrow cavity Yellow marrow Red marrow 5
6 Skeletal System Classification of Bones Long Humerus, femur Short Carpals, tarsals Flat Ribs, sternum Irregular Vertebrae, facial bones Skull 6
7 Spine Spinal column (vertebral column) 7 Cervical 12 Thoracic 5 Lumbar 1 Sacrum (5 sacral) 1 Coccyx (4 or 5 coccygeal ) Thorax Upper Extremity Pectoral girdle Clavicles Scapulae Arm Humerus Radius Ulna Wrist 8 carpals (2 rows of 4) Hand 5 Metacarpals 14 Phalanges 7
8 Lower Extremity Ligaments, Cartilage & Joints Ligaments connect bone to bone Cartilage covers bone ends Bones come together at joints Fibrous little or no movement Cartilaginous some movement Synovial allow different types of motion Synovial Joints Joint capsule contains synovial fluid Types Plane or gliding Saddle Hinge Pivot Ball & socket Ellipsoidal 8
9 Injuries to Skeletal System Can involve joints &/or bones May be open or closed Sign & symptoms: Swelling Pain Deformity Crepitus Musculoskeletal Injuries X-rays used to determine type of injury Fracture Dislocation Musculoskeletal Injuries Fracture Dislocation 9
10 Assessment 6 Ps Pain/tenderness Pallor or skin color Pulses Paresthesia Paralysis Pressure/puffiness Management When in doubt, splint Importance of splinting Reduces pain Controls bleeding Prevents further injury Splinting never takes precedence over ABCs! Objectives of Splinting Stabilize injury to prevent movement Prevent further injury by stabilizing bone ends Provide some pain relief by stabilization Restore or maintain circulation to extremity Provide padding during transport 10
11 If it is painful, swollen, or deformed, splint it Rules of Splinting Completely immobilize injury & surrounding area Bones From joint above to joint below Joints From bone above to bone below In Preparation for Splinting Support injured area Remove clothing & jewelry Assess distal pulse, motor & sensory function In Preparation for Splinting Apply gentle, inline traction if Pulses are absent Distal extremity is cyanotic Gross deformity is present Do not reinsert protruding bone ends Cover open wounds with sterile dressings Pad splint Maintain position of function Splint before moving patient 11
12 Types of Splints Rigid board Ladder Traction Air Vacuum Formable Anatomic Sling and swathe Rigid Board Splint Skill 28-1: Rigid Splint 1. Check distal pulses; stabilize extremity above and below fracture site before manipulating extremity 2. Apply rigid splints on at least 2 sides of extremity 12
13 Skill 28-1: Rigid Splint 3. Wrap splints securely to extremity, moving distal to proximal 4. Recheck distal pulses after applying splints Skill 28-1: Rigid Splint Video Clip coming soon Ladder Splint 13
14 Traction Splint Skill 28-2: Traction Splint 1. Check distal pulses while supporting injured extremity 2. Attach ankle strap and apply manual traction, then check distal pulse Skill 28-2: Traction Splint 3. Adjust traction splint to proper length using uninjured extremity as guide 4. Slide splint under injured extremity and fasten strap at top of splint; recheck distal pulse 14
15 Skill 28-2: Traction Splint 5. Attach traction device to ankle strap; ratchet up traction until device takes traction away from EMT applying manual traction 6. Recheck distal pulse after traction is turned over to device Skill 28-2: Traction Splint 7. Attach leg straps to secure leg in splint Skill 28-2: Traction Splint Video Clip coming soon 15
16 Skill 28-2: Traction Splint Video Clip coming soon Air Splint Vacuum Splint 16
17 Skill 28-3: Vacuum Splint 1. Lay splint on flat area, smooth out until plastic beads are evenly distributed. Remove some air from splint so sides do not collapse when splint is shaped 2. Place splint underneath extremity and bend it into a U-shape around extremity, fasten Velcro fasteners. Form each major curve around any bend in extremity so that extremity is held completely in place Skill 28-3: Vacuum Splint 3. Use pump to remove remaining air, leaving splint rigid 4. Check distal circulation on extremity Skill 28-3: Vacuum Splint Video Clip coming soon 17
18 Pillow Splint Formable Splint Application Video Clip coming soon Anatomic Splint 18
19 Sling and Swathe Skill 28-4: Sling and Swathe 1. Check distal pulse and sensation, then apply sling 2. Wrap upper arm to chest without restricting breathing Skill 28-4: Sling and Swathe 3. Recheck distal pulse and sensation after securing sling 19
20 Reassessment Reassessment after splinting is essential Recheck distal: Pulse Sensation Motor function Multisystem Trauma Skeletal trauma may be obvious & distracting, but may not be the most serious injury Assess patient for potential life threats Manage life threats first Use anatomic splinting if patient is in load & go situation Summary Musculoskeletal system has many important functions & is commonly injured Injuries present with pain, swelling, deformity After the ABCs, assess the 6 Ps Manage with splinting, elevation, & cold Reassess after splinting 20
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