Chapter 13 Musculoskeletal Injuries. §Rarely life-threatening §Can have serious consequences and...
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Transcript of Chapter 13 Musculoskeletal Injuries. §Rarely life-threatening §Can have serious consequences and...
Chapter 13
Musculoskeletal Injuries
Musculoskeletal Injuries
Rarely life-threateningCan have serious consequences and
permanent disability if not recognized or care for properly
Mechanism of injury is an important clue as to what injuries may be present
Definitions
Fracture A break in the continuity of bone
• May be complete, with ends widely separated or incomplete with a hairline crack
• May be open or closed
Sprains Injuries to ligaments
• Usually from stretching forces
Definitions
Strains Injuries to muscles or tendons
• Usually from over stretching or violent contractions
Dislocations Displacement of bones in a joint from their
normal anatomical positions.• Stretching or tearing of ligaments must also take
place
Prehospital Care
A painful, swollen, deformed extremity is treated as if a significant bony or soft tissue injury has occurred
Mechanisms of Injury
Forces Direct Indirect Twisting Violent muscular contractions Pathological
Bone & Joint Injuries
Open and Closed Injuries Closed or simple fractures
• Displaced (angulated) or non-displaced Open or compound fractures
• Can result from– penetrating wounds
– lacerations from crush injuries
– sharp bone fragments tearing through the soft tissue
• Can be displaced or non-displaced
Signs and Symptoms
Pain and Tenderness Most common
• Often only signs of fracture
• Point tenderness or guarding
• Pain may be referred distal or proximal to the injury site
Deformity or Angulation Protuberance of bone end against soft tissues Overriding or separation of bone fragments
Signs and Symptoms
Swelling and Discoloration Can be an early sign or may not be apparent for
several hours• Always remember to do a bilateral comparison
• Initially may be redden, ecchymosis may appear quickly or be delayed
Loss of Motion Can result from pain on attempted movement or gross
disruption of area• Never attempt to force movement
Less Common Signs and Symptoms
Grating or Crepitus• Sound or sensation
• Do Not attempt to elicit this finding
Exposed Bone• Obvious sign of an open fracture
Loss of Distal Pulse or Sensation• Numbness and/or tingling
• False Motion
Involuntary Muscle Spasms
Dislocations
Complete or Partial Can result from direct or indirect forces Can be associated with a fracture Signs specific to dislocations include:
• Loss of motion
• Deformity at joint
• Joint locked into position
• Pain & swelling over joint
Care of Musculoskeletal Injuries
Perform Scene Size-upInitial Assessment
Use Appropriate Body Substance Isolation Do not become distracted by grotesquely
angulated or deformed extremities Life-threatening conditions ALWAYS come first
• Direct attention to extremities after managing life-threatening conditions and after stabilization of spinal injuries
Care con’t.
Detailed Exam Carefully cut away clothing to expose injury
site Use DOTS (deformity, open injuries, trauma
and swelling) or DCAP/BTLS (deformities, contusions,
abrasions, punctures/burns, tenderness, lacerations and swelling)
Care con’t.
Administer oxygenDress open woundsTreat for shockApply cold packs (if applicable) to reduce
swelling and painSplint (as necessary to your situation) and
elevate following splitting if applicable
Splinting
Rationale for Splinting Reduces pain Prevents further injury
• Bleeding (average blood loss with a closed fracture)– Radius & ulna 150-250 ml
– Humerus 250 ml
– Pelvis 1500-3000 ml
– Femur 1000 ml
– Tib/Fib 500 ml
Splinting
General Rules
Immobilize Critical Patient with a Spine Board When in Doubt, Splint Splint Prior to Moving Pad Splints (Remove Clothing) Immobilize Above & Below Injury
Splinting con’t.
General Rules con’t.
Check & Recheck Neurovascular Function Cover Open Wounds Treat Protruding Bones Splint in Position Found Severe Deformities
Splinting
Types Rigid Soft Sling and Swathe Improvised Air Splints
Application In Lab
Specific Musculoskeletal Injuries
BonePossible Signs &Symptoms Treatment
Clavicle Obvious deformity Sling & swatheShoulder Dropped shoulder, arm
held to chest, loss of contourSling & swathe
Humerus Obvious deformity,swelling, limited motion
Rigid splint, sling &swathe
Elbow Obvious swelling, deformity Rigid splint & sling& swathe
Radius/UlnaWrist
Deformity Rigid splint, slingand swathe
Hand Deformity, loss of function Position of function,rigid splint, sling &swathe
Specific Musculoskeletal Injuries
BonePossible Signs &Symptoms Treatment
Pelvis Pain, shock, mobility ofpelvic ring oncompression
Spine board
Dislocated Hip Pain & locked joint Legs together withsupport, spine board
Hip Injury Shortened & externallyrotated extremity
Same
Femur Swelling, deformity, signsof shock
Isolated mid-femur,traction splint;
Knee Deformity, locked,unstable
Rigid, position found
Tib/Fib Deformity Rigid splintAnkle/Foot Pain, deformity Soft splint
Head and Spinal Injuries
~ 2 Million Head and Spinal injuries Yearly Which Are Serious Enough to Require Medical Attention 80,000 permanently disabled
• ~48% from MVAs
• ~21% from Falls
• ~14% from Sports
• ~15% from Acts of Violence
• ~2% Other
Head and Spinal Injuries
Should Be Considered Serious If: Fall from a height equal to or greater than own
height Diving mishap (hitting board or diving into
shallow water) Unconsciousness for unknown reason Blunt force trauma to the head, trunk or pelvis Gunshot wound penetrating the head or trunk
Head and Spinal Injuries
Seriousness con’t. Motor vehicle accident where person is
unrestrained and has impact with windshield Thrown (from vehicle, motorcycle, horse, etc. Broken helmet (motorcycle, bicycle, football,
industrial) Lightening strike Unconscious in water 5 feet or less in depth
Spinal Injuries
Signs and Symptoms Point tenderness Pain with movement (Do Not have patient
attempt movement) Paralysis of arms &/or legs
• Numbness, tingling, weakness• Loss of sensation
Significant trauma to head, shoulders, back, abdomen, pelvis
Spinal Injuries
Signs and Symptoms con’t. Intermittent pain along spine, down legs Bruises, cuts or edema along the spine Respiratory distress Shock Unresponsiveness Incontinence Priapism
Head Injuries
Signs and Symptoms (may be obvious immediately or develop over time) Alternating level of consciousness Slow, bounding pulse Deformity (can be obvious) (rare) Penetrating injury Blood or CSF from the nose or ears Raccoon eyes Battle’s sign
Head Injuries
Signs and Symptoms con’t. Cushing’s syndrome (B.P.-up, Pulse-down) Nausea, vomiting Visual disturbances
• Doll’s eye response, Unequal or unreactive pupils Headaches Irregular or abnormal respiratory patterns
• Cheyne-Stokes, Ataxic Respirations, Apneustic Respirations, Diaphragmatic Respirations
Head Injuries
Signs and Symptoms con’t. Seizures Personality changes
• Combative or aggressive Auditory disturbances
• Ringing
• Equilibrium problems (Do Not Test) Posturing
• Decorticate or Decerebrate
Head and Spinal Injuries
General Rule of Thumb If mechanism of injury exerts great force to the
upper body or if there is soft tissue damage to the head, face or neck due to trauma, assume there is a possible cervical spinal injury.
Any unconscious patient who is the victim of an accident must be cared for as a spinal injury patient.
Head and Spinal Injuries
Assessment and Care Minimize movement A, B, C’s with in-line stabilization Control external bleeding Maintain body temperature Ongoing assessment every 5 minutes Oxygen if available
Chest Injuries
Signs and Symptoms Pain at injury site Pleurisy Dyspnea Inadequate or unequal chest expansion Hemoptysis Cyanosis Weak, rapid pulse
General Principles of Care
Secure and maintain airway (modified jaw thrust)
Control external bleedingCover penetrating/perforating woundsReassess patient every 5 minutes
Specific Injuries
Rib Fractures Common injury 4-9 (5-10) most common Patient often leans toward injured sign Multiple fractures (Flail chest)
• 2 or more ribs with 2 or more fracture points
• Watch for paradoxical breathing
Specific Injuries
Penetrating Chest Injuries Pneumothorax Tension Pneumothorax Spontaneous Pneumothorax Hemothorax Sucking Chest Wound Pericardial Tamponade
• Narrowing of systolic & diastolic pressure readings
• JVD (jugular vein distention)
Specific Injuries
Compression Injury Complications Pulmonary Contusion
• Most commonly from blunt trauma Myocardial Contusion
• Not detectable in the field
Abdominal Injuries (Blunt and Penetrating)
Signs and Symptoms Bruising
Imprint marks, Entry & exit wounds B.P. down, pulse up, shock Local or diffuse abdominal tenderness, referred
pain Abdominal distension, Nausea and/or vomiting Evisceration Other signs/symptoms of bleeding or shock
Assessment and Care
Leave in position found if possible If evisceration present, lie patient supine with knees
slightly flexed and supported
Inspect for entry and exit woundsControl external bleeding, stabilize impaled
objects, treat for shockEviscerations
Do Not replace organs, cover with an occlusive dressing, keep patient warm