Chapter 14: Injuries to Muscles and Bones

Cognitive Objectives

5-3.1 Describe the function of the musculoskeletal system.

5-3.2 Differentiate between an open and a closed painful, swollen, deformed injury.

5-3.3 List the emergency medical care for a patient with a painful, swollen, deformed extremity.

5-3.4 Relate mechanism of injury to potential injuries of the head and spine.

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Cognitive Objectives

5-3.5 State the signs and symptoms of a potential spine injury.

5-3.6 Describe the method of determining if a responsive patient may have a spine injury.

5-3.7 List the signs and symptoms of injury to the head.

5-3.8 Describe the emergency medical care for injuries to the head.

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Affective Objectives

5-3.9 Explain the rationale for the feeling patients who have need for immobilization of the painful, swollen, deformed extremity.

5-3.10 Demonstrate a caring attitude towards patients with a musculoskeletal injury who request emergency medical services.

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Affective Objectives

5-3.11 Place the interests of the patient with a musculoskeletal injury as the foremost consideration when making any and all patient care decisions.

5-3.12 Communicate with empathy to patients with a musculoskeletal injury, as well as with family members and friends of the patient.

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Psychomotor Objectives

5-3.13 Demonstrate the emergency medical care of a patient with a painful, swollen, deformed extremity.

5-3.14 Demonstrate opening the airway in a patient with suspected spinal cord injury.

5-3.15 Demonstrate evaluating a responsive patient with a suspected spinal cord injury.

5-3.16 Demonstrate stabilizing of the cervical spine.

Knowledge and Attitude Objectives

1. Describe the mechanisms of injury for musculoskeletal injuries.

2. Describe the need for body substance isolation techniques when examining or treating patients with musculoskeletal injuries.

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Knowledge and Attitude Objectives

• Shoulder girdle• Dislocation of the

shoulder • Elbow injury • Injury to the forearm• Injury to the hand,

wrist, or fingers

• Pelvic fracture • Hip injury • Injury to the thigh• Knee injury• Leg injury • Injury to the ankle or foot

3. Explain how to splint the following sites and injuries:

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Knowledge and Attitude Objectives

4. Explain the two types of head injuries.

5. Describe the treatment of facial injuries.

6. Explain the mechanism of spine injuries.

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Knowledge and Attitude Objectives

7. Describe the signs, symptoms, and treatment of the following injuries:• Fractured ribs • Flail chest • Penetrating chest wound

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Skill Objectives

1. Perform body substance isolation techniques when treating a patient with musculoskeletal injuries.

2. Examine a patient with musculoskeletal injuries.

3. Evaluate the circulation and sensation of a patient with an extremity injury.

4. Treat injuries of the face.

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Skill Objectives

5. Treat the following injuries of the chest:• Fractured ribs • Flail chest• Penetrating chest injuries

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Injuries to Muscles and Bones

• First responders encounter many types of musculoskeletal injuries.

• Providing proper care at the scene can prevent additional injury and disability.

The Skeletal System

• Consists of 206 bones• Four functions:

1. Supports the body

2. Protects vital structures

3. Assists in body movement

4. Manufactures red blood cells

Divisions of the Skeletal System

• Head• Spinal column• Shoulder girdle• Upper extremity

• Rib cage• Pelvis• Lower extremity

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Divisions of the Skeletal System

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Spine

• Consists of a series of separate bones called vertebrae• Spinal cord

– Nerves that carry messages to and from brain– Passes through hole in center of each vertebra

• Primary support structure for the entire body

Muscular System

• Provides support and movement• Muscles are attached to bones by tendons.• Body has three types of muscles:

– Voluntary (skeletal): Controlled by person– Involuntary (smooth): Cannot be controlled by person– Cardiac: Found only in the heart

Mechanism of Injury

• How injuries occur • Causes of musculoskeletal injuries:

– Direct force– Indirect force– Twisting force

• PSDE = Painful, swollen, deformed extremity

Fractures

• Two types: – Open– Closed

• Both kinds injure adjacent soft tissues.

• Can result in bleeding

Dislocations and Sprains

• Dislocations– A disruption tears the supporting ligaments of the

joint. – Very painful to move

• Sprains – Joint injury caused by excessive stretching of

supporting ligaments– A partial dislocation

Body Substance Isolation

• Patients with musculoskeletal injuries may haveopen wounds.

• Wear approved gloves.• Use heavy rescue gloves if responding to scene

involving broken glass.

Signs and Symptomsof Extremity Injuries

• Pain at injury site• Open wound• Swelling and discoloration (bruising)• Inability to move extremity• Deformity or angulation• Tenderness at injury site

Exam of an Injured Limb

• Check an injured limb for:– Open wounds– Bleeding– Swelling– Deformity– Bruising

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Exam of an Injured Limb

• Check the extremity for: – Pulse– Capillary refill – Sensation– Movement

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Treatment of Musculoskeletal Injuries

• All limb injuries are treated the same way in the field: – Cover open wounds. – Control bleeding if necessary. – Splint limb.

Principles of Splinting

• Remove clothing.• Assess limb.• Cover all open

wounds with dressing.• Do not attempt to

move before splinting.• Immobilize joint above

and below injury.

Splints

• Rigid splints – Made from firm material (padded boards)

• Soft splints – Inflatable, clear plastic

• Traction splints – Holds a lower extremity fracture in alignment

Elbow Injuries

• Do not move an injured elbow from the position in which you find it.

• Pillow splints helpstabilize injured elbows.

Hip Injuries

• Hip fractures – Occur at the upper end of the femur– Osteoporosis causes bones to become more fragile.

• Dislocated hips – Extremely painful

Injuries of the Thigh

• A fractured femur is very unstable and usually produces significant deformity.

• Often much bleeding and swelling• Treat for shock and help prevent further injury.

Injuries to the Head

• Common causes of death, paralysis, and permanent brain injury

• May occur from many different kinds of trauma• Types:

– Closed head injury – Open head injury

Signs and Symptomsof Head Injuries

• Confusion• Unusual behavior• Unconsciousness• Decreasing consciousness• Nausea or vomiting• Unequal pupils

• Paralysis• Seizures• External head trauma:

– Bleeding– Bumps– Contusions

Treatment of Head Injuries

• Stabilize head in a neutral position.• Maintain an open airway using the jaw-thrust technique.• Support patient’s breathing.• Monitor circulation.

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Treatment of Head Injuries

• Check to see if CSF or blood is seeping from wound, nose, or ears.

• Control bleeding.• Examine and treat other

serious injuries.• Arrange for prompt transport.

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Treatment of Facial Injuries

• Stabilize head in a neutral position.• Maintain an open airway.• Support breathing as needed.• Monitor circulation.• Control bleeding.• Look for and stabilize other serious injuries.• Arrange for prompt transport.

Injuries to the Spine

• Mechanisms of injury– Pressure on spinal cord from displaced vertebrae,

swelling, or bleeding– Cord is severed, resulting in paralysis.– Gunshot wounds– Falls, motor vehicle collisions, and stabbing

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Injuries to the Spine

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Signs and Symptomsof Spinal Injuries

• Laceration, bruise, or other sign of injury to head, neck, or spine

• Tenderness• Extremity weakness, paralysis, or loss of movement• Loss of sensation or tingling in any part of the body

below neck

Treatment of Spinal Injuries

• Stabilize head and neck in neutral position.• Maintain an open airway.• Support patient’s breathing.• Monitor circulation.• Assess pulse, movement, and sensation in all

extremities.

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Treatment of Spinal Injuries

• Examine and treat other serious injuries.• Do not move patient.• Assist in immobilizing patient onto a longboard.• Arrange for prompt transport to an appropriate medical

facility.

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Motorcycle and Football Helmets

• In most instances, helmets do not have to be removed.• Only remove helmet if:

– Face mask or visor interferes with adequate ventilation or airway management.

– Helmet is too loose, making immobilization inadequate.

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Motorcycle and Football Helmets

• If you remove a football helmet, you should also remove the shoulder pads.

• You may have to provide extra padding to maintain neutral position.

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Injuries to the Chest

• Chest cavity contains lungs, heart, and several major blood vessels.

• Chest cavity is protected by chest wall.• Chest wall is made up of the ribs, cartilage, and chest

muscles.• Common chest injuries include rib fractures, flail chest,

and penetrating wounds.

Treatment of Rib Fractures

• Place a pillow against injured ribs.• Prevent excessive movement.• Administer high-flow oxygen.• Arrange for transport to hospital.

Flail Chest

• Three or more ribs are broken in at least two places.• Injured part moves opposite chest wall.• Place a pillow firmly over flail section.• Monitor breathing.• Monitor and support ABCs.

Penetrating Chest Wounds

• Results from penetration of chest wall by an object• Introduces air and blood between lung and chest

wall• May result in lung collapse• Severe blood loss into chest cavity can produce

hemorrhagic shock.

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Penetrating Chest Wounds

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Treatment of Penetrating Chest Wounds

• Quickly seal an open chest wound with an occlusive dressing.

• Administer high-flow oxygen.• Monitor breathing.• Stabilize any impaled object.• Prepare for transport.