MusculoskeletalEmergencies

Emergency Nursing Core Curriculum

Acknowledgement is made to the following expert for the development of this module: Karen Belotti, RN, BSN

2007Reviewed 2010

Musculoskeletal EmergenciesObjectives

For selected musculoskeletal emergencies the participant will be able to:

Compare the etiology Describe assessment findings Identify the clinical management

Musculoskeletal Emergencies Always remember…..

Musculoskeletal Emergencies The basics

Bleeding control Immobilization Neurovascular assessment

Musculoskeletal Emergencies

The result of over stretching a muscle at the point of attachment to the tendon

Musculoskeletal EmergenciesStrains - definition

Musculoskeletal EmergenciesSprains - definition

A wrenching or twisting injury to a ligament with hyperextension, hyperflexion or torsion of a joint

The most commonly sprained or strained joint is the ankle

Musculoskeletal EmergenciesSprains

Mild to severe pain with disability and loss of function.

May describe a snapping or popping sound

Point tenderness

Musculoskeletal EmergenciesStrains & Sprains – signs & symptoms

Mild to severe edema Ecchymosis Mild to marked deformity

Musculoskeletal EmergenciesStrains & Sprains – signs & symptoms

Immobilization Elevation Ice Rest Analgesia

Musculoskeletal EmergenciesStrains & Sprains - treatment

Musculoskeletal EmergenciesStrains & Sprains - Pneumonic:

PRICE ProtectRest IceCompressionElevation

Musculoskeletal EmergenciesFractures

Disruption in the normal continuity of the bone, cartilage or both

Musculoskeletal EmergenciesFractures - types

ObliqueSpiralComminuted Impacted

CompressionGreenstickAvulsionDepressed

Open vs. Closed

Musculoskeletal EmergenciesFractures - Oblique

Oblique: Fracture resulting from a twisting force

Musculoskeletal EmergenciesFractures - Spiral

Spiral:Twisting force while

foot firmly planted

Musculoskeletal EmergenciesFractures - Comminuted

Comminuted:Severe direct force

causes more than two bone fragments

Musculoskeletal EmergenciesFractures - Impacted

Impacted:Fractured bone

ends jam together

Musculoskeletal EmergenciesFractures - Compression

Compression:Severe force

jams vertebrae together

Musculoskeletal EmergenciesFractures - Greenstick

Greenstick:Compression

force, most commonly seen in children

Musculoskeletal EmergenciesFractures - Avulsion

Avulsion:Forceful contraction

of muscle mass causes bone to break away from insertion point

Musculoskeletal EmergenciesFractures - Depressed

Depressed:Blunt trauma to flat

bone usually associated with significant soft tissue damage

Musculoskeletal EmergenciesFractures – open vs. closedOpen: Much higher incidence

of infection - contaminated

Considered surgical emergency

Can cause significant blood loss

Musculoskeletal EmergenciesFractures - signs & symptoms

Tenderness or pain Deformity Decreased mobility Swelling Ecchymosis

Musculoskeletal EmergenciesFractures - signs & symptoms Crepitus Muscle spasm Inability to bear weight Decreased or absent pulses Pallor, shock

pelvic fractures femur fractures

Immobilize Remove jewelry or

constrictive clothing from injured extremity

Musculoskeletal EmergenciesFractures - treatment

Apply ice to reduce swelling and pain

Elevate extremity above the level of the heart

Musculoskeletal EmergenciesFractures - treatment

Prepare for: closed reduction splinting or casting

If open fracture prepare for surgery

Cover with sterile, saline-soaked dressing

Musculoskeletal EmergenciesFractures

Occurs when a joint exceeds it’s normal range of motion and the articular surfaces are no longer in direct contact.

Musculoskeletal EmergenciesDislocation & Subluxations

Result: Impaired circulation Ligament injury Nerve damage Disruption of muscle insertions

Musculoskeletal EmergenciesDislocation & Subluxations

Fracture are often associated with dislocation injuries

Common areas of dislocations include the shoulder, elbow, hip and knee

Musculoskeletal EmergenciesDislocation & Subluxations

Signs & Symptoms Localized pain,

moderate to severe Point tenderness Joint deformity

Musculoskeletal EmergenciesDislocation & Subluxations

Signs & Symptoms Decreased or absent range of

motion Edema Diminished or absent distal pulses

and sensation

Musculoskeletal EmergenciesDislocation & Subluxations

Interventions: Keep NPO! Remove jewelry or constrictive

clothing from injured extremity Apply ice to reduce swelling and

pain

Musculoskeletal EmergenciesDislocation & Subluxations

Prepare reduction procedures Monitor neurovascular status

of injured extremity Immobilize joint post

reduction

Musculoskeletal EmergenciesDislocation & Subluxations

Radial head subluxation Causes:

lifting by the hand swinging while holding the hands pulling arms through the sleeves catching by the hand to prevent a fall pulling along when in a hurry

Musculoskeletal EmergenciesNursemaids Elbow

Musculoskeletal EmergenciesNursemaids Elbow

Treatment: Provider manipulation of

affected extremity X-rays not always indicated Prone to recurrences

The separation of skin and subcutaneous tissue from the underlying musculofascial planes

Musculoskeletal EmergenciesDegloving Injuries

Signs & Symptoms Area of skin is torn

away from underlying vascular supply

Pain Hemorrhage

Musculoskeletal EmergenciesDegloving Injuries

Control bleeding Irrigate and cleanse area Administer medications and

evaluate effectiveness analgesics antibiotics tetanus immunization

Musculoskeletal EmergenciesDegloving Injuries - treatment

Occurs when increasing interstitial pressure inside the fascial compartment results in neurovascular compromise causing soft tissue damage to the confined space

Musculoskeletal EmergenciesCompartment Syndrome

Causes: Crush injuries Contusions Snake bites Circumferential extremity burns Onset 4 to 8 hours after injury

Musculoskeletal EmergenciesCompartment Syndrome

Increasingly severe pain at rest or with passive movement

Tense, swollen area Diminished sensation

Musculoskeletal EmergenciesCompartment Syndrome

Progressive loss of muscle or motor function

Loss of pulses (late sign) Increased compartment pressures

Musculoskeletal EmergenciesCompartment Syndrome

Interventions: Maintain extremity in neutral

position, at the level of the heart. Must not be left dependent

Musculoskeletal EmergenciesCompartment Syndrome

Remove all casts, splints or appliances

Assist with obtaining compartment measurements

Monitor extremity perfusion every 15 minutes

Musculoskeletal EmergenciesCompartment Syndrome

Prepare for surgical release of affected area

Fasciotomy

Musculoskeletal EmergenciesCompartment Syndrome

Case Scenario

Which of the following is not a symptom of compartment syndrome?

A. pain upon passive movement

B. petechiae

C. paraesthesia of the affected extremity

D. decreased capillary filling time

Case Scenario

Which of the following is not a symptom of compartment syndrome?

A. pain upon passive movement

B.petechiaeC. paraesthesia of the affected

extremity

D. decreased capillary filling time

Case Scenario

Which of the following findings indicates successful reduction of nursemaid’s elbow?

A. the arm is immobile

B. the radial pulse is strong

C. the elbow moves freely

D. the patient cries when the arm is examined

Case Scenario

Which of the following findings indicates successful reduction of nursemaid’s elbow?

A. the arm is immobile

B. the radial pulse is strong

C.the elbow moves freelyD. the patient cries when the arm is

examined