Lecture 10: Musculoskeletal Injuries

Question 1

What are the S/S of serious MSK/extremity injuries?

Answer 1

Suspicious MOI
snap/pop/tear heard or felt by patient
crepitus: pt. movement/palpation
inability to move/use affected part
pain+++
Tenderness
deformity to the limb
bone fragments protruding through skin
moderate to severe swelling
discoloration
loss of sensation
limb that is cold to the touch
severe external bleeding

Question 2

What are the basic types of MSK injuries?

Answer 2

Fracture
luxation/subluxation
sprain
strain

Question 3

What are the five diagnostic P’s of fractures?

Answer 3

Pain- severe pain?
Paralysis- partial/full loss of ability to move?
Paresthesia - loss sensation, tingling?
pallor - has limb lost its color, pale, cyanotic?
pulselessness - absence of distal pulse?

Question 4

What is the approximal internal blood loss related with different bone fractures?

Answer 4

Rib: 125 ml
radius or ulna: 250-500 ml
humerus: 500-750 ml
tibia or fibula: 500-1000 ml
Femur: 1000-2000 ml
pelvis: 1000-massive ml

Question 5

What is the names of the rules used to determine if the ankle/foot/knee need x-rays?

Answer 5

the Ottawa rules

Question 6

What is the treatment for closed fractures?

Answer 6

PMSC pre and post splinting
Apply gentle in-line traction and to splint in “near anatomical” position without pain
pathological angulations: attempt to splint in near anatomic position without resistance
prevent shock, supplemental O2
arrange for appropriate transport as required

Question 7

What kind of fractures should you splint as found?

Answer 7

joint fractures, open fractures of long bones

Question 8

What is the treatment for open fractures?

Answer 8

bandage wound/exposed bone to prevent infection
MSC pre and post splinting
splint in near anatomical position without pain
pathological angulations: attempt to splint in near anatomic position without resistance
prevent shock
arrange for appropriate transport as required

Question 9

What is the treatment for luxations?

Answer 9

digits and recurrent luxation” gentle reduction/splint, PMSC pre & post, refer MD tx//xray (R/O #)

all other joints: splint as found to reduce further risk to neuro/circulation
PMSC pre/ post
refer to MD

Question 10

What is the treatment for subluxation?

Answer 10

PIER
verify MSC, joint integrity
refer to MD prn
X-ray prn to R/O#

Question 11

What is the eval steps for a sprain and strains?

Answer 11

HOPPS (on field)
HOPPSS (off field) (specific palpation added)

Question 12

What is the tx for sprains and strains?

Answer 12

PIER/ PRICE
protect rest ice compression elevation

Question 13

What is the general treatment for extremity injuries?

Answer 13

control bleeding, if present
immobilize injured part
apply ice
elevate if appropriate
no further injury/fractures open after splinting
summon more advanced care as needed
monitor vital signs
minimize or treat for shock
administer supplemental O2 as needed
check+ recheck distal circulation
Keep victim comfortable

Question 14

What is the difference in observation of posterior hip dislocations vs anterior hip dislocation?

Answer 14

posterior: leg in internal rotation, adduction
anterior: external rotation, abduction

Question 15

What is a clear sign of hip fractures?

Answer 15

Shortening of the leg with external rotation

Question 16

How much should you traction a femoral traction splint?

Answer 16

if person conscious: traction to comfort
Unconscious: traction to about 10% of body weight for a max of 15lbs