Module 17- Assessment and Treatment Flashcards
(118 cards)
1
Q
What are the principles of Assessment?
A
- Scene Assessment
- Scene safety
- Routine precautions and PPE
- Initial assessment
- mental status
- ABC’s
- Identify priority pt’s
2
Q
If there are no immediate life-threatening injuries and only localized musculoskeletal trauma, what do we do?
A
continue with a focused history and physical examination
3
Q
If there is a significant MOI, what do we do?
A
- Complete a rapid trauma assessment and perform a detailed physical examination en route
4
Q
What are the priorities of assessment and treatment?
A
- Identify injuries
- Manage life threats
- Prevent further harm to injured structures
- Support injured area
- Administer pain meds
5
Q
What do we determine for the history of the present injury?
A
- Determine the MOI
- Determine patient condition prior to injury
- Determine patient position after the injury
6
Q
How do we determine medical history?
A
- Use SAMPLE
- Pay attention to previous musculoskeletal injuries and disorders
7
Q
What do we conduct in our physical examination?
A
- Obtain baseline vital signs
- Evaluate the injured extremity (OPQRST for pain)
- Compare extremity to other side, noting differences in length, position, and skin color
- Cont examination of extremity using DCAP-BTLS
- Evaluate 6 p’s for musculoskeletal
8
Q
Slow laboured breathing, skin cyanotic & pale
A
= BAD!!!
9
Q
Full and regular breathing, skin pink
A
= GOOD!!
10
Q
What should we inspect?
A
- Deformity
- Skin changes
- Swelling
- Lacerations
- Muscle spasms
- Abnormal limb positioning
- Altered range of motion
- Color changes
11
Q
What should we palpate?
A
- Include injury site and regions above and below injury
- Identify areas with point tenderness
- May be difficult to assess with intoxicated patients or those with spinal injuries
12
Q
What is the motor function examination?
A
- Consider the preinjury level of function
- Weakness or deficits may be due to prior injuries or medical problems
- Carry out the test with and without resistance
- Some patients may be too weak to overcome any outside resistance
- Test both sides simultaneously
13
Q
What is a sensory examination?
A
- Attempt to identify pre existing deficits or other disorders
- Assess for the presence or absence of sensation and quality and symmetry of sensation
- First ask patient if he or she feels any abnormal sensations
- Next, conduct gross sensory examination
14
Q
General Interventions
A
- Identify the type and extent of injury.
- Create an environment that maximizes the normal healing process
- This begins in the prehospital environment with a thorough assessment and proper immobilization to prevent further harm.
15
Q
What may pain be caused by?
A
- The injury itself
- Continued movement of unstable fracture
- Muscle spasm
- Surrounding soft-tissue injury
- Nerve injury
- Muscle ischemia
16
Q
What is the goal of dealing with pt’s pain?
A
- The goal is to diminish pt’s pain to a tolerable level
- Need to first assess the level of pain and continually reassess after each intervention to determine effectiveness
17
Q
What are the basics to control pt’s pain?
A
- Splinting
- Resting
- Elevating
- Applying heat or cold
18
Q
When simple procedures are not effective, consider analgesics and antispasmodic, which include?
A
- Tylenol- 960-1000mg
- Ibuprofen- 400mg
- Ketorolac- 10-15mg (works faster than tylenol and ibuprofen, usually given when pt can’t take anything by mouth)
- Fentanyl
- Morphine- 2-5mg max of 4 doses (lowers BP)
- Diazepam
- Lorazepam
19
Q
What are the rules for medication use?
A
- Use only for hemodynamically stable patients
- Obtain complete vitals before and after administration
- Reassess pain level after administration to determine efficacy of treatment
20
Q
What does splinting do for the pt?
A
- Provides support and prevents motion
- Decreases pain
- Reduces risk of further injury
- Helps control bleeding
21
Q
How do we splint an unstable pt with multiple fractures?
A
- There is no time to splint each injury
- Splint the axial skeleton on a backboard or alternative device (Secure injured extremities to the body)
- This will protect against spinal injuries and reduce extremity movement
22
Q
What are the splinting principles for any injury?
A
- Adequately visualize the injured area
- Assess and record PMS before and after splinting
- Cover all wound with dry sterile dressings (don’t push exposed bones under the skin)
- Pad splint well and firmly
- Support injured site manually with one hand above and one below the injury
- For severe angulations, gently apply longitudinal traction to attempt to realign and restore circulation
23
Q
How do we splint fractures?
A
- Immobilize the bone ends and the two adjacent joints
24
Q
How do we splint dislocations?
A
- Extend the splint along the entire length of the bone above and the entire length of the bone below the dislocated joint
25
How do we splint knees?
- Splint knee straight if not directly injured and angulated
26
How do we splint elbows?
- Splint elbow at a right angle
27
What do we do if pt complains of severe pain or offers resistance to movement?
- Discontinue traction
- Splint in position of deformity
- Carefully monitor distal PMS
28
Why don't we cover finger or toes with the splint?
- Allow for monitoring or skin color, temperature, and condition (CTC).
- Review BLS standards
29
What are the five types of splints?
1. Board splints
2. Inflatable splints
3. Vacuum splints
4. Traction splints
5. Improvised splints
30
Rigid splints contain...
- Padded board
- Piece of heavily cardboard
- Aluminum splint
- SAM splint
31
Pneumatic Splints
- Air/ inflatable splints
- Useful for immobilizing fractures of the lower leg and forearm
(Can slow bleeding and minimize swelling)
- PASG for femur and pelvis is a common example
- Not useful for joints, or angulated or open fractures
32
What are the pneumatic splint cautions?
- Ensure that it does not lose pressure
- Ensure that it is not overinflated
- Likely when applied in a cool area and moved to a warmer environment
- Also likely when applied before aeromedical transport and taken to higher altitude
33
Vacuum Splints
- Available either as a mattress for the entire body or a smaller splint for individual extremities
- Composed of beads that conform to the body when air is removed from splint
34
Pillow Splints
- Effective means to immobilize an injured foot or ankle
- Invaluable for padding backboards for patients with dislocated hips
35
Traction Splints
- Provide constant pull on a fractured femur, thereby preventing the broken bone ends from overriding
- Help alleviate pain and reduce bleeding associated with midshaft femur fractures
36
Buddy Splinting
- Place padding between digits
- Tape or tie injured digit to adjacent, noninjured digit
- Do not let tape pass over joints
37
What are complications of musculoskeletal injuries?
- Neurovascular injuries
- Compartment syndrome
- Crush syndrome
- Thromboembolic disease
38
Neurovascular Injuries
- The skeletal system normally protects the neurovascular structure within the limbs
- May occur when fracture fragments lacerate or impale nerves, leading to neurological deficit
- May occur during dislocations when nerves and vessels are stretched and damaged
39
What is compartment syndrome?
- Occurs when blood is confined within the compartment formed by inelastic fascia
- Permits only limited swelling
- May be caused by fractures, crush injuries, bleeding disorders, or burns
40
What are the signs & symptoms of compartment syndrome?
- Burning pain- not relieved with narcotics
- numbness/ tingling
- Firm tissue
- Skin pallor
- Paralysis of muscle
- Loss of distal pulse
41
What is the treatment for compartment syndrome?
- Elevate the extremity to heart level
- Place ice packs over the extremity
- Open or loosen tight clothing
42
What is crush syndrome?
- MOI: Compressive force on muscle that prohibits metabolism and circulation
- Occurs from trauma, prolonged (>4-6 hours body weight laying on extremity, etc
- Muscle cells die and release contents into localized vasculature
43
What is the treatment for crush syndrome?
- Per direct medical control
- Should be done before release of force
- High flow oxygen
- Crystalloid bolus
- After extrication:
Consider salbutamol nebulizer (helps to push potassium back
to intracellular space), calcium (protect against the surge of
potassium), and sodium bicarbonate, for ECG changes
44
Thromboembolic Disease
- Deep vein thrombosis (DVT)
- Pulmonary embolism
- May occur after prolonged immobilization following pelvic and lower extremity injuries
45
What is the assessment of deep vein thrombosis?
- Swelling
- Discomfort
- Worsens with use
- Warmth
- Erythema
46
What is the assessment for pulmonary embolism?
- When DVT dislodges it can cause a PE
- Clot travels to and occludes a portion of all the pulmonary arteries
47
Signs and symptoms of Pulmonary Embolism
- Sudden onset of dyspnea
- Pleuritic chest pain
- Tachypnea
- Right-sided heart failure
- Shock
- Cardiac arrest
48
What is the treatment for thromboembolic disease?
- Maintain airway
- Oxygenate
- Crystalloid administration
- Rapid transport
49
Shoulder Girdle: Clavicle Fractures
- Common, particularly in children
- Occur to middle third of bone
50
MOI of shoulder girdle: clavicle fractures
MOI: Falling onto outstretched arm or direct contact
51
S/S of shoulder girdle: clavicle fractures
S&S: pain in shoulder, swelling, unwillingness to raise arm, leaning towards injured side
52
MOI Shoulder Girdle: Scapula Fractures
- MOI: Direct, forceful trauma
- Often associated with more serious injuries
- Pneumothorax, hemothorax and # ribs
53
S/S Shoulder Girdle: Scapula Fractures
S&S: Pain that increase with arm adduction, swelling, ecchymosis
54
What is the treatment for shoulder girdle fractures?
- Sling and swathe
- Immobilize against body
- Consider other, more serious injuries (particularly spinal injuries), and treat for these
- Scapula fractures warrant full SMR
55
MOI Midshaft Humerus Fractures
MOI: Typically occur to younger patient in high-impact injuries (eg, MVCs)
56
S/S Midshaft Humerus Fractures
S&S: substantial deformity, swelling, ecchymosis, gross instability, crepitus, possible neurovascular damage
57
What is the treatment for midshaft humerus fractures?
- If angulated, apply longitudinal traction to correct deformity
- Stop if pt’s pain is too severe or for worsening distal PMS
- Apply rigid splint from axilla to elbow
- Sling and swath
- Apply cold packs
58
Elbow Injuries
Distal humerus and proximal radius/ ulna
59
MOI Elbow injuries
MOI: Both may result from fall onto outstretched arm
60
S/S Elbow injuries
S&S: Pain, ecchymosis, possible neurovascular damage
61
What is the treatment for elbow injuries?
- Remember to check distal PMS before splinting
- If PMS is present, splint in position found
- If PMS is absent, apply gentle traction
- Immediate transport
62
Forearm Fractures
Commonly involve both radius and ulna
63
MOI Forearm fractures
MOI: Direct force or fall onto outstretched hand
64
S/S Forearm fractures
S&S: Tenderness, angulation (Colles fractures is dorsally angulated), swelling
65
What is the treatment for forearm fractures?
- Immobilize with rigid splint
- Sling
- Ice
- Continue monitoring distal PMS
66
Wrist and Hand Fractures
May lead to significant long-term disability
67
MOI Wrist and Hand Fractures
MOI: Falls, fights, or during sporting events
68
Boxer’s fracture
Fracture of fifth metacarpal
69
Metacarpal shaft fracture
Compartment syndrome is possible within the hand
70
Mallet finger (baseball #)
Finger is jammed into an object, resulting in an avulsion # of the extended tendon
71
What is the treatment for wrist and hand fractures?
- Splint wrist at 30 degrees or dorsiflexion
- Slightly flex fingers
- Secure forearm to rigid splint
- Elevate hand
72
Pelvic Fractures
- Relatively uncommon
- 3% of all fractures
- High mortality in blunt trauma patients
- 8% to 50%
- Depending on severity
- Death usually results from massive hemorrhage
73
Lateral compression
Side impact
74
Anterior-posterior compression
- Head on
- The pelvis spreads apart and open like a book
75
Vertical shear
- Major force applied from above or below
- Shortening of limb, and risk for massive hemorrhage
76
Straddle fracture
- Occurs when a person land in the region of the perineum and sustains bilateral fractures of the inferior and superior rami
77
Open Pelvis fractures
- Life threatening injury
- Caused by high-velocity injury with subsequent massive hemorrhage
- Mortality rate of 25% to 50%
78
What is the treatment for pelvic fractures?
- ABCs
- Spinal precautions
- Assess for other injuries
- Bleeding, laceration, bruising, instability
- Do not reassess for instability once found
- Large-bore IVs
- IV fluids given to maintain perfusion
- Stabilize pelvis (depending on local protocols).
- Pelvic binder, sheet wrap
- Rapidly transport to appropriate facility
79
Hip fractures
Involve fracture of proximal femur
80
MOI Hip Fractures
- MOI: In elderly patients with osteoporosis who have fallen
- MOI: In younger patients, often occurs in high-energy impact
81
S/S for hip fractures
- Pain, -articularly with movement; hearing or feeling a snap; swelling; deformity; shortening; external rotation
82
What is the treatment for hip fractures?
Depends on MOI
- Low-impact: basic splinting
- High impact:
- May require traction
- Treat as you would any other trauma patient
- Buddy splint
- Immobilize, establish vascular access, treat for shock
83
MOI Femoral Shaft Fractures
MOI: High-energy impacts
- Frequently occur with other injuries
84
S/S of Femoral shaft fractures
- Pain
- Angulation
- External rotation
- Shortening, edema
- Bruising
- Muscle spasms
- Shock
85
What is the treatment for femoral shaft fractures?
- ABCs
- Full spinal immobilization
- IV access
- Traction splint
- Pain medication
86
MOI Knee Fractures
- MOI: direct blow to the knee, axial loading of leg, or powerful contraction of quadriceps
87
S/S of Knee Fractures
S&S: Pain, decreased ROM, pain with movement and weight bearing, ecchymosis, swelling, possible deformity
88
What is the treatment for knee fractures?
- With good distal circulation, splint in position found
- With absent distal circulation, consider possible manipulation
- Elevate leg
- Apply cold
- Frequently reassess distal PMS
- High incidence of compartment syndrome and neurovascular injury
89
MOI Tibia & Fibula Fractures
MOI: direct trauma or rotation/ compressive forces
90
S/S Tibula & Fibula Fractures
S&S: Often have significant deformity and soft-tissue damage, possible compartment syndrome, pain, significant instability
91
What is the treatment of tibia and fibula fractures?
- Apply long, rigid splint
- Administer pain medications as necessary
- If grossly angulated, attempt to realign after analgesics
- Elevate
- Apply cold
- Continually reassess PMS
92
MOI Ankle Fractures
MOI: sudden, forceful movements of the foot
- Damage the malleoli and may cause dislocation
93
S/S of Ankle fractures
- Pain
- Deformity
- Swelling
- May lead to damaged nerves and blood vessels, compartment syndrome, and chronic ankle pain and arthritis
94
What is the treatment of ankle fractures?
- Immobilize with commercial or pillow splint
- Elevate
- Apply cold
- Continually reassess distal PMS
- If absent with a fracture-dislocation, contact direct medical control for possible prehospital reduction
95
MOI Calcaneus Fractures
MOI: Occurs when jumping from a height or when powerful force is applied directly to the heel
96
What is the treatment of calcaneus fractures?
- Use a commercial or pillow splint
- Apply ice
- Consider spinal immobilization if MOI is suggestive
97
Joint injuries and Dislocations
- Shoulder girdle injuries and dislocations
- Elbow dislocations
- Finger dislocations
- Hip dislocations
- Knee dislocations
98
MOI Acromioclavicular Joint Separation
MOI: direct blow to the superior aspect of the shoulder
99
S/S Acromioclavicular Joint Separation
S&S: pain and tenderness in the region of AC joint
100
MOI Sternoclavicular Joint Separation
MOI: direct blow to clavicle or when strong pressure is applied to posterior shoulder
101
S/S Sternoclavicular Joint Separation
S&S: pain and swelling at sternoclavicular joint
102
Sternoclavicular Joint Separation
- Assess for other, more dangerous associated injuries.
- Trachea, vasculature, esophagus
- Sensation of choking, pain on swallowing
103
MOI Shoulder Dislocation
MOI: Fall onto abducted and externally rotated outstretched arm
104
S/S Shoulder Dislocation
- Arm held by the side
- Supported by the other arm
- Pain with movement
- Acromion bulges
- Palpable humeral head in the axilla
- Frequent, painful muscle spasms
105
What is the treatment for AC separation?
Sling and swath
106
What is the treatment for posterior sternoclavicular dislocation
- Put patient supine, injured arm abducted with rolled towel under shoulder blade
- Pay attention to ABCs
107
What is the treatment for dislocated shoulder's?
- Splint in position found
- Sling and swath
- Pain medications
108
MOI for Elbow Dislocation
MOI: Patient, less than 6 years old, has arm suddenly pulled, as when being lifted
109
S/S for Elbow Dislocation
S&S: Pain, arm held still in flexion, only mild swelling
110
What is the treatment for elbow dislocation?
- Splint in position found
- Sling and swath
- Consider analgesics
111
MOI Finger Dislocation
MOI: sudden “jamming” or overextension of fingers
112
S/S Finger Dislocation
S&S: Pain and deformity, possible compromised neurovasculature
113
What is the treatment for finger dislocations?
- Splint entire hang in position of function
- Use soft dressing to support digit
- Do not attempt relocation unless directed by direct medical control.
114
MOI Hip Dislocation
MOI: deceleration injuries
- Flexed knee strikes immobile object
115
S/S Hip Dislocation
S&S (posterior): Leg is flexed, abducted, internally rotated, and shortened, pain, soft-tissue swelling
116
What is the treatment for hip dislocation?
- Full spinal immobilization
- Consider other injuries
- Preform full trauma assessment
- Splint injury in position found with blankets and pillows
- Perform frequent neurovascular checks
117
MOI Knee Dislocation
MOI: high-energy direct trauma or powerful twisting
- Often reduces spontaneously
118
S/S Knee Dislocation
S&S: pain, patient often states, “knee gave out”, significant deformity, decreased range of motion
