Musculoskeletal Injuries

Question 1

Compartment Syndrome

Answer 1

Swelling within a confined body compartment, like the connective tissue compartments in the leg or inside the skull, that results in ischemia.

Question 2

Acetaminophen

Answer 2

An analgesic used to treat mild to moderate pain and to reduce fever.

Question 3

Describe the treatment principles for a stable injury.

Answer 3

Pain Free Activity
Pain Management (RICE, Medications)
Support

Question 4

Describe how a rescuer can use two classes of drugs in a pain management regimen.

Answer 4

Give 400mg of Ibuprofen every 6 hours and 500mg of Acetaminophen every 6 hours, but stagger. Ibuprofen given at 0, 6, 12, and 18 hours… while Acetaminophen given at 3, 9, 15, 21 hours…

Question 5

Neurovascular Bundle

Answer 5

An artery, vein, and nerve combination routed through the body together.

Question 6

What are three different classes of pain medications? Give examples and list common side effects.

Answer 6

NSAIDs

Ibuprofen
Naproxen sodium
Aspirin
Ketorolac

Side Effects: Stomach Irritation/Pain, Increased Bleeding

Non-Opioid Analgesics

Acetaminophen

Side Effects: Nausea

Opioids

Morphine
Hydrocodone
Oxycodone
Fentanyl

Side Effects:

• Increase reaction time
• Drowsiness
• Constipation
• Suppress shivering – makes it difficult to maintain body core temp
• Depressed respiratory drive

Question 7

Describe the treatment principles for an unstable long bone injury.

Answer 7

• Check CSMs
• Traction into Position if necessary (deformity/angulation)
• Hand stable
• Splint Stable
• Check and continue to the Monitor CSMs
• Pain Management (RICE, Medications)
• Evacuation

Question 8

Describe the treatment steps for a pelvic fracture.

Answer 8

• Check CSMs
• Hand Stable
• Splint Stable – apply pelvic binder; consider binding feet together w/toes pointing upward
• Check CSMs
• Stabilize patient in litter
• Monitor Patient including CSMs

Question 9

Describe the principles of spine packaging (i.e. backboard and litters).

Answer 9

• Secure weight centers – hips/shoulders 1^st, head last.
• Tie down low; don’t tie where hands grab.
• Make sure straps go across bone and not soft areas (i.e. abdomen); no straps across knee caps.
• If suspect neck injury use a soft collar.
• Pad voids/pressure points – behind knees, low back, behind head, knots.
• No chin strap.
• Tie hands if needed.

Question 10

Ibuprofen

Answer 10

A NSAID used to treat fever and mild to severe pain.

Question 11

What responsibility does a rescuer have when carrying and/or providing medications?

Answer 11

Checking medications for expiration, integrity, indications, contraindications.

Checking any drug interactions between medication and medications/supplements patient is taking regularly.

Checking patient’s medications/supplements in pre-trip screening (if applicable).

Getting informed consent from the patient.

Question 12

Litter

Answer 12

A device used to transport a patient. It is essentially a stretcher with a raised edge.

Question 13

Opioid

Answer 13

A substance that reduces the brain’s ability to respond to pain impulses from the site of the injury.

Question 14

Describe the pain management principle a rescuer should initially follow.

Answer 14

Treat problem causing the pain.

Examples:

• Dislocation – Reduce it if indirect and is a shoulder, digit, patella.
• Unstable Extremity – stabilize, loosen splint
• Abscess – Drain it
• Headache 2° Dehydration – Hydrate

Question 15

Describe the significance of the neurovascular bundle as it relates to musculoskeletal injuries.

Answer 15

The neurovascular bundle consists of blood vessels and nerves that run alongside our bones. Musculoskeletal injuries would kink or tear the neurovascular bundle creating a critical system problem.

Question 16

What is the maximum daily dosage for Acetaminophen? Ibuprofen?

Answer 16

Acetaminophen = 3,000mg

Ibuprofen = 2,400mg (recommended maximum for pain = 1,200mg – 1,600mg)

Question 17

Describe the main functions of the musculoskeletal system.

Answer 17

Support, Protection, Movement

Question 18

List 5 high risk musculoskeletal injuries/conditions and their anticipated problems.

Answer 18

Unstable Femur – volume shock; ischemia

Unstable Pelvis – volume shock; ischemia

Compartment Syndrome – ischemia to infarction

Joint Infection – Systemic Infection; Joint damage

Open Fracture – Ischemia, bleeding, infection, systemic infection

Question 19

Describe the risks of fully immobilizing a patient.

Answer 19

• Increases time and complexity of evacuation.
• Can delay treatment of other problems.
• Can impair airway control, thermoregulation, and survival efforts.
• Can lead to pressure sores / ischemia.
• Can increase pain.

Question 20

Spine Board

Answer 20

An extrication tool used to transport a patient.

Question 21

Describe the treatment steps for a femur fracture.

Answer 21

• Check CSMs
• Traction into Position if necessary (obvious deformity/angulation)
• Hand Stable
• Splint Stable – buddy splint method (refer to p. 38 in field guide)
• Check CSMs
• Stabilize patient in litter
• Monitor Patient including CSMs

Question 22

How are joint injuries managed differently? Why?

Answer 22

Due the fact that joints are complex (many bones, ligaments, tendons) we leave as is (NO traction into position). We typically will splint in the position found unless CSMs are compromised and/or the position is hindering splinting or the evacuation process. If one or more of these is an issue, rescuers can move the limb into a better position barring no significant increase in pain or no resistance is felt.

Question 23

Describe the principles of splinting.

Answer 23

Comfortable – no pressure points, can be adjusted

Complete – provides stability and protection; immobilized joint above/below if long bone, long bone above/below if joint;

Compact – not bigger than necessary; allow for CSM checks

Question 24

Compare/contrast stable and unstable injuries.

Answer 24

Question 25

What is the purpose of pain?

Answer 25

Signal that limits our movement, so we do not hurt ourselves.

Question 26

Musculoskeletal System

Answer 26

An organic system consisting of muscles, ligaments, tendons, and bones used to support/provide protection and move the body.

Question 27

Vacuum Mattress

Answer 27

An extrication tool used to provide rigid support to spine injured patients. Can also be used for other injuries and illnesses.

Question 28

What is the overall goal of pain management?

Answer 28

To keep pain at tolerable level for an awake patient.