Musculoskeletal Trauma Flashcards
(82 cards)
1
Q
Components of Musculoskeletal System
A
- Bones
- Joints
- Muscles
- Cartilage
- Ligaments
- Tendons
2
Q
Physiology of Musculoskeletal System
A
- Bones: framework
- Joints: bending
- Muscles: movement
- Cartilage: flexibility
- Ligaments: connect bone to bone
- Tendons: connect muscle to bone
3
Q
Bones
A
• Formed of dense connective tissues
• Vascular and susceptible to
bleeding on injury
4
Q
Shapes of Bones
A
- Irregular
- Long
- Short
- Flat
5
Q
Self-Healing Nature of Bone
A
- Break causes soft tissue swelling and a blood clot in the fracture area
- Interruption of blood supply causes the bone section to die
- Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone
6
Q
Muscles, Cartilage, Ligaments, & Tendons
A
Striated Muscle Cardiac Muscle Smooth Muscle Bone Tendon - muscle to bone Ligament bone to bone
7
Q
Mechanisms of Musculoskeletal Injury
A
- Direct force
- Indirect force
- Twisting (rotational) force
8
Q
Injury to Bones and Connective Tissue
A
• Fracture: any break in a bone (open or closed) – Comminuted—broken in several places – Greenstick—incomplete break – Angulated—bent at angle • Dislocation: “coming apart” of a joint
9
Q
Injury to Bones and Connective Tissue
A
- Sprain: stretching and tearing of ligaments
* Strain: overstretching of muscle
10
Q
Injury to Bones and Connective Tissue
A
• Not all injuries can be confirmed as a fracture in the field
• Splinting an extremity with a
suspected fracture helps prevent blood loss from bone tissues
11
Q
Assessment: Musculoskeletal Injuries
A
- Rapidly identify and treat life-threatening conditions
- Be alert for injuries besides grotesque wound
- Pain and tenderness
- Deformity and angulation
12
Q
Assessment: Musculoskeletal Injuries
A
- Grating (crepitus)
- Swelling
- Bruising
- Exposed bone ends
- Nerve/blood vessel compromise (decreased CMS)
- Compartment syndrome
13
Q
Six P’s of Assessment
A
- Pain or tenderness
- Pallor (pale skin)
- Parasthesia (pins and needles)
- Pulses diminished or absent
- Paralysis
- Pressure
14
Q
Think About It: Musculoskeletal
A
- Do my patient’s musculoskeletal injuries add up to serious multiple trauma?
- Does my patient have circulation, sensation, and motor function distal to the suspected fracture or dislocation?
15
Q
Treatment: Musculoskeletal Injuries
A
- Take standard precautions
- Perform primary assessment
- Take spinal precautions
- Splint any suspected extremity fractures after treating life threatening conditions
- Cover open wounds with sterile dressings
16
Q
Advantages of Splinting
A
- Minimizes movement of disrupted joints and broken bone ends
- Prevents additional injury to soft tissues (nerves, arteries, veins, muscles)
- Decreases pain
- Minimizes blood loss
- Can prevent a closed fracture from becoming an open fracture
17
Q
Principles of Splinting
A
- Care for life-threatening problems first
- Expose injury site
- Assess distal CSM
- Align long-bone injuries to anatomical position
- Do not push protruding bones back into place
- Immobilize both injury site and adjacent joints
- Choose splinting method based on severity of condition and priority decision
- Apply splint before moving patient to stretcher
- Pad voids
18
Q
Realigning Deformed Extremity
A
• Assists in restoring effective circulation to extremity and to fit it to splint
• If not realigned, splint may be ineffective, causing increased
pain and possible further injury
• If not realigned, increased chance of nerves, arteries, and veins being compromised
• Increased pain is only momentary
19
Q
Hazards of Splinting
A
- “Splinting patient to death”—splinting before life-threatening conditions addressed
- Not ensuring ABC’s
- Too tight—compresses soft tissues
- Too loose—allows too much movement
- Splinting in deformed position
20
Q
Treatment: Splinting Long Bone and Joints
A
• Select splint appropriate to
injury
• Standard precautions
• Manually stabilize injury site
21
Q
Treatment: Splinting Long Bone and Joints
A
• Assess circulation, sensation, and motor function
• Realign injury if deformed or if
distal extremity is cyanotic or pulseless
22
Q
Treatment: Splinting Long Bone and Joints
A
• Measure or adjust splint; move it into position
• Apply and secure splint to immobilize injury site, adjacent
joints
• Reassess CSM distal to injury
23
Q
Treatment Traction Splint
A
.
24
Q
Shoulder Girdle Injuries
A
• Assessment
– Pain in shoulder
– Dropped shoulder
– Severe blow to back over scapula
25
Shoulder Girdle Injuries: Tx
```
• Treatment
– Assess distal CSM
– Use sling and swathe
– Do not attempt to straighten or
reduce
– Reassess distal CSM
```
26
Forearm, Wrist, and Hand Injuries
• Signs
– Forearm: deformity and tenderness
– Wrist: deformity and tenderness
– Hand: deformity and pain; dislocated fingers
27
Splinting Forearm, Wrist, and Hand Injuries
• Padded rigid splint
– From elbow past fingertips
– Roll of bandage placed in hand
– Sling and swathe
28
Splinting Forearm, Wrist, and Hand Injuries
• Soft splint
– Roll of bandage placed in hand
– Tie forearm, wrist, and hand into fold of one pillow or between two pillows
– Tape finger to adjacent uninjured finger
29
Pelvic Injuries
```
• Assessment
– Pain in pelvis, hips, or groin
– Pain when pressure applied
– Cannot lift legs
– Lateral rotation of foot
– Unexplained pressure in bladder
```
30
Pelvic Injuries
```
• Treatment
– Move patient as little as possible
– Determine CSM distal to injury
– Straighten lower limbs to anatomical position
– Stabilize lower limbs
– Assume spinal injuries
– Treat for shock
```
31
Hip Dislocation/Fracture: Assessment
```
• Assessment
– Anterior hip dislocation
– Posterior hip dislocation
• Rotation of leg and foot
– Pain and unable to stand
```
32
Hip Dislocation/Fracture: Tx
```
• Treatment
– Assess distal CSM
– Move patient onto spine board
– Immobilize limb with pillows and blankets
– Secure patient to spine board
– Reassess distal CSM
```
33
Femoral Shaft Fracture: Assessment
• Assessment
– Intense pain
– Possibly open fracture
– Injured limb may be shortened
34
Femoral Shaft Fracture: Tx
```
• Treatment
– Control bleeding
– Assess distal CSM
– Apply traction splint
– Reassess distal
CSM
– Treat for shock
```
35
Knee Injury: Assessment
• Assessment
– Pain and tenderness
– Swelling
– Deformity with swelling
36
Knee Injury: Tx
• Treatment
– Assess distal CSM
– Immobilize in current position
– Reassess distal CSM
37
Tibia/Fibula Injury: Assessment
• Assessment
– Pain and tenderness
– Swelling
– Possible deformity
38
Tibia/Fibula Injury: Tx
• Treatment
– Air inflated splint
– Two-splint method
– Single splint with ankle hitch
39
Ankle/Foot Injury: Assess
• Assessment
– Pain
– Swelling
– Possible deformity
40
Ankle/Foot Injury: Tx
```
• Treatment
– Assess distal CSM
– Stabilize limb
– Lift limb
– Place cravats under ankle
– Lower limb into pillow
– Tie pillow around ankle
– Apply ice pack as needed
```
41
Chapter Review: Musculoskeletal Trauma
* Bones bleed. Fractures cause blood loss within the bone.
* Splinting of long bone fractures involves immobilizing adjacent joints.
* Splinting protects the patient from further injury.
42
Chapter Review: Musculoskeletal Trauma
* You may need to be creative while splinting. There are many correct ways to splint the same extremity.
* Injuries to bones and joints should be splinted prior to moving the patient.
43
Chapter Review: Musculoskeletal Trauma
• If patient has multiple trauma or appears to have shock do not waste time splinting individual fractures. Place patient on long
spine board and secure limbs to board. Splint individual fractures en route if time and priorities allow.
44
Remember: Musculoskeletal Trauma
• Bones, joints, muscles, cartilage, tendons, and ligaments make up the musculoskeletal system.
• Bones provide the body with structure, store metabolic materials, and produce red
blood. Joints are the places where bones articulate to create movement.
45
Remember: Musculoskeletal Trauma
• Fractures, dislocations, sprains, and strains are musculoskeletal injuries that are caused by direct force, indirect force, and twisting force. Injuries should be splinted prior to moving the patient.
46
Remember: Musculoskeletal Trauma
* A closed extremity injury is one in which the skin has not been broken. An open extremity injury is one in which the skin has been broken.
* Pelvic fractures and femoral shaft fractures often indicate more severe internal injuries.
47
Remember: Musculoskeletal Trauma
• EMTs must learn specific techniques for immobilizing particular injuries but at the
same time must foster creativity while applying the general rules of splinting.
48
Questions to Consider: Musculoskeletal Trauma
* Have I fully addressed life threats and maintained my priorities even in the presence of a grossly deformed extremity?
* Does the patient have an injury that requires splinting?
49
Questions to Consider: Musculoskeletal Trauma
* Does the patient have multiple fractures, multiple trauma, or shock?
* Does the patient have adequate CSM distal to the musculoskeletal injury?
* Should I align the angulated extremity fracture?
50
Critical Thinking: Musculoskeletal Trauma
• Patients who suffer fractures can be in extreme pain. Pain can cause anxiety and elevated pulse rates. How could you
differentiate between a patient with a rapid pulse and anxiety from pain versus a patient with rapid pulse and anxiety from
shock?
51
206, major names, long bones, major bones that make up the skeleton
irregular
long bones
short
flat
.
52
pg 698 axial and appendicular skeleton
know the difference between these
53
skeletal, striated or voluntary all the same thing
.
54
cardiac - automaticity
differentiates from other muscle
55
smooth, involuntary - make
GI tract, blood vessels
```
urinary bladder,
uterus (termed uterine smooth muscle),
male & female reproductive tracts,
gastrointestinal tract,
respiratory tract,
erector pili of skin,
the ciliary muscle,
and iris of the eye
```
56
ligaments - make sure you know this - gave examples
attach bone to bone
57
tendons - make sure you know this achilles tendon - muscle to bone
know the difference between tendon and bone
attach bone to muscle
58
MOI for musculoskeletal
twisting, direct, indirect - don't work about
59
facture
break in a bone
60
comminuted
broken in several places
61
greenstick
incomplete fracture
62
angulated
bent at an angle
63
dislocation
occurs at a joint - shoulder and hip ball and socket joint
separation of the join
64
sprain
stretch or tear ligament
65
strain
stretch or tear a muscle
66
splint to stop any further injury from occurring
.
67
splinting the pt to death
focus on the real problem not the traumatic injury
airway - then bag
RTA
orthopedic injury will not kill the pt
68
assessment
fell or hear crepitus
| swelling, bruising, eposes ends, here /blook vessel, compartment syndrome
69
six Ps of assessment
parin'pallor parastehsie........
70
if they have life threading injury the spine board can be the splint
.
71
principles
assess distal pms align to anatomical......
72
before splint assess pms, split assess pms
.
73
review splinting hazards
| wrap in the direction of venous blood flow
can check PMS with cap refill
74
if no pulse in the extremity, realign to get it back in place
.
75
fracture - splint - immobilize adjacent bone ends
joint below and the joint above
.
76
traction splint
mid shaft femur - only thing you can use a traction splint on
measure on the good leg
muscles go into tetany - constant contraction
jagged bone ends start cutting tissue
same length as good leg or pt tells you they have some relief
never roll onto the injured side
make sure we know who you use it for mid shaft femur fracture for
77
shoulder girdle
sling and swath
78
pelvic injuries
tie legs together
79
hip fracture / dislocation
most hip fracture are actually fractures of the proximal femur
neck of the femur
seldom a fracture to the socket joint
80
posterior - turned in
| anterior - turned out
pg 721
81
scoop stetcher is the device of choice for a hip fracature
.
82
ankle or foot - use a pillow
.
