Musculoskeletal Trauma Flashcards

Question

what are imflammatory/degenerative conditions?

Answer 1

May present with join pain, tenderness, and fatigue | May cause difficulty walking, moving, and performing normal daily functions without assistance

Answer 2

BURSITIS – acute or chronic inflammation of the small synovial sacs that reduce friction and cushion the ligaments/tendons/joints Results from repeated trauma, gout, and infection Localized pain, swelling, and tenderness at joint – typically olecranon (elbow), above patella (knee), and shoulder

Answer 3

TENDINITIS – inflammation of a tendon and/or its protective sheath Presents similarly to bursitis Caused by repeated trauma to a muscle group Usually affects major tendons of the upper and/or lower extremities

Answer 4

inflammation of a joint

Answer 5

OSTEOARTHRITIS – inflammation of a joint resulting from wearing down of the articular cartilage Most common type of connective tissue disorder; general wear and tear of articular cartilage Results in bony overgrowths – causing pain, stiffness, decreased movement, and joint enlargement (especially in the fingers) Predisposing factors include trauma, obesity, and aging RHEUMATOID ARTHRITIS – chronic disease that causes deterioration of peripheral joint connective tissue Inflammation of the synovial joints – causing immobility, pain (especially with movement), and fatigue 2-3x more common in women GOUT – inflammation of joints and connective tissue due to buildup of uric acid crystals Most frequently in males who have high concentrations of uric acid in the blood (metabolism end-product that is not easily dissolved) Peripheral joint pain, swelling, and possible deformity

Answer 6

Musculoskeletal injury on its own is rarely life threatening Typically well assessed and well managed at the scene, however cannot be conclusively diagnosed without x-ray/ultrasound Serious injury occurs when the energy is transmitted down the bone to the internal organs Always consider mechanism of injury to evaluate potential for internal injuries Assessment will follow the same pattern as any patient – scene assessment, primary assessment, focused history and focused secondary assessment Should also include a rapid trauma assessment and detailed secondary assessment for traumatic patients, especially if presenting with altered LOC Ensure that if the mechanism is on a roadway, you are protected from oncoming traffic If the injury was from an assault, ensure the assailant is not on scene Contact appropriate resources, whenever necessary

Answer 7

AVPU and ABCs, as with all other patients Identify the risk of C-spine/spinal injuries – take appropriate precautions Musculoskeletal injuries can look very gruesome, but should not be a cause for tunnel vision As mentioned, they are often not life threatening on their own, but may look “bad” Classified in 4 different ways: Life and limb threatening injuries Life threatening injuries with minor musculoskeletal injuries Non-life threatening injuries but serious limb-threatening musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal injuries If the patient falls into the 4th category, only an focused secondary assessment is needed For more severe injuries, do a detailed secondary, as the patient may have one distracting injury that does not allow them to give an accurate account of their injuries

Answer 8

Performed for any patient with signs/symptoms/mechanism of serious injury Perform assessment from head to toe – hands on assessment for any patient who is altered LOC or who may have a distracting injury Remember to only palpate the pelvis once if crepitus, instability, or pain exists – do not want to manipulate the pelvis if it could be fractured to avoid causing life-threatening hemorrhage Evidence of blood loss/swelling may be difficult to see in the femurs due to muscle mass Check upper and lower extremities for stability, sensation, colouration, temperature, and circulation If the patient is conscious, have them show grip strength, joint movement, and range of motion bilaterally; check plantar flexion (pushing down on a gas pedal) and dorsiflexion (pulling toes towards nose) Accompany physical assessment with detailed history

Answer 9

Primary assessment will provide initial findings, while detailed history and secondary assessment will provide further information about initial findings Secondary assessment should be performed: ON SCENE – stable patients only ENROUTE – unstable patients (where time permits) Remove or cut any restrictive clothing, jewellery, or shoes – remove before more inflammation sets in and it is harder to remove Have partner/bystander stabilize injured extremity to avoid movement/manipulation Make sure to expose to all injury sites and compare to uninjured side Complete OPQRST Full 5 Ps before and after any manipulation/splinting of injury Pain, Pallor, Pulse, Paralysis, and Paresthesia (can also include ‘Pressure’ as a 6th P, if applicable) Question about whether the patient heard a “snap”, “pop”, or “crack” and whether the sound came before or after fall

Answer 10

Manage all ABC issues and spinal precautions prior to worrying about extremity splinting With the exception of the pelvis Goal is to prevent further injury Protect against infection by covering open injuries and avoid overt manipulation to avoid nerve and vessel damage Splint injuries in position found unless circulation is compromised – manipulate into neutral alignment (one attempt only) Explain all actions to the patient, as initial manipulation will probably cause increased pain until splinted Do not reduce a dislocation Stop all realignment attempts when you meet resistance or patient complains of intense increase in pain Do not attempt alignment of injuries within 7cm of a joint (considered joint injury if within 7cm) If unable to secure to joint above and below, secure limb directly against body for stability Place limb in position of function or neutral whenever possible

Answer 11

Immobilization is aimed to prevent: Movement of broken bone ends Dislodging of bone from a joint Reduce further stress on muscles, ligaments, or tendons Secure splinting device above and below the injury – holds joints in place to prevent the transmission of movement through long bone Wrap splint from distal to proximal Ensures the pressure of the dressing causes the blood to be moved into systemic circulation instead of into distal limb Assists venous dressing Wrap dressing tightly enough to ensure its secured, but not so tight that you can’t get a finger under it Be sure to check 5 Ps before, during, and after splinting REMEMBER – R. I. C. E. (Rest, Immobilize, Cold, Elevate); do not apply cold directly onto skin For muscular and joint injuries, alternate heat and ice after 48hrs

Answer 12

RIGID SPLINTS Firm and durable supports – cardboard, plastic, metal, synthetic, or wood Require added padding to reduce discomfort when applied Speed splint is typically used in prehospital setting in Ontario Other pre-formed splints are also available, just not typically purchased by EMS FORMABLE SPLINTS Malleable – able to be shaped to fit extremity SAM splint is typically used in EMS Can be used to splint a hand/wrist, most commonly Is also used to support a flail segment in chest trauma Are made of foam and mesh, or can be “ladder” splints made of soft metal wires Form splint around your own arm loosely before applying to patient Wrap circumferentially from distal to proximal SOFT SPLINTS Typically considered air splints or pillow splints – built in padding or inflate with air to support injury Positions the limb in an aligned position without extreme manipulation and provides pressure to injury – reduce internal/external hemorrhage Not to be used above knee or elbow Change in temperatures can change the pressure within an air splint Pillow/blanket splint allows for the ankle/foot to be wrapped comfortable in position found, with triangular bandages to secure it TRACTION SPLINTS Used primarily for closed femur fractures, but can also be used for tibia/fibula fractures Is occasionally taught for use in hip fractures Uses the force against the truck and the tension against the ankle to pull bone ends apart from rubbing Use cravats after traction is applied to hold extremities together Can be used for bilateral femur fractures as well One femur = 10% of body weight (max. 15lbs) Bilat femurs = 20% of body weight (max. 30lbs) Tib/Fib = 5-7lbs Contraindicated for use in femur fractures in patients with knee, tibia, or foot injuries

Answer 13

Involve either iliac crest or pelvic ring Iliac crest fractures are often isolated and stable – cared for by simple immobilization Pelvic ring fractures often serious, unstable, and life-threatening – due to “ring” structure = 2 fracture sites Pelvis is active in blood cell production; adjacent to major blood vessels feeding lower extremities, interfering with lower extremity circulation High risk of circulatory compromise – vessels can empty into pelvic and retroperitoneal cavities May also result in hip dislocation Care involves stabilizing pelvis Cravats or pillow/blanket padding Securing patient to scoop stretcher or spinal board Managing hemodynamic compromise Rapid transport Remember – pelvis fracture is “load and go” no matter if the patient is deemed stable or not

Answer 14

Could be of traumatic or non-traumatic (degenerative) cause Degenerative disease is typical for older age, history of degenerative issues, may have limited pain, and no significant traumatic mechanism Traumatic mechanism usually leads to extreme discomfort Proximal fractures (neck and intertrochanteric) – may appear to be hip fractures or associated with hip/pelvic trauma (more common in elderly) Femur = foot externally rotated and shortened Mid-shaft fractures – causes by higher levels of force and result in greater blood loss Distal fractures (condylar and epicondylar) – extensive injury and usually involved blood vessels before they enter the knee/lower leg Manage obvious femur fractures with traction splint (if fracture is not compound) One femur – “stay and play”, if otherwise stable; Bilat femur – “load and go”, even if patient is stable Ensure 5 Ps before, during, and after splinting

Answer 15

Can occur separately or together Tibia is the most commonly fractured leg bone – often causing compound fracture If only tibia is fractured, leg may remain inline but is not strong enough to bear weight Fibula fracture may accompany tibia fracture, or may be related to knee or ankle injuries If only fibula is fractured, leg may remain inline and may be stable with symptoms being discomfort when bearing weight If distal circulation is present, use speed splint to immobilize the patient’s leg If distal circulation is absent, consider use of sager splint Ensure 5 Ps before, during, and after care R.I.C.E

Answer 16

Most frequently fractured bone in the human body Typically caused by transmitted forces – falling only outstretched arm and force travelling up arm and ending with clavicle Main concern is the fact that the clavicles are very close to upper lungs and the vasculature of the upper body – risk of pneumothorax or hemorrhage if left unsecured Typical presentation involved pain to clavicle and shoulder, with shoulder rotated forward Can either use a sling and swathe with cold pack to immobilize clavicle May also use a tension splint – figure 8 around shoulders, with traction being “twisted” and pulled from back Use a pen or a tongue depressor to turn traction 5 Ps before, during, and after

Answer 17

Due to position of humerus into shoulder, and proximity to axillary artery, traction to humerus is difficult to accomplish without compromising circulation Best treated if the body is used as a “splint” Sling and swathe with cold pack Can wrap a triangular around the patient’s wrist and use as a countertraction to anchor arm to body If the patient is conscious, have them hold arm in position of comfort May also use a speed splint – best for mid-shaft or distal humerus injuries 5 Ps before, during, and after

Answer 18

May involve the bones individually or together Most common fracture is the distal end of the radius, as it meets the wrist Referred to as Colle’s fracture (silver fork fracture) – wrist angulates upwards and circulation may be compromised, causing hand to become ashen in colour Typically not a life or limb threatening injury If only one of the bones are fractured, the angulation may be minor Use speed splint or SAM splint to immobilize forearm – secure above and below fracture, just like all other long bone fractures Additionally, the patient may be more comfortable with a sling and swathe applied after splint Leave at least the fingernail beds exposed to be able to check distal circulation, but when possible leave a small gab for radial pulse check 5 Ps before, during, and after

Answer 19

May dislocate anteriorly or posteriorly Anterior = foot turned outward and head of femur palpable in inguinal area Posterior = flexed knee and internally rotated limb; head of femur buried in muscle mass of buttock (not often palpable) Treat the same way as a pelvic fracture – padding and careful movement/transport Not considered a “load and go” unless circulation is compromised or other serious injuries present 5 Ps are still required with any manipulation Compare the length and positioning of the injured leg against the non-injured leg for evidence of changes/deformity Compare circulation of both legs Remember that hip dislocations are more common in elderly patients, and the new spinal restriction standard requires a collar to be applied for any patient over 65 y/o who has had a fall

Answer 20

May include fractures of the femur, tibia, patellar dislocation, or frank dislocation of the knee Dislocation of the patella most common Anterior dislocation – angled up; posterior dislocation – angled down Any knee injury could be considered serious to the patient’s quality of life and limit the patient’s mobility in the future Knee is a large joint responsible for significant weight bearing and ambulation Damage to the knee could result in popliteal artery damage – compromising distal circulation Whenever possible, immobilize knee injuries in the position found Use the “A” frame technique – one ridged splint on medial side and one on lateral side – to support injured knee Do not attempt to reduce a knee dislocation Multiple ligaments, vessels, nerves, and synovial fluid sacs that may become injured Still require 5 Ps before, during, and after

Answer 21

Fracture often causes obvious deformity due to smaller diameter of ankle Foot fractures are typically painful but do not present gross deformity since bones are very small and cannot angulate (other than toes) Sprains are common ankle injuries, however present with isolated swelling more than overt deformity Dislocation can occur in any direction Anterior = dorsiflexion (upward pointing) Posterior = lengthen plantar reflex (downward pointing) Lateral = foot turned outward *most common* Use a pillow splint for gross deformity/foot angulation Use a speed splint for injuries that do not result in significant angulation 5 Ps before, during, and after Cold pack should be applied to reduce swelling

Answer 22

Fractures often involve proximal humerus, lateral scapula, and distal clavicle Dislocation can be in multiple directions Anterior = displaces forward – patient often holding arm against body and pulling across midline Posterior = elbow and forearm held away from body due to internal rotation of shoulder Inferior = humoral head is down, patients arm may be locked above head or hanging down immobile Sling and swathe whenever possible Secure arm against the patient’s body with a bulky dressing between arm and body 5 Ps before, during, and after Cold pack on shoulder Do not try and reduce a dislocation If the patient has had prior dislocations to shoulder, recurrence is common

Answer 23

High occurrence of nerve/vascular involvement – especially with children Brachial artery Medial, ulnar, and radial nerves Often occurs from falling on outstretched hand In children, common with someone grabbing and pulling arm forcefully Use speed splint or sling/swathe to immobilize injury against body Ensure 5 Ps before, during, and after Do not try and reduce a dislocation

Answer 24

Commonly associated with direct trauma Noticeable deformity is common Often associated with emotional distress since the patient uses their hands for daily function Use SAM splint to immobilize wrist/hand Ensure distal circulation Monitor capillary refill If fingers are fractures, splint injured finger against stable finger next to it, or use a tongue depressor as a rigid splint Do not attempt to manipulate finger dislocations/fractures

Answer 25

``` Splinting/Immobilization Hot packs – to improve circulation Cold packs – to reduce inflammation Patient positioning Patient coaching/breathing Oxygen therapy (if needed) ```

Musculoskeletal Trauma Flashcards

(50 cards)