Chapter 28 LO - Jones & Bartlett...

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Musculoskeletal Trauma

Lesson Goal

Recognize and manage patients with musculoskeletal trauma

Lesson Objectives

Describe function of muscular system

Describe composition of muscular system

Describe, compare, and contrast different injuries to muscular system

Describe function of skeletal system

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

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Lesson Objectives

Describe composition of skeletal system: Head

Spinal column

Thorax

Upper and lower extremities

Describe structures within a joint

Compare and contrast different types of joints

Lesson Objectives

Distinguish between open & closed skeletal injuries

Define splinting

List reasons for splinting

List rules for splinting

Lesson Objectives

Explain splinting procedures

Explain complications of splinting

Explain situations in which splinting on scene is not acceptable and why


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Introduction

EMS commonly called to assess and manage musculoskeletal injuries

EMTs need to understand functions of musculoskeletal system, musculoskeletal injuries, and care of musculoskeletal injuries

Muscular System

Functions Provide shape

Protection

Motion

Move blood through body

Move food through digestive tract

Types of Muscles

Voluntary Under conscious control

Involuntary Automatic

Function without thought

Skeletal Striated

Voluntary

Cardiac Striated

Involuntary

Smooth Nonstriated

Involuntary


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Types of Muscles

Muscle groups work together under control of nervous system

Movement is produced when muscles contract & shorten

Skeletal muscles—contained within fascia

Injuries to the Muscular System

Types of injuries Strain Sprain Laceration Contusion Crushing injury Avulsion Puncture

Swelling may impede circulation

Injuries to the Muscular System

Assessment of a muscular injury yields a painful, swollen extremity

6 Ps Pain

Pallor

Pulses

Paresthesia

Paralysis

Pressure/puffiness


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Forces that Produce Injury

Direct

Indirect

Twisting

Treatment of Muscular Injuries

Similar to treatment of other soft tissue injuries

Splint

Functions of Skeletal System

Support & protect

Made of calcium & living tissue

Rich blood supply

Marrow cavity Yellow marrow Red marrow


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Skeletal System

Classification of Bones

Long Humerus, femur

Short Carpals, tarsals

Flat Ribs, sternum

Irregular Vertebrae, facial bones

Skull


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Spine

Spinal column (vertebral column) 7 Cervical

12 Thoracic

5 Lumbar

1 Sacrum (5 sacral)

1 Coccyx (4 or 5 coccygeal )

Thorax

Upper Extremity

Pectoral girdle Clavicles Scapulae

Arm Humerus Radius Ulna

Wrist 8 carpals (2 rows of 4)

Hand 5 Metacarpals 14 Phalanges


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Lower Extremity

Ligaments, Cartilage & Joints

Ligaments connect bone to bone

Cartilage covers bone ends

Bones come together at joints Fibrous—little or no movement

Cartilaginous—some movement

Synovial—allow different types of motion

Synovial Joints

Joint capsule contains synovial fluid

Types Plane or gliding

Saddle

Hinge

Pivot

Ball & socket

Ellipsoidal


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Injuries to Skeletal System

Can involve joints &/or bones

May be open or closed

Sign & symptoms: Swelling

Pain

Deformity

Crepitus

Musculoskeletal Injuries

X-rays—used to determine type of injury Fracture

Dislocation

Musculoskeletal Injuries

Fracture

Dislocation


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Assessment

6 Ps Pain/tenderness

Pallor or skin color

Pulses

Paresthesia

Paralysis

Pressure/puffiness

Management

When in doubt, splint

Importance of splinting Reduces pain

Controls bleeding

Prevents further injury

Splinting never takes precedence over ABCs!

Objectives of Splinting

Stabilize injury to prevent movement

Prevent further injury by stabilizing bone ends

Provide some pain relief by stabilization

Restore or maintain circulation to extremity

Provide padding during transport


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Rules of Splinting

If it is painful, swollen, or deformed, splint it

Completely immobilize injury & surrounding area Bones

• From joint above to joint below

Joints• From bone above to bone

below

In Preparation for Splinting

Support injured area

Remove clothing & jewelry

Assess distal pulse, motor & sensory function

In Preparation for Splinting

Apply gentle, inline traction if Pulses are absent

Distal extremity is cyanotic

Gross deformity is present

Do not reinsert protruding bone ends

Cover open wounds with sterile dressings

Pad splint

Maintain position of function

Splint before moving patient


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Types of Splints

Rigid board

Ladder

Traction

Air

Vacuum

Formable

Anatomic

Sling and swathe

Rigid Board Splint

Skill 28-1: Rigid Splint

1. Check distal pulses; stabilize extremity above and below fracture site before manipulating extremity

2. Apply rigid splints on at least 2 sides of extremity


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3. Wrap splints securely to extremity, moving distal to proximal

4. Recheck distal pulses after applying splints


Video Clip coming soon

Ladder Splint


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Traction Splint

Skill 28-2: Traction Splint

1. Check distal pulses while supporting injured extremity

2. Attach ankle strap and apply manual traction, then check distal pulse


3. Adjust traction splint to proper length using uninjured extremity as guide

4. Slide splint under injured extremity and fasten strap at top of splint; recheck distal pulse


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5. Attach traction device to ankle strap; ratchet up traction until device takes traction away from EMT applying manual traction

6. Recheck distal pulse after traction is turned over to device


7. Attach leg straps to secure leg in splint




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Air Splint

Vacuum Splint


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Skill 28-3: Vacuum Splint

1. Lay splint on flat area, smooth out until plastic beads are evenly distributed. Remove some air from splint so sides do not collapse when splint is shaped

2. Place splint underneath extremity and bend it into a U-shape around extremity, fasten Velcro fasteners. Form each major curve around any bend in extremity so that extremity is held completely in place


3. Use pump to remove remaining air, leaving splint rigid

4. Check distal circulation on extremity




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Pillow Splint

Formable Splint Application


Anatomic Splint


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Sling and Swathe

Skill 28-4: Sling and Swathe

1. Check distal pulse and sensation, then apply sling

2. Wrap upper arm to chest without restricting breathing

Skill 28-4: Sling and Swathe

3. Recheck distal pulse and sensation after securing sling


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Reassessment

Reassessment after splinting is essential

Recheck distal: Pulse

Sensation

Motor function

Multisystem Trauma

Skeletal trauma may be obvious & distracting, but may not be the most serious injury

Assess patient for potential life threats

Manage life threats first

Use anatomic splinting if patient is in “load & go” situation

Summary

Musculoskeletal system has many important functions & is commonly injured

Injuries present with pain, swelling, deformity

After the ABCs, assess the “6 Ps”

Manage with splinting, elevation, & cold

Reassess after splinting


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