Lesson 14 Injuries to Muscles and Bones Lesson 14
Provides shape/support for body
Bones protect vital internal organs
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Direct force: force applied directly to body
Indirect force: force transferred from original body site along an extremity to another point
Twisting forces: part of body forced to move in unnatural direction
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fracture/joint dislocation more likely
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First Responders not responsible for determining type of musculoskeletal injury:
Fractures
Dislocations
Sprains
Closed fracture - skin not broken
Open fracture - open wound at site
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Dislocations
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Dislocations
One or more bones at joint displaced from normal position
Ligaments holding bone are torn
Result from strong forces
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Serious bleeding may result
With severe dislocation, joint/limb will look deformed
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Sprains
Ankles, knees, wrists, fingers most common
Considerable swelling often occurs rapidly
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Many causes
Often you will recognize musculoskeletal injury is present
Emergency care is same regardless of injury type
Usually not life threatening
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If large forces involved, consider potential for spinal injury
Expose injury site
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Assess for Circulation, Sensation, And Movement (CSM) Below the Injury Site
Check pulse below injury
Touch fingers/toes
Have patient wiggle fingers/toes
Bone movement further injures soft tissues
Movement generally increases blood flow - may increase internal bleeding/ swelling
Manually stabilize or splint injured area
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Perform standard patient care
Control any life threats
Cover open wounds with sterile dressing
Apply cold pack
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Stabilize injured extremity manually
If appropriate, splint extremity
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Splinting
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Splinting
Movement may worsen musculoskeletal injury and cause more pain
Splint injured arm or leg if risk of area being moved (unless help expected quickly)
Always splint an extremity before transporting victim
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Splinting
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Don’t secure with tape
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Splint in position found
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Splint injury first
If you splint injury in position found and this position makes use of sling difficult – do not use sling
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Guidelines for Slings continued
Do not move arm into position for sling if it causes pain
A cold pack can be used inside sling
Do not cover fingers inside sling
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Skill:
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Bring lower end of bandage to opposite side of neck.
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Scapula fractures are rare
Shoulder dislocations are common
Goal is to stabilize area from trunk to upper arm
Use soft splint. Do not move extremity
Assess for circulation, sensation, and movement
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Apply sling and binder to support and immobilize arm
if this causes pain use larger soft splint
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Treat fractures near shoulder with soft splint
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Apply rigid splint along outside of arm
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Tie above injury and at elbow
Support wrist with sling and wide swathe
If it causes pain to raise wrist for a sling, use long rigid splint
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Fractures occur above or below elbow
Patient unable to move joint
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Splinting Elbow Injuries
If elbow bent, apply rigid splint from upper arm to wrist
If more support needed, use sling at wrist and binder around chest
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Splinting Elbow Injuries
If elbow straight, apply rigid splint from upper arm to hand
If more support needed, use binders around chest and upper arm and lower arm and waist
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Skill:
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Soft splint and sling often sufficient
Rigid splint provides more support
Assess circulation, sensation, movement in hand and fingers
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Wrist Injuries
Apply rigid splint on palm side of arm from forearm past fingertips
Tie above and below wrist
Leave fingers uncovered
Support forearm and wrist with sling and apply binder around upper arm and chest
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Fractures occur when patient punches something with closed fist
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Place roll of gauze in palm
Bandage entire hand
Place rigid splint on palm side of hand. Pad between hand and splint
Support further with sling and swathe
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Use soft splint if finger cannot be straightened without pain
Don’t manipulate finger into normal position
Use rigid splint, secured with tape
Tape finger to adjoining finger with gauze in between
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Forces may also cause spinal injury
Assess patient, without moving extremity
Femur fracture can damage femoral artery
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Fractures more common in elderly
Bleeding and pain may be severe
Dislocations occur at any age
Falls
Immobilize leg and hip in position found
Pad between legs and bandage together (unless this causes more pain)
Treat for shock but do not elevate legs
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Severe pain/shock may occur
Keep patient from moving
Use rigid splint if lying down with leg supported by ground
Use folded blankets/coats to immobilize leg in position found
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Check circulation and sensation in foot and toes
Put rigid splint on each side of leg
Pad body areas and voids
Inside splint should extend from groin past foot
Outside splint should extend from armpit past foot
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Traction Splint for Femur Fractures
Traction splint maintains continual pull on femur to keep bone ends in normal position
First Responders usually assist other EMS personnel
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Femur, tibia or fibula fractures indistinguishable from knee injuries
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Splint in position found
Apply soft splint by rolling blanket or placing pillow around knee
If knee straight, make anatomical splint
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If possible, put rigid splint on both sides of leg
Pad body areas and voids
Check circulation and sensation in foot and toes first and periodically after splinting
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Splinting the Knee
If knee is straight apply two splints along both sides of knee
If knee is bent, splint in position found
Tie splints with cravats or bandages
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Either or both bones of lower leg can be fractured
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Three-sided cardboard splint can be used
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Skill:
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Check circulation. Gently slide four to five strips of bandages under both legs.
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Ankle Injuries
Commonly a sprain occurring when foot forcefully twisted to one side
Fractures or dislocations
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Involve almost any bone/ligament of foot
Treat same as ankle injuries
Toe fractures can be very painful
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toe is significantly bent
foot is very painful
More common in lower ribs and along side
Cause severe pain, discoloration, swelling
Pain often sharper upon breathing in
Patient may breathe shallowly and hold/support area
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Have patient sit/stand in easy breathing position
Support ribs with pillow or soft padding loosely bandaged over area and under arm
Immobilize arm with sling and swathe
Monitor breathing