Muscle Skeletal Trauma for EMS

Musculoskeletal InjuriesMusculoskeletal Injuries

ScenarioScenario

You respond to a soccer field for an You respond to a soccer field for an “accidental injury.” Your patient is a “accidental injury.” Your patient is a 33-year old male who is complaining 33-year old male who is complaining of severe right ankle pain. You note of severe right ankle pain. You note gross angulation and deformity of gross angulation and deformity of the ankle and carefully remove his the ankle and carefully remove his shoe to assess his distal circulation. shoe to assess his distal circulation. Your examination reveals that there Your examination reveals that there is almost no perfusion to his foot. is almost no perfusion to his foot.

DiscussionDiscussionDiscussionDiscussion

What exam findings would lead you to believe What exam findings would lead you to believe that perfusion to the extremity is poor?that perfusion to the extremity is poor?

Describe actions that should be taken Describe actions that should be taken immediately to improve blood flow to the immediately to improve blood flow to the foot.foot.

How will you determine if your actions are How will you determine if your actions are successful?successful?

What anatomical structures are likely What anatomical structures are likely involved in this injury?involved in this injury?

What exam findings would lead you to believe What exam findings would lead you to believe that perfusion to the extremity is poor?that perfusion to the extremity is poor?

Describe actions that should be taken Describe actions that should be taken immediately to improve blood flow to the immediately to improve blood flow to the foot.foot.

How will you determine if your actions are How will you determine if your actions are successful?successful?

What anatomical structures are likely What anatomical structures are likely involved in this injury?involved in this injury?

Introduction to Musculoskeletal InjuriesIntroduction to Musculoskeletal Injuries

Millions of Americans experience Millions of Americans experience annually.annually.

Multiple MOIMultiple MOI Falls, Crashes, Violence, etcFalls, Crashes, Violence, etc Multi-system traumaMulti-system trauma

Anatomy & Physiology of the Anatomy & Physiology of the Musculoskeletal SystemMusculoskeletal System

Skeletal Tissue & StructureSkeletal Tissue & Structure Protections organsProtections organs Allows for efficient movementAllows for efficient movement Stores salts and other materials needed Stores salts and other materials needed

for metabolismfor metabolism Produces RBC’sProduces RBC’s

Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System

Muscular InjuryMuscular Injury ContusionContusion Compartment SyndromeCompartment Syndrome Penetrating InjuryPenetrating Injury FatigueFatigue Muscle CrampMuscle Cramp Muscle SpasmMuscle Spasm StrainStrain


Appendicular skeleton (126 bones)Appendicular skeleton (126 bones) Pectoral girdle (4)Pectoral girdle (4)

ClavicleClavicle ScapulaScapula

Upper limbs (60)Upper limbs (60) Pelvic girdle (2)Pelvic girdle (2) Lower limbs (60)Lower limbs (60)

Anatomy — Skeletal SystemAnatomy — Skeletal System

Bone ClassificationsBone Classifications

Long bonesLong bones

Short bonesShort bones

Flat bonesFlat bones

Irregular bonesIrregular bones

Anatomy — Skeletal SystemAnatomy — Skeletal System

Posterior viewPosterior view


Bone AgingBone Aging Birth to Adult (18-20)Birth to Adult (18-20)

Transition from flexible to firm boneTransition from flexible to firm bone Adult to elderly (40+)Adult to elderly (40+)

Reduction in collagen matrix and calcium Reduction in collagen matrix and calcium saltssalts

Diminution of bone strengthDiminution of bone strength Spinal curvatureSpinal curvature


Muscular Tissue Muscular Tissue & Structure& Structure

600 muscle 600 muscle groupsgroups

Types of Types of musclesmuscles

SmoothSmooth StriatedStriated CardiacCardiac

Skeletal MusclesSkeletal Muscles

Have striationsHave striations

Greater strengthGreater strength

Referred to as striated muscleReferred to as striated muscle

Are under voluntary controlAre under voluntary control

Also called voluntary musclesAlso called voluntary muscles

Skeletal MusclesSkeletal Muscles

Conscious controlConscious control 40% of total body mass40% of total body mass Two attachmentsTwo attachments

Origin: More fixed and proximal Origin: More fixed and proximal attachmentattachment

Insertion: More movable and distal Insertion: More movable and distal attachmentattachment

Contractions are rapid and forcefulContractions are rapid and forceful

Smooth MusclesSmooth Muscles

Walls of hollow organs (e.g., urinary Walls of hollow organs (e.g., urinary bladder and uterus) bladder and uterus)

Walls of tubes (e.g., respiratory, Walls of tubes (e.g., respiratory, digestive, reproductive, urinary, and digestive, reproductive, urinary, and circulatory systems)circulatory systems)

Innervated by autonomic nervous Innervated by autonomic nervous systemsystem Regulates size of lumen of tubular structuresRegulates size of lumen of tubular structures

Contractions strong and slowContractions strong and slow

Cardiac MusclesCardiac Muscles


Have strength of skeletal muscle and endurance Have strength of skeletal muscle and endurance of smooth muscleof smooth muscle

Provide for movement of blood through the body Provide for movement of blood through the body on a continuous basison a continuous basis

Respond to stimulation from the nervous systemRespond to stimulation from the nervous system

Highly sensitive to lack of oxygenHighly sensitive to lack of oxygen

Respond to lack of oxygen with pain in that area Respond to lack of oxygen with pain in that area (angina)(angina)


MyocardiumMyocardium Forms middle layer of Forms middle layer of

heartheart

Innervated by Innervated by autonomic nervous autonomic nervous system but contracts system but contracts spontaneously without spontaneously without any nerve supplyany nerve supply

Contractions are Contractions are strong and rhythmicstrong and rhythmic

TendonsTendons

Bands of connective tissue Bands of connective tissue Bind muscles to bonesBind muscles to bones

Allow for power of movement across Allow for power of movement across jointsjoints

Supplied by sensory fibers that Supplied by sensory fibers that extend from muscle nervesextend from muscle nerves

BursaeBursae Flattened, closed sacs of synovial fluidFlattened, closed sacs of synovial fluid

Where tendon rubs against bone, Where tendon rubs against bone, ligament, or other tendonligament, or other tendon

Reduce friction Reduce friction

Act as shock absorberAct as shock absorber

Fill with fluid when infected or injuredFill with fluid when infected or injured

CartilageCartilage

Connective tissue covering epiphysisConnective tissue covering epiphysis

Surface for articulationSurface for articulation

Allows for smooth movement at Allows for smooth movement at jointsjoints

LigamentsLigaments

Connective tissue that crosses jointsConnective tissue that crosses joints

Attaches bone to boneAttaches bone to bone

Stretch more easily than tendonsStretch more easily than tendons

Allow for stable range of motionAllow for stable range of motion

FasciaFascia

Dense fibrous connective tissueDense fibrous connective tissue

Forms bands or sheetsForms bands or sheets

Covers muscles, blood vessels, and Covers muscles, blood vessels, and nervesnerves

Supports and anchors organs to Supports and anchors organs to nearby structuresnearby structures

Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System

Joint InjuryJoint Injury SprainSprain SubluxationSubluxation DislocationDislocation

Bone InjuryBone Injury Open FractureOpen Fracture Closed FractureClosed Fracture Hairline FractureHairline Fracture Impacted FractureImpacted Fracture

Pathophysiology — Mechanism of Pathophysiology — Mechanism of InjuryInjury

Five forces cause bone and joint injuryFive forces cause bone and joint injury

Direct forceDirect force

Indirect forceIndirect force

Twisting forceTwisting force

PathologicalPathological

Fatigue Fatigue

Classifications of Musculoskeletal Classifications of Musculoskeletal InjuriesInjuries

Injuries include:Injuries include: FracturesFractures SprainsSprains StrainsStrains

Joint dislocationsJoint dislocations

Musculoskeletal InjuriesMusculoskeletal Injuries

Direct traumaDirect trauma Blunt force applied to an extremityBlunt force applied to an extremity

Indirect traumaIndirect trauma Vertical fall that produces spinal fracture Vertical fall that produces spinal fracture

distant from site of impactdistant from site of impact

Pathological conditionsPathological conditions Some forms of arthritisSome forms of arthritis MalignancyMalignancy

Pathophysiology — FracturesPathophysiology — Fractures

Unstable — Proximal and distal ends move Unstable — Proximal and distal ends move freely in relationship to each otherfreely in relationship to each other

Impacted — Jammed together so there is no Impacted — Jammed together so there is no movement between proximal and distal bonesmovement between proximal and distal bones

Open — Skin is open, allowing introduction Open — Skin is open, allowing introduction of bacteria, dirt, and other foreign bodiesof bacteria, dirt, and other foreign bodies

Closed — Skin is intactClosed — Skin is intact

Fracture with dislocation — Fracture at joint Fracture with dislocation — Fracture at joint with injury to supporting structureswith injury to supporting structures

FracturesFractures

Break in continuity of bone or Break in continuity of bone or cartilagecartilage

Complete or incompleteComplete or incomplete Line of fracture through boneLine of fracture through bone

Open or closedOpen or closed Integrity of skin near fracture siteIntegrity of skin near fracture site

Classification of FracturesClassification of Fractures

OpenOpen

ClosedClosed

ComminutedComminuted

GreenstickGreenstick

SpiralSpiral


ObliqueOblique

TransverseTransverse

StressStress

PathologicalPathological

EpiphysealEpiphyseal

Pathophysiology — Fractures Pathophysiology — Fractures Impacted Impacted

Joint DislocationsJoint Dislocations Normal articulating ends of two or more bones Normal articulating ends of two or more bones

are displacedare displaced Luxation: Complete dislocationLuxation: Complete dislocation Subluxation: Incomplete dislocationSubluxation: Incomplete dislocation

Frequently dislocated jointsFrequently dislocated joints

Suspect joint dislocation when joint is deformed Suspect joint dislocation when joint is deformed or does not have normal range of motionor does not have normal range of motion

Dislocations can result in great damage and Dislocations can result in great damage and instabilityinstability

Pathophysiology — Fractures Pathophysiology — Fractures Dislocation - AngulatedDislocation - Angulated

SprainsSprains Partial tearing of ligamentPartial tearing of ligament

Caused by sudden twisting or stretching of Caused by sudden twisting or stretching of joint beyond normal range of motionjoint beyond normal range of motion

Common in ankle and kneeCommon in ankle and knee

Graded by severityGraded by severity First-degree sprainFirst-degree sprain Second-degree sprainSecond-degree sprain Third-degree sprainThird-degree sprain

StrainsStrains Injury to muscle or its tendonInjury to muscle or its tendon

Overexertion or overextensionOverexertion or overextension

Common in back and armsCommon in back and arms

May have significant loss of functionMay have significant loss of function

Severe strains may cause avulsion of bone Severe strains may cause avulsion of bone from attachment sitefrom attachment site

Pathophysiology of the Musculoskeletal Pathophysiology of the Musculoskeletal SystemSystem

Inflammatory & Degenerative Inflammatory & Degenerative ConditionsConditions BursitisBursitis TendinitisTendinitis ArthritisArthritis

OsteoarthritisOsteoarthritis DegenerativeDegenerative

Rheumatoid ArthritisRheumatoid Arthritis Chronic, systemic, progressive, debilitatingChronic, systemic, progressive, debilitating

GoutGout Inflammation of joints produced by accumulation of Inflammation of joints produced by accumulation of

uric acid crystalsuric acid crystals

BursitisBursitis

Inflammation of bursaInflammation of bursa Small, fluid-filled sac acts as cushion at Small, fluid-filled sac acts as cushion at

a pressure point near jointsa pressure point near joints Most important bursae are around knee, Most important bursae are around knee,

elbow, and shoulderelbow, and shoulder

BursitisBursitis

Bursitis is usually from:Bursitis is usually from: Pressure Pressure FrictionFriction Injury to membranes surrounding the Injury to membranes surrounding the

jointjoint

TreatmentTreatment Rest, ice, and analgesicsRest, ice, and analgesics

TendonitisTendonitis Inflammation of tendonInflammation of tendon

Often caused by injuryOften caused by injury

Symptoms include:Symptoms include: PainPain TendernessTenderness Restricted movement of muscle attached to affected Restricted movement of muscle attached to affected

tendontendon

TreatmentTreatment Nonsteroidal antiinflammatory drugs (NSAIDs)Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroid medicationsCorticosteroid medications

ArthritisArthritis

Joint inflammationJoint inflammation Pain, swelling, stiffness, and rednessPain, swelling, stiffness, and redness

Joint diseaseJoint disease Involving one or many jointsInvolving one or many joints Many causesMany causes

Varies in severityVaries in severity Mild ache and stiffnessMild ache and stiffness Severe pain and later joint deformitySevere pain and later joint deformity

ArthritisArthritis

Osteoarthritis (degenerative arthritis) Osteoarthritis (degenerative arthritis) most commonmost common

Pain usually managed with Pain usually managed with antiinflammatory agentsantiinflammatory agents

Extremity TraumaExtremity Trauma

Signs and symptomsSigns and symptoms Pain on palpation or movementPain on palpation or movement Swelling, deformitySwelling, deformity CrepitusCrepitus Decreased range of motionDecreased range of motion False movement (unnatural movement False movement (unnatural movement

of extremity)of extremity) Decreased or absent sensory perception Decreased or absent sensory perception

or circulation distal to injuryor circulation distal to injury

Six "P"s of Compartment Six "P"s of Compartment SyndromeSyndrome

PainPain On palpation (tenderness)On palpation (tenderness) On movementOn movement

PallorPallor——pale skin or poor capillary pale skin or poor capillary refillrefill

ParesthesiaParesthesia——pins and needles pins and needles sensationsensation

PulsesPulses——diminished or absentdiminished or absent ParalysisParalysis——inability to moveinability to move PressurePressure

Associated ComplicationsAssociated Complications HemorrhageHemorrhage

InstabilityInstability

Loss of tissueLoss of tissue

Simple laceration and contaminationSimple laceration and contamination

Interruption of blood supplyInterruption of blood supply

Nerve damageNerve damage

Long-term disabilityLong-term disability

AssessmentAssessment

Determine if life-threatening conditions Determine if life-threatening conditions are presentare present Care for those firstCare for those first

Never overlook musculoskeletal traumaNever overlook musculoskeletal trauma

Don’t allow noncritical musculoskeletal Don’t allow noncritical musculoskeletal injury to distract from priorities of careinjury to distract from priorities of care

Musculoskeletal AssessmentMusculoskeletal Assessment

Four classes of patientsFour classes of patients Life-/limb-threatening injuries or conditionsLife-/limb-threatening injuries or conditions

Includes life-/limb-threatening musculoskeletal Includes life-/limb-threatening musculoskeletal traumatrauma

Other life-/limb-threatening injuries and Other life-/limb-threatening injuries and simple musculoskeletal traumasimple musculoskeletal trauma

Life-/limb-threatening musculoskeletal Life-/limb-threatening musculoskeletal trauma trauma

No other life-/limb-threatening injuriesNo other life-/limb-threatening injuries Isolated, non-life-/limb-threatening injuriesIsolated, non-life-/limb-threatening injuries

Musculoskeletal Injury AssessmentMusculoskeletal Injury Assessment Scene Size-upScene Size-up Initial AssessmentInitial Assessment

Categories of urgencyCategories of urgency Life & Limb threatening injuryLife & Limb threatening injury Life threatening injury and minor musculoskeletal Life threatening injury and minor musculoskeletal

injuryinjury Non-life threatening injuries but serious Non-life threatening injuries but serious

musculoskeletal injuriesmusculoskeletal injuries Non-life threatening injuries and only isolated minor Non-life threatening injuries and only isolated minor

musculoskeletal injuriesmusculoskeletal injuries Rapid Trauma AssessmentRapid Trauma Assessment Focused H&PFocused H&P

6 P’s: Pain, Pallor, Paralysis, Paresthesia, 6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, PulsesPressure, Pulses

Detailed Physical ExamDetailed Physical Exam Ongoing AssessmentOngoing Assessment Sports Injury ConsiderationSports Injury Consideration

Age-Associated Changes Age-Associated Changes in Bonesin Bones

Water content of intervertebral disks Water content of intervertebral disks decreasesdecreases

Increased risk of disk herniationIncreased risk of disk herniation Loss of stature is common – ½ - 3/4 Loss of stature is common – ½ - 3/4

inch inch Bone tissue disorders shorten trunkBone tissue disorders shorten trunk

Age-Associated Changes Age-Associated Changes in Bonesin Bones

Vertebral column assumes arch shapeVertebral column assumes arch shape

Costal cartilages ossify, making thorax Costal cartilages ossify, making thorax more rigidmore rigid

Shallow breathing due to rigid thoracic cageShallow breathing due to rigid thoracic cage

Facial contours changeFacial contours change

FracturesFractures

Limb-Threatening InjuriesLimb-Threatening Injuries

Knee dislocationKnee dislocation Fracture or dislocation of ankleFracture or dislocation of ankle Subcondylar fractures of elbowSubcondylar fractures of elbow Require rapid transportRequire rapid transport

Musculoskeletal Injury ManagementMusculoskeletal Injury Management

Other Injury ConsiderationOther Injury Consideration Pediatric Musculoskeletal InjuryPediatric Musculoskeletal Injury Athletic Musculoskeletal InjuryAthletic Musculoskeletal Injury Patient Refusals & ReferralPatient Refusals & Referral Psychological SupportPsychological Support


General PrinciplesGeneral Principles Protecting Open WoundsProtecting Open Wounds Positioning the limbPositioning the limb Immobilizing the injuryImmobilizing the injury Checking Neurovascular FunctionChecking Neurovascular Function

Musculoskeletal Injury ManagementMusculoskeletal Injury Management Splinting DevicesSplinting Devices

Rigid splintsRigid splints Formable SplintsFormable Splints Soft SplintsSoft Splints Traction SplintsTraction Splints Other Splinting AidsOther Splinting Aids

Vacuum SplintsVacuum Splints Air SprintsAir Sprints Cravats or Velcro SplintsCravats or Velcro Splints

Fracture CareFracture Care Joint CareJoint Care Muscular & Connective Tissue CareMuscular & Connective Tissue Care


Care for Specific FracturesCare for Specific Fractures PelvisPelvis

Scoop StretcherScoop Stretcher PASGPASG Fluid ResuscitationFluid Resuscitation

FemurFemur Traction SplintsTraction Splints PASGPASG Fracture versus hip doslocationFracture versus hip doslocation


Care Specific FracturesCare Specific Fractures Tibia/FibulaTibia/Fibula ClavicleClavicle

Most frequently fractured bond in the bodyMost frequently fractured bond in the body Transmitted to 1Transmitted to 1stst and 2 and 2ndnd rib rib Alert for lung injuryAlert for lung injury

HumerusHumerus Radius/UlnaRadius/Ulna


Care for Specific Joint InjuriesCare for Specific Joint Injuries HipHip KneeKnee AnkleAnkle FootFoot ShoulderShoulder ElbowElbow Wrist/HandWrist/Hand FingerFinger

Joint Injuries

Alert for PMS Compromise


Soft & Connective Tissue InjuriesSoft & Connective Tissue Injuries TendonTendon LigamentLigament MuscleMuscle

Musculoskeletal Injury ManagementMusculoskeletal Injury ManagementMedicationsMedications

Nitrous OxideNitrous Oxide 50% O2:50% N50% O2:50% N Non-explosiveNon-explosive Effects dissipate in Effects dissipate in

2-5 minutes2-5 minutes Easily diffused into Easily diffused into

air filled spaces in air filled spaces in body.body.

DoseDose Inhaled & self Inhaled & self

administeredadministered OnsetOnset

1-2 minutes1-2 minutes

Not A Biotel OptionNot A Biotel Option DiazepamDiazepam

BenzodiazepineBenzodiazepine AntianxietyAntianxiety AnalgesicAnalgesic DoseDose

5-15 mg titrated5-15 mg titrated OnsetOnset

10-15 minutes10-15 minutes DurationDuration

15-60 minutes15-60 minutes Counter AgentCounter Agent

FlumazenilFlumazenil

Dislocation of Acromioclavicular Dislocation of Acromioclavicular JointJoint

Humerus InjuryHumerus Injury Older adults and Older adults and

childrenchildren

Difficult to stabilizeDifficult to stabilize

ComplicationsComplications Radial nerve damage if Radial nerve damage if

fracture in middle or fracture in middle or distal portion of distal portion of humeral shafthumeral shaft

Humeral neck fracture Humeral neck fracture may cause axillary may cause axillary nerve damagenerve damage

Internal hemorrhage Internal hemorrhage into jointinto joint

Posterior Dislocation of the Elbow Posterior Dislocation of the Elbow Joint with Marked DeformityJoint with Marked Deformity

Severe Open Fracture of Severe Open Fracture of ForearmForearm

Penetration of Forearm Caused by Nail Penetration of Forearm Caused by Nail GunGun

Greenstick Fracture WithGreenstick Fracture WithMarked DeformityMarked Deformity

Fracture of the Distal RadiusFracture of the Distal Radius

Hand Injury from a Motorcycle CrashHand Injury from a Motorcycle Crash

Femur InjuryFemur Injury

Diameter of right Diameter of right thigh represents thigh represents increased blood increased blood volume of 2 to 3 Lvolume of 2 to 3 L

Open Fracture of the Lower LegOpen Fracture of the Lower Leg

Subtalar DislocationSubtalar Dislocation

Foot that was Run Over by the Foot that was Run Over by the Wheel of a Railway CoachWheel of a Railway Coach

Musculoskeletal Injury ManagementMusculoskeletal Injury ManagementMedicationsMedications

Oxygen Oxygen n Nitrous OxideNitrous Oxide n Morphine SulfateMorphine Sulfate FluidsFluids

Oxygen Oxygen n Nitrous OxideNitrous Oxide n Morphine SulfateMorphine Sulfate FluidsFluids

Nitrous OxideNitrous Oxide Nitrous OxideNitrous Oxide Class:Class: Gaseous Analgesic/Anesthetic Gaseous Analgesic/Anesthetic Route:Route: Inhalation Adult Dose: Instruct Inhalation Adult Dose: Instruct

patient to inhale deeply through patient-patient to inhale deeply through patient-held mask or mouthpiece Pediatric held mask or mouthpiece Pediatric

Dose:Dose: Instruct patient to inhale deeply Instruct patient to inhale deeply through patient-held mask or through patient-held mask or mouthpiece Drug mouthpiece Drug

Action:Action: Depresses the central nervous Depresses the central nervous system Increases oxygen tension in the system Increases oxygen tension in the blood thereby reducing hypoxia Onset:2 blood thereby reducing hypoxia Onset:2 minutes - 5 minutes Duration:2 minutes - minutes - 5 minutes Duration:2 minutes - 5 minutes 5 minutes

Nitrous OxideNitrous Oxide Nitrous OxideNitrous Oxide Indications:Indications: Adjunct analgesic for ischemic chest Adjunct analgesic for ischemic chest

pain Severe pain or discomfort in all patients pain Severe pain or discomfort in all patients without contraindications. without contraindications.

Precautions: Precautions: Must be self administered Check Must be self administered Check machine gauges daily for proper machine gauges daily for proper concentrations Monitor blood pressure and pulse concentrations Monitor blood pressure and pulse oximetry values during administration oximetry values during administration

Side Effects:Side Effects: Hypotension Dizziness Nausea and Hypotension Dizziness Nausea and vomiting vomiting

ContraindicationsContraindications: Any altered level of : Any altered level of consciousness or head injury Chronic obstructive consciousness or head injury Chronic obstructive pulmonary disease Chest trauma or pulmonary disease Chest trauma or actual/suspected pneumothorax Abdominal actual/suspected pneumothorax Abdominal trauma Major facial trauma Acutely psychotic trauma Major facial trauma Acutely psychotic patients Pregnancy, other than active labor Any patients Pregnancy, other than active labor Any patient (adult or pediatric) unable to self-administer patient (adult or pediatric) unable to self-administer Decompression sicknessDecompression sickness

Morphine SulfateMorphine Sulfate

IndicationsIndications Pain and anxiety secondary to AMI Pain and anxiety secondary to AMI Chest pain unrelieved by NitroglycerinChest pain unrelieved by NitroglycerinPulmonary edemaPulmonary edemaPain secondary to amputations or fractures Pain secondary to amputations or fractures

Precautions: Precautions: Monitor respiratory status and Monitor respiratory status and blood pressure closely.blood pressure closely.

Notify Biotel prior to administration if patient is Notify Biotel prior to administration if patient is >65yrs of age, debilitated, has altered mental >65yrs of age, debilitated, has altered mental status, or systolic BP<110mmHgstatus, or systolic BP<110mmHg

CHF: be prepared to intubateCHF: be prepared to intubate

Antidote: Naloxone (Narcan®)Antidote: Naloxone (Narcan®)

Morphine SulfateMorphine SulfateMorphine SulfateMorphine Sulfate ClassClass:: Narcotic Analgesic Narcotic Analgesic Route:Route: SlowSlow IV push IV push

Dose:Dose: Adult: Adult: Administer in titrated doses of 2 - Administer in titrated doses of 2 - 4mg, up to a maximum of 10mg 4mg, up to a maximum of 10mg

Pediatric:Pediatric: 0.1mg/kg0.1mg/kg

Drug Action:Drug Action: Alleviates pain Alleviates pain Decreases peripheral vascular resistance - Decreases peripheral vascular resistance -

vasodilatorvasodilator Decreases cardiac workload and oxygen demand Decreases cardiac workload and oxygen demand

on the hearton the heart

Muscle Skeletal Trauma for EMS

Documents

Transcript of Muscle Skeletal Trauma for EMS