Musculoskeletal Emergencies Emergency Nursing Core Curriculum Acknowledgement is made to the...
-
Upload
greta-jude -
Category
Documents
-
view
217 -
download
1
Transcript of Musculoskeletal Emergencies Emergency Nursing Core Curriculum Acknowledgement is made to the...
MusculoskeletalEmergencies
Emergency Nursing Core Curriculum
Acknowledgement is made to the following expert for the development of this module: Karen Belotti, RN, BSN
2007Reviewed 2010
Musculoskeletal EmergenciesObjectives
For selected musculoskeletal emergencies the participant will be able to:
Compare the etiology Describe assessment findings Identify the clinical management
Musculoskeletal Emergencies Always remember…..
Musculoskeletal Emergencies The basics
Bleeding control Immobilization Neurovascular assessment
Musculoskeletal Emergencies
The result of over stretching a muscle at the point of attachment to the tendon
Musculoskeletal EmergenciesStrains - definition
Musculoskeletal EmergenciesSprains - definition
A wrenching or twisting injury to a ligament with hyperextension, hyperflexion or torsion of a joint
The most commonly sprained or strained joint is the ankle
Musculoskeletal EmergenciesSprains
Mild to severe pain with disability and loss of function.
May describe a snapping or popping sound
Point tenderness
Musculoskeletal EmergenciesStrains & Sprains – signs & symptoms
Mild to severe edema Ecchymosis Mild to marked deformity
Musculoskeletal EmergenciesStrains & Sprains – signs & symptoms
Immobilization Elevation Ice Rest Analgesia
Musculoskeletal EmergenciesStrains & Sprains - treatment
Musculoskeletal EmergenciesStrains & Sprains - Pneumonic:
PRICE ProtectRest IceCompressionElevation
Musculoskeletal EmergenciesFractures
Disruption in the normal continuity of the bone, cartilage or both
Musculoskeletal EmergenciesFractures - types
ObliqueSpiralComminuted Impacted
CompressionGreenstickAvulsionDepressed
Open vs. Closed
Musculoskeletal EmergenciesFractures - Oblique
Oblique: Fracture resulting from a twisting force
Musculoskeletal EmergenciesFractures - Spiral
Spiral:Twisting force while
foot firmly planted
Musculoskeletal EmergenciesFractures - Comminuted
Comminuted:Severe direct force
causes more than two bone fragments
Musculoskeletal EmergenciesFractures - Impacted
Impacted:Fractured bone
ends jam together
Musculoskeletal EmergenciesFractures - Compression
Compression:Severe force
jams vertebrae together
Musculoskeletal EmergenciesFractures - Greenstick
Greenstick:Compression
force, most commonly seen in children
Musculoskeletal EmergenciesFractures - Avulsion
Avulsion:Forceful contraction
of muscle mass causes bone to break away from insertion point
Musculoskeletal EmergenciesFractures - Depressed
Depressed:Blunt trauma to flat
bone usually associated with significant soft tissue damage
Musculoskeletal EmergenciesFractures – open vs. closedOpen: Much higher incidence
of infection - contaminated
Considered surgical emergency
Can cause significant blood loss
Musculoskeletal EmergenciesFractures - signs & symptoms
Tenderness or pain Deformity Decreased mobility Swelling Ecchymosis
Musculoskeletal EmergenciesFractures - signs & symptoms Crepitus Muscle spasm Inability to bear weight Decreased or absent pulses Pallor, shock
pelvic fractures femur fractures
Immobilize Remove jewelry or
constrictive clothing from injured extremity
Musculoskeletal EmergenciesFractures - treatment
Apply ice to reduce swelling and pain
Elevate extremity above the level of the heart
Musculoskeletal EmergenciesFractures - treatment
Prepare for: closed reduction splinting or casting
If open fracture prepare for surgery
Cover with sterile, saline-soaked dressing
Musculoskeletal EmergenciesFractures
Occurs when a joint exceeds it’s normal range of motion and the articular surfaces are no longer in direct contact.
Musculoskeletal EmergenciesDislocation & Subluxations
Result: Impaired circulation Ligament injury Nerve damage Disruption of muscle insertions
Musculoskeletal EmergenciesDislocation & Subluxations
Fracture are often associated with dislocation injuries
Common areas of dislocations include the shoulder, elbow, hip and knee
Musculoskeletal EmergenciesDislocation & Subluxations
Signs & Symptoms Localized pain,
moderate to severe Point tenderness Joint deformity
Musculoskeletal EmergenciesDislocation & Subluxations
Signs & Symptoms Decreased or absent range of
motion Edema Diminished or absent distal pulses
and sensation
Musculoskeletal EmergenciesDislocation & Subluxations
Interventions: Keep NPO! Remove jewelry or constrictive
clothing from injured extremity Apply ice to reduce swelling and
pain
Musculoskeletal EmergenciesDislocation & Subluxations
Prepare reduction procedures Monitor neurovascular status
of injured extremity Immobilize joint post
reduction
Musculoskeletal EmergenciesDislocation & Subluxations
Radial head subluxation Causes:
lifting by the hand swinging while holding the hands pulling arms through the sleeves catching by the hand to prevent a fall pulling along when in a hurry
Musculoskeletal EmergenciesNursemaids Elbow
Musculoskeletal EmergenciesNursemaids Elbow
Treatment: Provider manipulation of
affected extremity X-rays not always indicated Prone to recurrences
The separation of skin and subcutaneous tissue from the underlying musculofascial planes
Musculoskeletal EmergenciesDegloving Injuries
Signs & Symptoms Area of skin is torn
away from underlying vascular supply
Pain Hemorrhage
Musculoskeletal EmergenciesDegloving Injuries
Control bleeding Irrigate and cleanse area Administer medications and
evaluate effectiveness analgesics antibiotics tetanus immunization
Musculoskeletal EmergenciesDegloving Injuries - treatment
Occurs when increasing interstitial pressure inside the fascial compartment results in neurovascular compromise causing soft tissue damage to the confined space
Musculoskeletal EmergenciesCompartment Syndrome
Causes: Crush injuries Contusions Snake bites Circumferential extremity burns Onset 4 to 8 hours after injury
Musculoskeletal EmergenciesCompartment Syndrome
Increasingly severe pain at rest or with passive movement
Tense, swollen area Diminished sensation
Musculoskeletal EmergenciesCompartment Syndrome
Progressive loss of muscle or motor function
Loss of pulses (late sign) Increased compartment pressures
Musculoskeletal EmergenciesCompartment Syndrome
Interventions: Maintain extremity in neutral
position, at the level of the heart. Must not be left dependent
Musculoskeletal EmergenciesCompartment Syndrome
Remove all casts, splints or appliances
Assist with obtaining compartment measurements
Monitor extremity perfusion every 15 minutes
Musculoskeletal EmergenciesCompartment Syndrome
Prepare for surgical release of affected area
Fasciotomy
Musculoskeletal EmergenciesCompartment Syndrome
Case Scenario
Which of the following is not a symptom of compartment syndrome?
A. pain upon passive movement
B. petechiae
C. paraesthesia of the affected extremity
D. decreased capillary filling time
Case Scenario
Which of the following is not a symptom of compartment syndrome?
A. pain upon passive movement
B.petechiaeC. paraesthesia of the affected
extremity
D. decreased capillary filling time
Case Scenario
Which of the following findings indicates successful reduction of nursemaid’s elbow?
A. the arm is immobile
B. the radial pulse is strong
C. the elbow moves freely
D. the patient cries when the arm is examined
Case Scenario
Which of the following findings indicates successful reduction of nursemaid’s elbow?
A. the arm is immobile
B. the radial pulse is strong
C.the elbow moves freelyD. the patient cries when the arm is
examined