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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

CHAPTER 28

Musculoskeletal Injuries

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

MusculoskeletalMusculoskeletalSystemSystem

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Anatomy & PhysiologyBones provide framework.

Joints allow for bending.

Muscles allow for movement.

Cartilage provides flexibility.

Tendons connect muscle to bone.

Ligaments connect bone to bone.

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TorsoTorso

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Pelvis andPelvis andLower Lower ExtremitiesExtremities

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Upper Upper ExtremitiesExtremities

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

BallBall--andand--Socket JointSocket Joint Hinge JointHinge Joint

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Types of MuscleSmooth (involuntary)

Found in organ walls & digestive system

Cardiac (myocardium)Found in walls of the heart

Skeletal (voluntary)

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Voluntary (Skeletal) Muscle

Attaches to the bones

Forms the major muscle mass of the body

Responsible for movement

Under conscious control

Gives the body shape

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Injuries toInjuries toBonesBones

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

MechanismsMechanismsof Injuryof Injury

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Types of Musculoskeletal Injuries

FractureBones break

DislocationJoints “come apart”

SprainStretching & tearing of ligaments

StrainOverexertion of muscle

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

All musculoskeletal injuries may present with the same symptoms & signs; care is directed at minimizing injury, not determining which type!

Types of MusculoskeletalInjuries

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Types of FracturesTypes of Fractures

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Signs & Symptoms of Musculoskeletal Injuries

Pain and tenderness

Deformity or angulation

Grating (crepitus)

Swelling

Continued…

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Bruising (discoloration)

Exposed bone ends

Joint locked in position

Nerve/blood vessel compromise

Signs & Symptoms of Musculoskeletal Injuries

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Emergency Care of Musculoskeletal Injuries

BSI.

Oxygen, if indicated.

Apply cervical collar as needed.

After control of life threats, splint injuries.

Cold pack/elevate.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

SplintingSplinting

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Bone fragments

Bone ends

Angulated joints

Splinting prevents motion of:

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Splinting minimizes:

Damage to muscles, nerves, blood vessels

Conversion of closed injury to open injury

Restriction of blood flow

Excessive bleeding

Pain/paralysis

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Splinting – General Rules

Assess distal pulse, motor function, and sensation (PMS) before & after application.

Immobilize joints above & below injury.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Splinting – General Rules

Remove or cut away clothing.

Cover open wounds with sterile dressings.

Do not replace protruding bone ends.

Pad splint.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Splinting – General Rules

If the following:

Severe deformity

Cyanotic distal extremity

Pulseless distal extremity

Then align with gentle traction unless resistance is felt.

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Align joints with gentle traction.

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Splinting – General Rules

Splint patient before moving.

When in doubt, splint.

Care for ABCs and life threats first.

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Types of SplintsTypes of Splints

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Hazards of Improper Splinting

Compression of nerves, tissues, and blood vessels

Delays transport of critical patients

Continued…

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Hazards of Improper Splinting

Reduced distal circulation from tight splints

May aggravate or worsen initial injury (splint loose or excessive motion)

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LongLong--Bone SplintingBone SplintingStabilize extremity manually.

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Assess distal PMS.Assess distal PMS.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Make sure splint extends several inchesMake sure splint extends several inchesbeyond joints above/below injury.beyond joints above/below injury.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Apply splint. Immobilize joints Apply splint. Immobilize joints above/below injury.above/below injury.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure extremity to splint.Secure extremity to splint.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure foot or hand in the positionSecure foot or hand in the positionof function.of function.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Reassess distal PMS.Reassess distal PMS.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Joint Immobilization:Joint Immobilization:Stabilize injured area manually.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Assess distal PMS.Assess distal PMS.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Immobilize injury site and bonesImmobilize injury site and bonesabove and below.above and below.

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Reassess distal PMS.Reassess distal PMS.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Pelvic InjuryPelvic fracture

Hip dislocation

Maintain strong suspicion of spinal injury.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Treatment of Pelvic Injury

Minimize motion of injured area.

Assess distal PMS.

Attempt to straighten lower extremities into anatomical position.

Pad between extremities with blanket.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Treatment of Pelvic Injury

Apply PASG if patient is hypotensive.

Place patient on spine board. (Use caution with log-roll!)

Reassess distal PMS.

Care for shock.

Transport.Continued…

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Treatment of Pelvic Injury

Pelvic wrap is an option.

Perform patient assessment.

Treat for shock.

When correctly placed, sheet will appear lower than iliac “wings.”

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Pelvic WrapPelvic WrapPrepare backboard.

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Pelvic WrapPelvic WrapLogroll patient & bring sheets around patient.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Pelvic WrapPelvic WrapSecure sheets without over-compressing.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Traction Splinting

Use a traction splint to immobilize a painful, swollen, or deformed thigh with no joint or lower leg pain.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Traction Splinting

Contraindications

Injury to:Knee or nearby areaHip (proximal femur)PelvisLower leg; or

Avulsion or partial amputation of lower leg

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Traction Splinting: Traction Splinting: Stabilize leg manually. Assess distal PMS.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Direct application of manual traction.Direct application of manual traction.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Adjust splint length and position.Adjust splint length and position.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Apply proximal securing device.Apply proximal securing device.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Apply distal securing device.Apply distal securing device.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Apply mechanical traction.Apply mechanical traction.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Position/fasten support straps. Position/fasten support straps. Reevaluate proximal/distal securing Reevaluate proximal/distal securing devices.devices.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Reassess distal PMS.Reassess distal PMS.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure patient and splint to long board.Secure patient and splint to long board.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Sling and Swathe:Sling and Swathe:Sling should be triangular.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Assess PMS; position sling.Assess PMS; position sling.

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Form sling.Form sling.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Fasten sling.Fasten sling.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Leave fingertips exposed. Check distal Leave fingertips exposed. Check distal PMS.PMS.

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Secure corner of sling.Secure corner of sling.

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

Tie swathe around sling.Tie swathe around sling.

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Splint for Injured ForearmSplint for Injured Forearm

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Splint for Injured FingerSplint for Injured Finger

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

1. List signs and symptoms of musculoskeletal injuries.

2. What complications will you prevent by splinting properly?

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

3. What must you assess before and after applying a splint?

4. When should you use traction while splinting an extremity?

5. When should you use a traction splint?

Review Questions

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

What priority would you assign to this patient? Why?

How would you continue your assessment?

STREET SCENESSTREET SCENES

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Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

What signs might you expect to find with a broken long bone?

What are you major concerns with possible broken bones in the extremities?

STREET SCENESSTREET SCENES

Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

What interventions are appropriate for this patient?

STREET SCENESSTREET SCENES

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Sample Documentation