Advanced Emergency Management of Musculoskeletal Injuries

1. MUSCULO – SKELETAL INJURIES ADVANCED ACCIDENT & EMERGENCY CARE COURSE CONCERN NYONI MRTC,AT,OSHEMAC,EMT, BScHC,MSc DM(NUST ) (Revised June 2016)

4. OBJECTIVES • DEFINE STRAIN,SPRAIN,& FRACTURE. • STATE TYPES OF FRACTURES. • DESCRIBE THE EMERGENCY MANAGEMENT OF STRAINS ,SPRAINS AND FRACTURES.

5. STRAIN • There is over stretching, and tearing of muscle & or tendon fibers • Usually occurs during exercise • There is pain, especially when the victim attempts to use the affected muscles • There is swelling and bruising in the affected area

7. SPRAIN • Is a joint injury where there is over stretching, twisting or tearing of the supporting joint capsule & LIGAMENTS • Ligaments are tough bands of tissue, that connect bones to each other • A sprain is a tempory dislocation, of bone ends, but generally joint surfaces fall back into alignment • Sprains can range from mild to severe • There is severe pain, especially when moving the joint, tenderness, swelling & bruising • Can often be mistaken as a fracture

10. SPRAINED ANKLE

12. EMERGENCY TREATMENT OF SPRAINS & STRAINS • SABC • RICE – - REST – to reduce blood flow to the injured area - ICE – to constrict blood vessels, and so reduce bleeding - COMPRESSION – bandage to reduce bleeding * KEEP CHECKING DISTAL CIRCULATION - ELEVATION – To reduce bleeding & swelling * If in doubt treat as a fracture

14. DO NOT use “Heat Rub”, or any similar ointments for strain & sprain injuries • They can only be used 72 hours post injury

15. FRACTURE • Is a break in the continuity of a bone • Fractures are defined as: • CLOSED or SIMPLE • OPEN or COMPOUND • There are several types of fractures: - Comminuted - Transverse - Oblique - Impacted - Spiral - Greenstick (Children)

16. SIMPLE # COMPOUND #

18. COMMINUTED FRACTURE

19. GREENSTICK FRACTURE seen in children only

20. CAUSES OF FRACTURES • Direct force • Indirect force • Twisting forces • Stress • Pathological

21. DIRECT FORCE

23. TWISTING FORCES

25. INDIRECT FORCE

26. INDIRECT FORCE

27. FRACTURED CLAVICLE – common when the victim falls on outstretched arms

28. Colles Fractures commonly occurs when the victim falls on outstretched arms. It has the typical appearance of a “Dinner fork”

29. TWISTING FORCES – common leg fractures occur in soccer, when the players foot sticks in the grass, & his leg twists violently

30. !!@**#??

31. STRESS

32. SIGNS & SYMPTOMS OF FRACTURES • Pain • Deformity • Swelling • Tenderness • Inability to move • Unnatural movement / Angulation • Guarding • Crepitus • Ecchymosis - bruising • Sound of the bone “cracking” • Open wound • Limb shortening • Signs of Hypovolaemic shock

33. FRACTURED TIBIA & FIBULA

35. OPEN FRACTURED PELVIS

36. EMERGENCY MANAGEMENT OF FRACTURES • SABC • Consider spinal injury - Immobilize • Realign limb • Control bleeding – Ring bandage • Assess distal neurovascular function • Apply gentle traction, for simple fractures only • Splint injured limb • Reassess neurovascular function after splinting • Reassure the victim • Cover the victim with a blanket • Observe for signs of shock, and treat accordingly • Evacuate ASAP – long bone fractures need O2 for 24 hours, to prevent Embolism

37. TYPES OF SPLINTS Traction Formable Pneumatic

41. COMPLICATIONS OF FRACTURES • SKULL – brain injury • FACIAL – airway compromise • VERTEBRAE – paralysis & respiratory difficulty/arrest • THORACIC – punctured chest organs / haemopneumothorax • PELVIS – ruptured pelvic organs / hypovolaemic shock / Peritonitis • LONG BONES – hypovolaemic shock / emboli • LIMB BONES – neurovascuar compromise

43. DISLOCATION • Is a frank disruption of bone ends at a joint • The supporting joint ligaments are torn • The dislocation may spontaneously reduce to it’s normal position, or bone ends remain completely separated from each other • Most commonly dislocated joints are: - Fingers - Shoulders (Anterior) - Elbows - Knees - Ankles - Hips

44. SIGNS & SYMPTOMS OF DISLOCATION INJURIES • Marked deformity • Swelling • Severe pain • “Locked joint” • Circulation may be disrupted

45. ANTERIOR SHOULDER DISLOCATION

46. ELBOW DISLOCATION

47. EXTREMITY DISLOCATIONS

48. EMERGENCY MANAGEMENT OF DISLOCATIONS • SABC • DO NOT attempt to reduce the dislocation • Assess neurovascular function before & after splinting • Splint limb in the position found • Reassure the victim • Evacuate ASAP

50. THE END Any questions ???????