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Chapter 29

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Chapter 29

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  1. Chapter 29 Musculoskeletal Care

  2. Objectives (1 of 2) • Describe the functions of the muscular system. • Describe the functions of the skeletal system. • List the major bone groupings in the body. • Differentiate between an open and closed painful, swollen, deformed extremity. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  3. Objectives (2 of 2) List the: • Reasons for splinting • General rules for splinting • Complications of splinting • Care for a patient with a swollen, painful, deformed extremity Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  4. Anatomy and Physiology of the Musculoskeletal System Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  5. Skeletal System Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  6. Fracture Broken bone Dislocation Disruption of a joint Sprain Joint injury with tearing of ligaments Strain Stretching or tearing of a muscle Types of Musculoskeletal Injuries Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  7. Mechanism of Injury • Force may be applied in several ways: • Direct blow • Indirect force • Twisting force • High-energy injury Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  8. Closed fracture A fracture that does not break the skin Open fracture External wound associated with fracture Nondisplaced fracture Simple crack of the bone Displaced fracture Fracture in which there is actual deformity. Fractures Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  9. Deformity Tenderness Guarding Swelling Bruising Signs and Symptoms of a Fracture (1 of 2) Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  10. Crepitus False motion Exposed fragments Pain Locked joint Signs and Symptoms of a Fracture (2 of 2) Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  11. Marked deformity Swelling Pain Tenderness on palpation Virtually complete loss of joint function Numbness or impaired circulation to the limb and digit Signs and Symptoms of a Dislocation Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  12. Signs and Symptoms of a Sprain • Point tenderness can be elicited over injured ligaments. • Swelling and ecchymosis appear at the point of injury to the ligaments. • Instability of the joint is indicated by increased motion. • Pain Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  13. Assessing Musculoskeletal Injuries (1 of 2) • Assess mechanism of injury • Initial assessment • Focused physical exam • Follow BSI precautions • Give oxygen if needed • DCAP-BTLS Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  14. Assessing Musculoskeletal Injuries (2 of 2) • If patient critically injured, transport immediately • Be alert for compartment syndrome • Splint injury • Transport • Check neurovascular status during transport Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  15. Evaluating Neurovascular Function • Examination of the injured limb should include assessment of the following: • Pulse • Capillary refill • Sensation • Motor function Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  16. Severity of Injury • Critical injuries can be identified using musculoskeletal injury grading system. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  17. Emergency Medical Care • Completely cover open wounds. • Apply the appropriate splint. • If swelling is present, apply ice or cold packs. • Prepare the patient for transport. • Always inform hospital personnel about wounds that have been dressed and splinted. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  18. Splinting • Flexible or rigid device used to protect extremity • Injuries should be splinted prior to moving patient, unless the patient is critical. • Splinting helps prevent further injury. • Improvise splinting materials when needed. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  19. General Principles of Splinting (1 of 3) • Remove clothing from the area. • Note and record the patient’s neurovascular status. • Cover all wounds with a dry, sterile dressing. • Do not move the patient before splinting. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  20. General Principles of Splinting (2 of 3) • Immobilize the joints above and below the injured joint. • Pad all rigid splints. • Maintain manual immobilization. • Use constant, gentle, manual traction if needed. • If you find resistance to limb alignment, splint the limb as is. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  21. General Principles of Splinting (3 of 3) • Immobilize all suspected spinal injuries in a neutral in-line position. • If the patient has signs of shock, align limb in normal anatomic position and transport. • When in doubt, splint. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  22. In-line Traction Splinting • Act of exterting a pulling force on a bony structure in the direction of its normal alignment. • Realigns fracture of the shaft of a long bone. • Use the least amount of force necessary. • If resistance is met or pain increases, splint in deformed position. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  23. Applying a Rigid Splint (1 of 2) • Provide gentle support and in-traction of the limb. • Another EMT-B places the rigid splint alongside or under the limb. • Place padding between the limb and splint as needed. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  24. Applying a Rigid Splint (2 of 2) • Secure the splint to the limb with bindings. • Assess and record distal neurovascular function. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  25. Applying an Air Splint • Hold the injured limb, apply gentle traction and support the injury site. • Partner should place splint around extremity. • If splint has a zipper, zip the splint up. • Inflate by pump or by mouth. • Check and record distal neurovascular function. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  26. Traction Splints • Do not use a traction splint under the following conditions: • Upper extremity injuries • Injuries close to or involving the knee • Pelvis and hip injuries • Partial amputation or avulsions with bone separation • Lower leg or ankle injuries Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  27. Applying a Hare Traction Splint(1 of 3) • Expose the injured limb and check pulse, motor, and sensory function. • Place splint beside the uninjured limb, adjust to proper length, and prepare straps. • Support the injured limb as your partner fastens the ankle hitch. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  28. Applying a Hare Traction Splint(2 of 3) • Continue to support the limb as your partner applies gentle in-line traction to the ankle hitch and foot. • Slide the splint into position under the injured limb. • Pad the groin and fasten the ischial strap. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  29. Applying a Hare Traction Splint (3 of 3) • Connect the loops of the ankle hitch to the end of the splint as your partner continues to maintain traction. • Carefully tighten the ratchet to the point that the splint holds adequate traction. • Secure and check support straps. • Assess distal neurovascular function. • Secure the patient and splint to a long board for transport. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  30. Applying a Sager Traction Splint (1 of 2) • Expose the injured extremity and check pulse, motor, and sensory function. • Adjust the thigh strap of the splint. • Estimate the proper splint length. • Arrange the ankle pads to fit the patient’s ankle. • Place the splint along the inner aspect of the thigh. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  31. Applying a Sager Traction Splint (2 of 2) • Secure the ankle harness. • Snug the cable ring against the bottom of the foot. • Pull out the inner shaft of the splint to apply traction. • Secure the limb to the splint. • Secure patient to a long spine board. • Check pulse, motor, and sensory function. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  32. Hazards of Improper Splinting • Compression of nerves, tissues, and blood vessels • Delay in transport of a patient with a life-threatening condition • Reduction of distal circulation • Aggravation of the injury • Injury to tissue, nerves, blood vessels, or muscle Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  33. Dislocation of the Shoulder • Most commonly dislocated large joint • Usually dislocates anteriorly • Is difficult to immobilize Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  34. Fractures of the Humerus • Occurs either proximally, in the midshaft, or distally at the elbow. • Consider applying traction to realign a severely angulated humerus, according to local protocols. • Splint with sling and swathe, supplemented with a padded board splint. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  35. Elbow Injuries • Fractures and dislocations often occur around the elbow. • Injuries to nerves and blood vessels common. • Assess neurovascular function carefully • Realignment may be needed to improve circulation. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  36. Fractures of the Forearm • Usually involves both radius and ulna • Use a padded board, air, vacuum, or pillow splint. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  37. Injuries to the Wrist and Hand • Follow BSI precautions. • Cover all wounds. • Form hand into the position of function. • Place a roller bandage in palm of hand. • Apply padded board splint. • Secure entire length of splint. • Apply a sling and swathe. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  38. Fractures of the Pelvis • May involve life-threatening internal bleeding • Assess pelvis for tenderness. • Stable patients can be secured to a long backboard or scoop stretcher to immobilize isolated fractures of the pelvis. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  39. Fractures of the Proximal Femur • Presents with very characteristic deformity • Fractures from trauma injuries best managed with traction splint or PASG and a spine board. • Isolated fracture in elderly can be managed with long spine board or a scoop stretcher. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  40. Femoral Shaft Fractures • Muscle spasms can cause deformity of the limb • Significant amount of blood loss will occur. • Immobilize with traction splint. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  41. Injuries of Knee Ligaments • Knee is very vulnerable to injury. • Patient will complain of pain in the joint and be unable to use the extremity normally. • Splint from hip joint to foot. • Monitor distal neurovascular function. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  42. Dislocation of the Knee • Produces significant deformity • More urgent injury is to the popliteal artery, which is often lacerated or compressed. • Always check distal circulation. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  43. Fractures About the Knee • If there is adequate distal pulse and no significant deformity, splint the limb with the knee straight. • If there is adequate distal pulse and significant deformity, splint the joint in the position of deformity. • If pulse is absent below the level of the injury, contact medical control immediately. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  44. Dislocation of the Patella • Usually dislocates to lateral side. • Produces significant deformity. • Splint in position found. • Support with pillows. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  45. Injuries to the Tibia and Fibula • Usually, both bones fracture at the same time. • Open fracture of tibia common. • Immobilize with a padded rigid long leg splint or an air splint that extends from the foot to upper thigh. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS

  46. Ankle Injuries • Most commonly injured joint • Dress all open wounds. • Assess distal neurovascular function. • Correct any gross deformity by applying gentle longitudinal traction to the heel. • Before releasing traction, apply a splint. Emergency Care and Transportation of the Sick and Injured, 8th Edition AAOS