Chapter 31 Flashcards
skeletal muscle attaches to the .. and usually crosses at least one …–> called voluntary muscle because it is under direct voluntary control of the brain
makes up the largest portion of the body’s …
bones; joint; muscle mass
all skeletal muscles are supplied with arteries, veins, and nerves
skeletal muscle tissue is directly attached to the bone by …
tendons
the skull protects the brain
the … protects the heart, lungs, and great vessels
the … consists of two scapulae and two clavicles
thoracic cage; pectoral girdle
a joint is formed wherever two bones come into contact. held together in a tough fibrous capsule
lubricated by …
allow motion
synovial fluid
significant force is generally required to cause fractures and dislocations: … blows … forces … forces … forces
direct
indirect
twisting
high-energy
fractures described as … or …
a … fracture is a simple crack of the bone
a … fracture produces deformity of the limb by shortening, rotating, or angulating it
nondisplaced; displaced
nondisplaced
displaced
types of fractures
….: bone is broken into more than 2 fragments
….: fracture that occurs in a growth section of a child’s bone
…: incomplete fracture that goes only partway through bone shaft
…: fracture that doesn’t run completely through bone
…: bone broken at an angle across bone
…: fracture of diseased bone
….: fracture caused by twisting force
…: fracture that occurs straight across bone
comminuted epiphyseal greenstick incomplete oblique pathologic spiral transverse
suspect a fracture if one+ of the following signs are present: … … … …
deformity
tenderness
guarding
swelling
signs of fractures contd: … … … … … …
bruising crepitus false motion exposed fragments pain locked joint
dislocation: disruption of a joint in which bone ends are no longer in contact
sometimes a dislocated joint will spontaneously … (go back to normal). those that don’t are a serious problem
reduce
dislocation signs and symptoms: marked … … …. that is aggravated by any attempt at movement .. on palpation loss of normal … … or …
deformity swelling pain tenderness joint motion numbness; impaired circulation
a … occurs when a joint is twisted/stretched beyond its normal range of motion
vulnerable joints are the knees, shoulders, and ankles
sprain
a … is a stretching/tearing of the muscle. causes pain, swelling, and bruising of the soft tissues in the area–> often no deformity is present and only minor swelling is noted at the site of the injury
strain
Orthopaedic injuries can also lead to systemic changes or illnesses.
Likelihood of having a complication is related to:
Strength of the … that caused the injury
Injury’s …
Patient’s overall …
force
location
health
when lacerations are present in an extremity, consider an …
any injury/deformity of the bone may be associated with … or … injury
open fracture; vessel; nerve
6 Ps of musculoskeletal assessment: … … … (numbness/tingling) … … ...
pain paralysis paresthesias pulselessness pallor pressure
A splint is a flexible or rigid device that is used to protect and maintain the position of an injured extremity.
Splint all …, …, and …before moving the patient unless he or she is in immediate danger.
Splinting reduces pain and makes it easier to transfer and transport the patient.
fractures; dislocations; sprains;
Splinting will help to prevent: Further … to muscles, the spinal cord, peripheral nerves, and blood vessels ...of the skin Restriction of ...blood flow Excessive bleeding of the … Increased pain ... of extremities
damage Laceration distal tissues Paralysis
General principles of splinting
Remove …from the area.
Note and record the patient’s …
Cover open wounds with a dry, sterile dressing.
Do not move the patient before splinting an extremity unless there is danger.
clothing
neurovascular status
General principles of splinting (cont’d)
… all rigid splints.
Maintain ….
If you encounter resistance, splint the limb in its deformed position.
Immobilize all suspected spinal injuries in a neutral, in-line position.
When in doubt, splint.
Pad
manual stabilization
rigid splints:
made from firm material
applied to the …, .., and/or … of an injured extremity
prevent motion at the injury site
sides; front; back
Two situations in which you must splint the limb in the position of deformity:
When the deformity is …
When you encounter …or … when applying gentle traction to the fracture of a shaft of a long bone
severe; resistance; extreme pain
formable splint:
Most commonly used formable splint is the precontoured, inflatable, clear plastic air splint
Comfortable
Provides …
Applies firm pressure to a …
Used to stabilize injuries below the … or …
uniform contact; bleeding wound; elbow; knee
formable splints contd:
Drawbacks:
The zipper can stick, clog with dirt, or freeze.
Significant changes in the weather or altitude affect the … of the air in the splint.
pressure
traction splints:
Traction: act of pulling on a body structure in the direction of its …
Used primarily to secure fractures of femur
Goals of in-line traction:
To stabilize the fracture fragments
To … the limb sufficiently
To avoid potential neurovascular compromise
normal alignment
align
traction splints contd: Do not use for: Injuries of the upper extremity Injuries close to or involving the ... Injuries of the … Partial … or …. with bone separation Lower leg, foot, or ankle injury Imagine where the uninjured limb would lie, and pull gently along the line of that imaginary limb until the injured limb is in approximately that position.
knee;
pelvis
amputations; avulsions
pelvic binder:
Used to splint the bony pelvis to reduce hemorrhage from bone ends, … disruption, and pain
Meant to provide temporary stabilization
venous
Clavicle fractures are common:
Patient will report …pain and hold the arm across the front of the body.
Fractures of the scapula are less frequent:
Almost always the result of a … blow to the back
Associated chest injuries pose the greatest threat
shoulder; forceful, direct
dislocation of shoulder:
The humeral head most commonly dislocates ….
Shoulder dislocations are very painful.
Stabilization is difficult because any attempt to bring the arm in toward the chest wall produces pain.
Splint the joint in whatever position is … for the patient.
anteriorly
most comfortable
humerus fractures
Occur proximally, in the …, or distally at the … Consider applying … to realign the fracture fragments before splinting them.
Splint the arm with a sling and swathe.
midshaft; elbow; traction
elbow injuries
Different types of injuries are difficult to distinguish without … examinations.
Fracture of the distal humerus
Common in children
Fracture fragments …significantly, producing deformity and causing injuries to nearby vessels and nerves.
Dislocation of the elbow typically occurs in athletes:
The ulna and radius are most often displaced …
x-ray; rotate; posteriorly
Fracture of olecranon process of ulna
Often associated with lacerations and abrasions
Patient will be unable to ….
Fractures of the radial head
Occurs from a fall on an outstretched arm or a direct blow to the lateral aspect of the elbow
Attempts to … the elbow or wrist cause discomfort.
extend the elbow; rotate
Usually the radius and the ulna break ….
Fractures of the distal radius are known as … fractures.
To stabilize fractures, you can use a padded board, air, vacuum, or pillow splint.
at the same time; Colles
injuries of wrist and hand
dislocations are usually associated with a …
isolated, nondisplaced fracture of a … bone is common
any questionable wrist injury should be splinted and evaluated in the ED
fracture; carpal
hip dislocation: ‘
dislocates only after significant injury
most dislocations are … and are frequently complicated by injury to the … nerve
do not attempt to reduce the dislocated hip in the field
posterior; sciatic
fractures of the proximal femur:
Break goes through the … of the femur, the … region, or across the … of the femur
Patients display characteristic deformity
Lie with the leg externally rotated, and injured limb is usually … than the opposite, uninjured limb
Assess pulses and motor and sensory functions, splint the lower extremity, and transport.
neck ; interochanteric; proximal shaft;
shorter
femoral shaft fractures:
Can occur in any part of the shaft, from the hip region to the femoral condyles just above the knee joint
Large muscles of the thigh … in an attempt to “splint” the unstable limb
Fractures may be open.
There is often significant … .
Bone fragments may penetrate or press on important nerves and vessels.
Carefully and periodically assess the distal neurovascular function.
Cover any wound with a dry, sterile dressing.
These fractures are best stabilized with a …
spasm; blood loss; traction splint
Types of knee injuries: ...injuries Dislocated ... Fracture of ...elements dislocation of knee is potentially limb-threatening--> limbs may be damaged/torn
Ligament
patella
bony
fractures about the knee:
May occur at distal end of the femur, proximal end of the tibia, or in the patella
Management
If adequate distal pulse and no significant deformity, splint the limb with the knee … .
If adequate pulse and significant deformity, splint the joint in the ….
If the pulse is absent below the level of injury, ….
straight; position of deformity; contact medical control
dislocation of patella:
Usually, the dislocated patella displaces to the …side and produces significant deformity.
Splint the knee in the position in which you …
lateral; find it
injuries of the tibia and fibula:
fracture may occur at any place between the .. joint and the .. joint
stabilize with a padded, rigid long leg splint or an air splint
knee; ankle
correct any gross deformity of ankle by applying … before releasing traction, apply a …
traction; splint
force of injury to foot is transmitted up the legs to the
spine
To splint the foot, apply a … splint, an … splint, or a …splint.
Leave the toes exposed.
rigid padded board; air; pillow
strains and sprains treatment is similar to fracture. use mnemonic …
RICES
compartment syndrome typically develops 6 to 12 hours after injury as a result of:
excessive ..
a severely … extremity
the rapid return of blood to an …
bleeding; crushed; ischemic limb
If you suspect the patient has compartment syndrome:
Splint the affected limb, keeping it at the level of the …
Transport immediately.
Reassess neurovascular status frequently during transport.
heart
