Mod 5 Musculoskeletal Trauma Flashcards
Extremities
-The portions of the skeleton that include the clavicles, scapulae, arms, wrists, and hands (upper extremities) and the pelvis, thighs, legs, ankles, and feet (lower extremities)
Bones
-Hard but flexible living structures that provide support for the body and protection to vital organs
Joints
-Places where bones articulate, or meet.
Short bones
-Found in hands and feet
Flat bones
-Sternum, shoulder blades, and ribs
Irregular bones
-Vertebrae of the spinal column are examples of irregular bones
Long bones
-Bones found in arm and thigh
Periostem
-Strong white fibrous material that covers bones
Muscles
-Tissues or fibers that cause movement of body parts or organs
Cartilage
-Tough tissues that covers the joint ends of bones and helps to form certain body parts such as the ear
Tendons
-Tissues that connect muscle to bone
Ligaments
-Tissues that connect bone to bone
MTB
-Muscle tendon bone
BLB
-Bone ligament bone
Three types of mechanisms that cause musculoskeletal injuries
- Direct force (If person was was to be struck by an automobile causing crushed tissues and fractures).
- Twisting or rotational forces can cause stretching or tearing of muscles and ligaments as well as broken bones
- Indirect force (for example if a person was to fall from a great height the direct force would be in feet and ankles while the indirect force could cause injury to knees, femurs, pelvis, and spinal column.
Bones cause bleeding. How much bleeding can a pelvis, femur, and tibia fibula fracture produce?
- Pelvis fracture = 3-4 pints (1,500-2,000 cc)
- Femur fracture = 2 pints (1,000 cc)
- Tibula-Fibula = 1 pint (500 cc)
Traction splint
-A splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. Traction splints are used primarily on femoral shaft fractures.
Fracture
-Any break in a bone
Comminuted fracture
-A fracture in which the bone is broken in several places
Greenstick fracture
-An incomplete fracture
Angulated fracture
-Fracture in which the broken bone segments are at an angle to each other.
Dislocation
-This disruption or “coming apart” of a joint
Sprain
-The stretching or tearing of ligaments
Strain
-Muscle injury resulting from overstretching or overexertion of the muscle
Closed extremity injury
-An injury to an extremity with no associated opening in the skin
Open extremity injury
-An extremity injury in which the skin has been broken or torn through from the inside by an injured bone or from the outside by something that has caused a penetrating wound with associated injury to bone.
Compartment syndrome
-Injury caused when tissues such as blood vessels and nerves are constricted within a space as from swelling or from a tight dressing or cast.
How compartment syndrome progresses
- A fracture or crush injury causes swelling
- Pressure and swelling caused by bleeding within muscle compartment becomes so great that body can no longer perfuse the tissues against pressure.
- Cellular damage occurs and causes more swelling
- Blood flow to the area is lost. Limb may be lost if pressure not relieved.
- CSM (Circulation, sensory, motor functions) may be reduced or absent
Crepitus
-A grating sensation or sound made when fractured bone ends rub together
Signs and symptoms of muskuloskeletal injuries
- Pain and tenderness
- Deformity or angulation
- Grating (crepitus)
- Swelling
- Bruising
- Exposed bone ends
- Joints locked into position
- Nerve and blood vessel compromise
The six P’s (assessing compromise to an extremity when a muskuloskeletal injury is suspected )
- Pain or tenderness
- Pallor (Pale skin or poor capillary refill)
- Parathesia or the sensation of pins and needles
- Pulses diminished or absent in the injured extremity
- Paralysis or inability to move
- Pressure
Care for musculoskeletal injuries
- Take and maintain standard precaution
- Primary assessment
- During secondary assessment apply cervical collar if spinal injury suspected
- After addressing life threats splint any suspected extremity fracture.
- If appropriate cover open wounds with sterile dressings elevate the extremity and apply a cold pack to reduce swelling
What to do when patient becomes unstable
-Managing extremity injuries becomes a low priority.
Effective splinting
-Minimizes movement of joints and broken ends and decreases pain
What happens if an injury is not realigned accordingly
- May cause further injury or more pain during transport
- Chance of nerves, arteries, and veins being compromised increases
- Realignment hurts only for a moment then is reduced by proper splinting.
Manual traction
-The process of applying tension to straighten and realign a fractured limb before splinting. Also called tension.
The three basic types of splints used on EMS units
- Rigid splints. Requires limb to be moved to the anatomic position. Used primarily for long bone injuries.
- Formable splints are capable of being molded to different angles and allow of considerable movement.
- Traction splints are specifically used for femur fractures.
General rules for immobilization
- Care for life threatening problems first
- Expose the injury site.
- Align long bone injuries to anatomic position
- Do not push protruding bones back into place
- Immobilize both the injury site and adjacent joints
- Choose a method of splinting
- Splint before moving patient to a stretcher or other location if possible
- Pad voids (spaces in between body parts)
Hazards of splinting
-Splinting before assessing life threatening injuries.
improper splinting
Splinting long bone or joint injuries
- Take appropriate standard precautions and expose area to be splinted
- Stabilize injury
- Assess CSM
- Realign injury if deformed, cyanotic, or pulse-less
- Measure or adjust splint and move it into place.
- Apply and secure splint to immobilize adjacent joints
- Reassess CSM
Signs and symptoms shoulder girdle injuries
- Pain in shoulder
- Dropped shoulder
- A severe blow to the back over the scapula may cause this injury
Signs and symptoms of pelvic injury
- Complaint of pain in the pelvis, hips, groin, or back
- Painful reaction to pressure on groin or pelvis
- Patient cannot lift leg
- Foot on injured side may turn outward
- Unexplained pressure on urinary bladder
- Bleeding from rectum, urethra, or vaginal opening
Anterior hip dislocation
-The patients entire lower limb is rotated outward and hip is usually flexed
Posterior hip dislocation
- Patients leg is rotated inward, the hip is flexed and knee is bent.
- Foot may hang loose
Hip fracture signs and symptoms
-Pain is localized
- Sensitive to pressure exerted on the lateral prominence of the hip
- Tissues discolored
- Swelling
- Cannot move limb while on back
- Unable to stand
- Foot on injured side usually turns outward
- Injured limb may appear shorter
- Geriatric patients are more susceptible due to brittle bones
Femoral shaft fracture signs and symptoms
- Intense pain
- Often an open fracture with deformity and protruding through the wound
- Injured limb may appear to be shortened
Knee injury signs and symptoms
- Pain and tenderness
- Swelling
- Deformity with obvious swelling
- Always check distal pulse
Tibia fibula injury care
- Always check CSM before and after splint application
- Apply air inflated splint
- Two splint method using 2 rigid board splints
- Single splint with an ankle hitch
Signs and symptoms of forearm, wrist, and hand injury
- Forearm Deformity and tenderness. If only one bone is broken deformity may be minor or absent
- Wrist, deformity and tenderness
- Hand, deformity and pain. Dislocated fingers are obvious.
