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EMRG 1130 > Module 17- Assessment and Treatment > Flashcards

Module 17- Assessment and Treatment Flashcards

1
Q

What are the principles of Assessment?

A
  • Scene Assessment
    • Scene safety
    • Routine precautions and PPE
  • Initial assessment
    • mental status
    • ABC’s
    • Identify priority pt’s
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2
Q

If there are no immediate life-threatening injuries and only localized musculoskeletal trauma, what do we do?

A

continue with a focused history and physical examination

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3
Q

If there is a significant MOI, what do we do?

A
  • Complete a rapid trauma assessment and perform a detailed physical examination en route
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4
Q

What are the priorities of assessment and treatment?

A
  • Identify injuries
  • Manage life threats
  • Prevent further harm to injured structures
  • Support injured area
  • Administer pain meds
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5
Q

What do we determine for the history of the present injury?

A
  • Determine the MOI
  • Determine patient condition prior to injury
  • Determine patient position after the injury
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6
Q

How do we determine medical history?

A
  • Use SAMPLE
  • Pay attention to previous musculoskeletal injuries and disorders
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7
Q

What do we conduct in our physical examination?

A
  • Obtain baseline vital signs
  • Evaluate the injured extremity (OPQRST for pain)
  • Compare extremity to other side, noting differences in length, position, and skin color
  • Cont examination of extremity using DCAP-BTLS
  • Evaluate 6 p’s for musculoskeletal
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8
Q

Slow laboured breathing, skin cyanotic & pale

A

= BAD!!!

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9
Q

Full and regular breathing, skin pink

A

= GOOD!!

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10
Q

What should we inspect?

A
  • Deformity
  • Skin changes
  • Swelling
  • Lacerations
  • Muscle spasms
  • Abnormal limb positioning
  • Altered range of motion
  • Color changes
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11
Q

What should we palpate?

A
  • Include injury site and regions above and below injury
  • Identify areas with point tenderness
  • May be difficult to assess with intoxicated patients or those with spinal injuries
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12
Q

What is the motor function examination?

A
  • Consider the preinjury level of function
    • Weakness or deficits may be due to prior injuries or medical problems
  • Carry out the test with and without resistance
    • Some patients may be too weak to overcome any outside resistance
  • Test both sides simultaneously
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13
Q

What is a sensory examination?

A
  • Attempt to identify pre existing deficits or other disorders
  • Assess for the presence or absence of sensation and quality and symmetry of sensation
  • First ask patient if he or she feels any abnormal sensations
  • Next, conduct gross sensory examination
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14
Q

General Interventions

A
  • Identify the type and extent of injury.
  • Create an environment that maximizes the normal healing process
    • This begins in the prehospital environment with a thorough assessment and proper immobilization to prevent further harm.
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15
Q

What may pain be caused by?

A
  • The injury itself
  • Continued movement of unstable fracture
  • Muscle spasm
  • Surrounding soft-tissue injury
  • Nerve injury
  • Muscle ischemia
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16
Q

What is the goal of dealing with pt’s pain?

A
  • The goal is to diminish pt’s pain to a tolerable level
  • Need to first assess the level of pain and continually reassess after each intervention to determine effectiveness
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17
Q

What are the basics to control pt’s pain?

A
  • Splinting
  • Resting
  • Elevating
  • Applying heat or cold
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18
Q

When simple procedures are not effective, consider analgesics and antispasmodic, which include?

A
  • Tylenol- 960-1000mg
  • Ibuprofen- 400mg
  • Ketorolac- 10-15mg (works faster than tylenol and ibuprofen, usually given when pt can’t take anything by mouth)
  • Fentanyl
  • Morphine- 2-5mg max of 4 doses (lowers BP)
  • Diazepam
  • Lorazepam
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19
Q

What are the rules for medication use?

A
  • Use only for hemodynamically stable patients
  • Obtain complete vitals before and after administration
  • Reassess pain level after administration to determine efficacy of treatment
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20
Q

What does splinting do for the pt?

A
  • Provides support and prevents motion
  • Decreases pain
  • Reduces risk of further injury
  • Helps control bleeding
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21
Q

How do we splint an unstable pt with multiple fractures?

A
  • There is no time to splint each injury
  • Splint the axial skeleton on a backboard or alternative device (Secure injured extremities to the body)
  • This will protect against spinal injuries and reduce extremity movement
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22
Q

What are the splinting principles for any injury?

A
  • Adequately visualize the injured area
  • Assess and record PMS before and after splinting
  • Cover all wound with dry sterile dressings (don’t push exposed bones under the skin)
  • Pad splint well and firmly
  • Support injured site manually with one hand above and one below the injury
  • For severe angulations, gently apply longitudinal traction to attempt to realign and restore circulation
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23
Q

How do we splint fractures?

A
  • Immobilize the bone ends and the two adjacent joints
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24
Q

How do we splint dislocations?

A
  • Extend the splint along the entire length of the bone above and the entire length of the bone below the dislocated joint
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25
Q

How do we splint knees?

A
  • Splint knee straight if not directly injured and angulated
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26
Q

How do we splint elbows?

A
  • Splint elbow at a right angle
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27
Q

What do we do if pt complains of severe pain or offers resistance to movement?

A
  • Discontinue traction
  • Splint in position of deformity
  • Carefully monitor distal PMS
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28
Q

Why don’t we cover finger or toes with the splint?

A
  • Allow for monitoring or skin color, temperature, and condition (CTC).
  • Review BLS standards
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29
Q

What are the five types of splints?

A
  1. Board splints
  2. Inflatable splints
  3. Vacuum splints
  4. Traction splints
  5. Improvised splints
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30
Q

Rigid splints contain…

A
  • Padded board
  • Piece of heavily cardboard
  • Aluminum splint
  • SAM splint
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31
Q

Pneumatic Splints

A
  • Air/ inflatable splints
  • Useful for immobilizing fractures of the lower leg and forearm
    (Can slow bleeding and minimize swelling)
  • PASG for femur and pelvis is a common example
  • Not useful for joints, or angulated or open fractures
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32
Q

What are the pneumatic splint cautions?

A
  • Ensure that it does not lose pressure
  • Ensure that it is not overinflated
    • Likely when applied in a cool area and moved to a warmer environment
    • Also likely when applied before aeromedical transport and taken to higher altitude
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33
Q

Vacuum Splints

A
  • Available either as a mattress for the entire body or a smaller splint for individual extremities
  • Composed of beads that conform to the body when air is removed from splint
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34
Q

Pillow Splints

A
  • Effective means to immobilize an injured foot or ankle
  • Invaluable for padding backboards for patients with dislocated hips
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35
Q

Traction Splints

A
  • Provide constant pull on a fractured femur, thereby preventing the broken bone ends from overriding
  • Help alleviate pain and reduce bleeding associated with midshaft femur fractures
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36
Q

Buddy Splinting

A
  • Place padding between digits
  • Tape or tie injured digit to adjacent, noninjured digit
  • Do not let tape pass over joints
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37
Q

What are complications of musculoskeletal injuries?

A
  • Neurovascular injuries
  • Compartment syndrome
  • Crush syndrome
  • Thromboembolic disease
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38
Q

Neurovascular Injuries

A
  • The skeletal system normally protects the neurovascular structure within the limbs
    • May occur when fracture fragments lacerate or impale nerves, leading to neurological deficit
    • May occur during dislocations when nerves and vessels are stretched and damaged
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39
Q

What is compartment syndrome?

A
  • Occurs when blood is confined within the compartment formed by inelastic fascia
    • Permits only limited swelling
  • May be caused by fractures, crush injuries, bleeding disorders, or burns
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40
Q

What are the signs & symptoms of compartment syndrome?

A
  • Burning pain- not relieved with narcotics
  • numbness/ tingling
  • Firm tissue
  • Skin pallor
  • Paralysis of muscle
  • Loss of distal pulse
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41
Q

What is the treatment for compartment syndrome?

A
  • Elevate the extremity to heart level
  • Place ice packs over the extremity
  • Open or loosen tight clothing
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42
Q

What is crush syndrome?

A
  • MOI: Compressive force on muscle that prohibits metabolism and circulation
    • Occurs from trauma, prolonged (>4-6 hours body weight laying on extremity, etc
  • Muscle cells die and release contents into localized vasculature
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43
Q

What is the treatment for crush syndrome?

A
  • Per direct medical control
  • Should be done before release of force
  • High flow oxygen
  • Crystalloid bolus
  • After extrication:
    Consider salbutamol nebulizer (helps to push potassium back
    to intracellular space), calcium (protect against the surge of
    potassium), and sodium bicarbonate, for ECG changes
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44
Q

Thromboembolic Disease

A
  • Deep vein thrombosis (DVT)
  • Pulmonary embolism
    • May occur after prolonged immobilization following pelvic and lower extremity injuries
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45
Q

What is the assessment of deep vein thrombosis?

A
  • Swelling
  • Discomfort
    • Worsens with use
  • Warmth
  • Erythema
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46
Q

What is the assessment for pulmonary embolism?

A
  • When DVT dislodges it can cause a PE
  • Clot travels to and occludes a portion of all the pulmonary arteries
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47
Q

Signs and symptoms of Pulmonary Embolism

A
  • Sudden onset of dyspnea
  • Pleuritic chest pain
  • Tachypnea
  • Right-sided heart failure
  • Shock
  • Cardiac arrest
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48
Q

What is the treatment for thromboembolic disease?

A
  • Maintain airway
  • Oxygenate
  • Crystalloid administration
  • Rapid transport
49
Q

Shoulder Girdle: Clavicle Fractures

A
  • Common, particularly in children
  • Occur to middle third of bone
50
Q

MOI of shoulder girdle: clavicle fractures

A

MOI: Falling onto outstretched arm or direct contact

51
Q

S/S of shoulder girdle: clavicle fractures

A

S&S: pain in shoulder, swelling, unwillingness to raise arm, leaning towards injured side

52
Q

MOI Shoulder Girdle: Scapula Fractures

A
  • MOI: Direct, forceful trauma
  • Often associated with more serious injuries
    • Pneumothorax, hemothorax and # ribs
53
Q

S/S Shoulder Girdle: Scapula Fractures

A

S&S: Pain that increase with arm adduction, swelling, ecchymosis

54
Q

What is the treatment for shoulder girdle fractures?

A
  • Sling and swathe
  • Immobilize against body
  • Consider other, more serious injuries (particularly spinal injuries), and treat for these
  • Scapula fractures warrant full SMR
55
Q

MOI Midshaft Humerus Fractures

A

MOI: Typically occur to younger patient in high-impact injuries (eg, MVCs)

56
Q

S/S Midshaft Humerus Fractures

A

S&S: substantial deformity, swelling, ecchymosis, gross instability, crepitus, possible neurovascular damage

57
Q

What is the treatment for midshaft humerus fractures?

A
  • If angulated, apply longitudinal traction to correct deformity
    • Stop if pt’s pain is too severe or for worsening distal PMS
  • Apply rigid splint from axilla to elbow
  • Sling and swath
  • Apply cold packs
58
Q

Elbow Injuries

A

Distal humerus and proximal radius/ ulna

59
Q

MOI Elbow injuries

A

MOI: Both may result from fall onto outstretched arm

60
Q

S/S Elbow injuries

A

S&S: Pain, ecchymosis, possible neurovascular damage

61
Q

What is the treatment for elbow injuries?

A
  • Remember to check distal PMS before splinting
  • If PMS is present, splint in position found
  • If PMS is absent, apply gentle traction
  • Immediate transport
62
Q

Forearm Fractures

A

Commonly involve both radius and ulna

63
Q

MOI Forearm fractures

A

MOI: Direct force or fall onto outstretched hand

64
Q

S/S Forearm fractures

A

S&S: Tenderness, angulation (Colles fractures is dorsally angulated), swelling

65
Q

What is the treatment for forearm fractures?

A
  • Immobilize with rigid splint
  • Sling
  • Ice
  • Continue monitoring distal PMS
66
Q

Wrist and Hand Fractures

A

May lead to significant long-term disability

67
Q

MOI Wrist and Hand Fractures

A

MOI: Falls, fights, or during sporting events

68
Q

Boxer’s fracture

A

Fracture of fifth metacarpal

69
Q

Metacarpal shaft fracture

A

Compartment syndrome is possible within the hand

70
Q

Mallet finger (baseball #)

A

Finger is jammed into an object, resulting in an avulsion # of the extended tendon

71
Q

What is the treatment for wrist and hand fractures?

A
  • Splint wrist at 30 degrees or dorsiflexion
  • Slightly flex fingers
  • Secure forearm to rigid splint
  • Elevate hand
72
Q

Pelvic Fractures

A
  • Relatively uncommon
    • 3% of all fractures
  • High mortality in blunt trauma patients
    • 8% to 50%
  • Depending on severity
    • Death usually results from massive hemorrhage
73
Q

Lateral compression

A

Side impact

74
Q

Anterior-posterior compression

A
  • Head on
  • The pelvis spreads apart and open like a book
75
Q

Vertical shear

A
  • Major force applied from above or below
  • Shortening of limb, and risk for massive hemorrhage
76
Q

Straddle fracture

A
  • Occurs when a person land in the region of the perineum and sustains bilateral fractures of the inferior and superior rami
77
Q

Open Pelvis fractures

A
  • Life threatening injury
  • Caused by high-velocity injury with subsequent massive hemorrhage
  • Mortality rate of 25% to 50%
78
Q

What is the treatment for pelvic fractures?

A
  • ABCs
  • Spinal precautions
  • Assess for other injuries
    • Bleeding, laceration, bruising, instability
  • Do not reassess for instability once found
  • Large-bore IVs
    • IV fluids given to maintain perfusion
  • Stabilize pelvis (depending on local protocols).
    • Pelvic binder, sheet wrap
  • Rapidly transport to appropriate facility
79
Q

Hip fractures

A

Involve fracture of proximal femur

80
Q

MOI Hip Fractures

A
  • MOI: In elderly patients with osteoporosis who have fallen
  • MOI: In younger patients, often occurs in high-energy impact
81
Q

S/S for hip fractures

A
  • Pain, -articularly with movement; hearing or feeling a snap; swelling; deformity; shortening; external rotation
82
Q

What is the treatment for hip fractures?

A

Depends on MOI
- Low-impact: basic splinting
- High impact:
- May require traction
- Treat as you would any other trauma patient
- Buddy splint
- Immobilize, establish vascular access, treat for shock

83
Q

MOI Femoral Shaft Fractures

A

MOI: High-energy impacts
- Frequently occur with other injuries

84
Q

S/S of Femoral shaft fractures

A
  • Pain
  • Angulation
  • External rotation
  • Shortening, edema
  • Bruising
  • Muscle spasms
  • Shock
85
Q

What is the treatment for femoral shaft fractures?

A
  • ABCs
  • Full spinal immobilization
  • IV access
  • Traction splint
  • Pain medication
86
Q

MOI Knee Fractures

A
  • MOI: direct blow to the knee, axial loading of leg, or powerful contraction of quadriceps
87
Q

S/S of Knee Fractures

A

S&S: Pain, decreased ROM, pain with movement and weight bearing, ecchymosis, swelling, possible deformity

88
Q

What is the treatment for knee fractures?

A
  • With good distal circulation, splint in position found
  • With absent distal circulation, consider possible manipulation
  • Elevate leg
  • Apply cold
  • Frequently reassess distal PMS
  • High incidence of compartment syndrome and neurovascular injury
89
Q

MOI Tibia & Fibula Fractures

A

MOI: direct trauma or rotation/ compressive forces

90
Q

S/S Tibula & Fibula Fractures

A

S&S: Often have significant deformity and soft-tissue damage, possible compartment syndrome, pain, significant instability

91
Q

What is the treatment of tibia and fibula fractures?

A
  • Apply long, rigid splint
  • Administer pain medications as necessary
  • If grossly angulated, attempt to realign after analgesics
  • Elevate
  • Apply cold
  • Continually reassess PMS
92
Q

MOI Ankle Fractures

A

MOI: sudden, forceful movements of the foot
- Damage the malleoli and may cause dislocation

93
Q

S/S of Ankle fractures

A
  • Pain
  • Deformity
  • Swelling
  • May lead to damaged nerves and blood vessels, compartment syndrome, and chronic ankle pain and arthritis
94
Q

What is the treatment of ankle fractures?

A
  • Immobilize with commercial or pillow splint
  • Elevate
  • Apply cold
  • Continually reassess distal PMS
    • If absent with a fracture-dislocation, contact direct medical control for possible prehospital reduction
95
Q

MOI Calcaneus Fractures

A

MOI: Occurs when jumping from a height or when powerful force is applied directly to the heel

96
Q

What is the treatment of calcaneus fractures?

A
  • Use a commercial or pillow splint
  • Apply ice
  • Consider spinal immobilization if MOI is suggestive
97
Q

Joint injuries and Dislocations

A
  • Shoulder girdle injuries and dislocations
  • Elbow dislocations
  • Finger dislocations
  • Hip dislocations
  • Knee dislocations
98
Q

MOI Acromioclavicular Joint Separation

A

MOI: direct blow to the superior aspect of the shoulder

99
Q

S/S Acromioclavicular Joint Separation

A

S&S: pain and tenderness in the region of AC joint

100
Q

MOI Sternoclavicular Joint Separation

A

MOI: direct blow to clavicle or when strong pressure is applied to posterior shoulder

101
Q

S/S Sternoclavicular Joint Separation

A

S&S: pain and swelling at sternoclavicular joint

102
Q

Sternoclavicular Joint Separation

A
  • Assess for other, more dangerous associated injuries.
    • Trachea, vasculature, esophagus
    • Sensation of choking, pain on swallowing
103
Q

MOI Shoulder Dislocation

A

MOI: Fall onto abducted and externally rotated outstretched arm

104
Q

S/S Shoulder Dislocation

A
  • Arm held by the side
  • Supported by the other arm
  • Pain with movement
  • Acromion bulges
  • Palpable humeral head in the axilla
  • Frequent, painful muscle spasms
105
Q

What is the treatment for AC separation?

A

Sling and swath

106
Q

What is the treatment for posterior sternoclavicular dislocation

A
  • Put patient supine, injured arm abducted with rolled towel under shoulder blade
  • Pay attention to ABCs
107
Q

What is the treatment for dislocated shoulder’s?

A
  • Splint in position found
  • Sling and swath
  • Pain medications
108
Q

MOI for Elbow Dislocation

A

MOI: Patient, less than 6 years old, has arm suddenly pulled, as when being lifted

109
Q

S/S for Elbow Dislocation

A

S&S: Pain, arm held still in flexion, only mild swelling

110
Q

What is the treatment for elbow dislocation?

A
  • Splint in position found
  • Sling and swath
  • Consider analgesics
111
Q

MOI Finger Dislocation

A

MOI: sudden “jamming” or overextension of fingers

112
Q

S/S Finger Dislocation

A

S&S: Pain and deformity, possible compromised neurovasculature

113
Q

What is the treatment for finger dislocations?

A
  • Splint entire hang in position of function
    • Use soft dressing to support digit
  • Do not attempt relocation unless directed by direct medical control.
114
Q

MOI Hip Dislocation

A

MOI: deceleration injuries
- Flexed knee strikes immobile object

115
Q

S/S Hip Dislocation

A

S&S (posterior): Leg is flexed, abducted, internally rotated, and shortened, pain, soft-tissue swelling

116
Q

What is the treatment for hip dislocation?

A
  • Full spinal immobilization
  • Consider other injuries
    • Preform full trauma assessment
  • Splint injury in position found with blankets and pillows
  • Perform frequent neurovascular checks
117
Q

MOI Knee Dislocation

A

MOI: high-energy direct trauma or powerful twisting
- Often reduces spontaneously

118
Q

S/S Knee Dislocation

A

S&S: pain, patient often states, “knee gave out”, significant deformity, decreased range of motion

EMRG 1130 (13 decks)

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