Mucoloskeletal Flashcards
1
Q
How do musculoskeletal injuries usually occur
A
From application of significant direct or transmitted force
2
Q
What are 5 common causes of musculoskeletal injuries
A
- Penetrating trauma
- Sports injuries
- Falls
- MVC’s
- Assault
3
Q
What is an indicator of significant musculoskeletal trauma, as well as underlying organ injury and internal/ external hemorrhage
A
Multi-system trauma
4
Q
Are injuries to upper extremities life threatening
A
No usually although painful and debilitating
5
Q
What is required for injury to lower extremities
A
Usually greater force of impact
- more often leading to possible internal hemorrhage and life/limb threat
6
Q
What 5 parts are included in musculoskeletal system
A
Bones Cartilage Ligaments Muscles Tendons
7
Q
What are some modern preventions of injury
A
- seatbelts and airbags
- sports equipment
- safety equipment (boots,vests,harnesses, WSIB regulations)
- canes, walkers, wheelchairs
8
Q
Blood vessels and major nerves run ______ with the bone proximal to distally
A
Parallel
9
Q
What makes up a joint
A
Arrangement of ligaments, cartilage, synovial fluid ( keeps joint together and allows range of motion)
10
Q
How is muscle connected to bone
A
By tendons
- direct skeletal movement through fibres and fasciculi along with muscle bodies
11
Q
Musculoskeletal system is complex arrangement of what tissues
A
Connective Skeletal Vascular Nervous Muscular
12
Q
What are the classification of musculoskeletal injuries
A
Muscular
Joint
Bone
13
Q
What is included in muscle injuries
A
Contusion, compartment syndrome, penetrating injury, muscle fatigue/cramps/spasm/strain
14
Q
What is included in joint injuries
A
Sprain, subluxation, dislocation
15
Q
What is included in bone injuries
A
Fractured
-closed, open, hairline, impacted, transverse, oblique, comminuted, spiral fatigue, greenstick,epiphyseal
16
Q
Muscle injuries may result from (3)
A
Blunt/ penetrating trauma
Overexertion
Oxygen depletion
17
Q
When can muscle injury contribute to shock or hypovolemia
A
in cases with large hematomas or penetrating trauma that causes vessel damage
18
Q
What does bone require constantly
A
Oxygenated circulation as it is living tissue
19
Q
What is a contusion
A
- Bruise
- Damage to muscle cells and blood vessels that supply them
20
Q
What causes a contusion to be painful
A
Small vessels leak blood into interstitial space causing pain, erythema, and ecchymosis
21
Q
What is cause of edema(swelling) from contusions
A
Due to body’s inflammatory response and engorged capillary beds
- swelling may make 1 lumbar larger than the other
22
Q
What is a Hematoma
A
When a contusion is more severe and blood pools beneath tissue layers
- large enough hematoma or significant muscular edema may cause hypovolemia
23
Q
Where can you get contusions
A
Anywhere on body
24
Q
What is compartment syndrome
A
Internal hemorrhage and swelling (from other injuries)
25
What happens in compartment syndrome when there is increased pooling of blood
Pressure builds up in fascial compartment where injury is
- obstructs blood flow, nerve impulses and venous return
- may lead to stop in arterial circulation
26
What is a signs of compartment syndrome
Pt seems to be in more discomfort than external signs indicate
- decreased distal circulation is a late sign
27
What are symptoms of compartment syndrome
Initially May be increased pain with movement, feeling of muscle tension, loss of distal sensation
28
What is a penetrating injury
Injury to deep underlying muscle masses and tendons
| - can affect muscle function
29
What is a sign that penetrating injury has damaged muscle/ tendon
Muscle/ tendon Can no longer fight opposing muscles to keep neutral alignment
30
What interventions are required with damaged muscle or tendon from penetrating injury
Surgical intervention
31
What can penetrating injury lead to
- Infection (from open wound or object that is penetrating)
| - ischemia = lack of oxygenated blood flowing to an area ( from decreased blood flow)
32
When do you remove penetrating objects
Never!
| Unless it interferes with ABCs (including CPR)
33
What is 1st degree burn concidered
Superficial
34
What is 2nd degree burn concidered
Partial thickness, blistering
35
What is 3rd degree burn concidered
Full thickness, partially or fully charred
36
What is 4th degree burn concidered
Complete thickness, likely into muscle and bone
37
What are the major concerns with burns
1. Infection
2. Hypovolemia
3. Hypothermia
4. Pain
38
Rule of 9s adult head
Front 4.5%
| Back 4.5%
39
Rule of 9s adult trunk
Front 18%
Back 18%
Total 36 %
40
Rule of 9s adult arms
Front 4.5 %
Back 4.5%
Total bilat 18%
41
Rule of 9s adult legs
Front 9%
Back 9%
Total 36%
42
Rule of 9s adult perineum
1 %
43
Rule of 9s pediatric head
Front 9%
Back 9%
Total 18%
44
Rule of 9s pediatric trunk
Front 18%
| Back 18%
45
Rule of 9s pediatric arms
Front 4.5%
Back 4.5 %
X 2 arms = 18%
46
Rule of 9s pediatric trunk
Front 18%
| Back 18%
47
Rule of 9s pediatric legs
Front 6.7
Back 6.7
X 2 arms 13.4 = 26.8%
48
Rule of palms
Size of pts palm accounts for 1% of their BSA burned
49
What is fatigued muscle
Muscles ability to respond to stimulation is lost or reduced through overactivity
50
What happens in fatigued muscle when it reaches limits of performance / ability
Decreased ability of muscle fibers to contract
51
What is depleted and roduced in muscle fatigue
Oxygen depleted
| Lactic acid is produced
52
What are symptoms of muscle fatigue
Decreased strength to muscle
| Painful when used
53
How to treat muscle fatigue
Requires restored oxygenation and proper rest
54
What is a muscle cramp
Muscle pain from overactivity, lack of oxygen, and accumulation of waste product
- circulatory system fails to remove waste product
55
What causes muscle cramp
Muscle fatigue from strenuous exercise or if muscle was in unusual position
56
How to treat muscle cramp
Obstructed circulation needs to be restored
| - change limbs position or massage the muscle
57
What is muscle cramps often associated with
Muscle spasms
58
What is a muscle spasm
Intermittent or continuous contraction of a muscle
59
What is clonic and tonic
```
Clonic = intermittent
Tonic = continual
```
60
What can be a sign of muscle spasm
-Can cause enough muscle spasm to look like skeletal deformity
-
61
How to treat muscle spasm
Rest, rehydration, restoration of circulation
62
What is rigor mortis
Entire body in muscle spasm following death
- usually sets in 1-3 hours after death
- subsides 6- 8 hours after death (depending on temp)
- caused by loss of ATP from body muscles after death
63
What is muscle strain
Injury from overstretching of muscle fibres from excessive forces, leading to tears in the fibres
64
How is muscle strain caused
During extreme muscle stress (heavy lifting, sprinting) or from muscle fatigue due to reduced # of muscle fibers working, leading to increased likelihood of muscle overload
65
Symptoms of muscle strain
- pain with any use of muscle involved
- pain on palpation of area
Causes limited use of affected area
66
Signs of muscle strain
Usually no outward signs
67
What are sprains
Tearing of a joint capsules CT - usually a ligament
68
What are signs / symptoms of sprain
Acute pain and inflammation/swelling
- ecchymotic discoloration sets in gradually
Can have complete joint failure as ligament tears affect joint function
69
What is a grade 1 sprain
Minor, incomplete tear.
Ligament is painful and swelling is minimal.
Joint is stable
70
What is grade 2 sprain
Significant, incomplete tear
Swelling and pain are moderate- severe
Joint is intact but stable
71
What is grade 3 sprain
Complete tear of ligament
May appear the same as fracture due to pain severity and spasm
Joint unstable
72
What is subluxation
Partial displacement of a bone end from its position in a joint capsule
73
What causes subluxation
Joint stress and stretching of ligaments
| - hyperextensio , hyperflexion, lateral rotation beyond normal ranges, or extreme axial force
74
Symptoms of subluxation
More significantly reduces joint t integrity than a sprain
- increasing pain and swelling rapidly
- limited range of motion and unstable joi t
75
What is dislocation
Complete displacement of a bone end from its position in joint capsule
76
Signs of dislocation
Noticeable deformity as joint gets stuck in an abnormal position once it is out of the socket
77
What are symptoms of dislocation
Painful, swollen, immobile
| - may damage or compress blood vessels and nerves
78
How does dislocations typically occur and what can it lead to
Occurs when the joint moves forcefully beyond it's normal range of motion
- may lead to ligament damage , socket damage, or associated cartilage damage
79
What is a fracture
Disruption in the continuity of the bone structure
80
What can cause a fracture
```
Direct force (bat to femur)
Or transmitted force (fall from ladder, landing on feet- impact transmitted from foot to ankle to tibia/fibula to femur)
```
81
What structures within bone are disrupted during bone fracture
Collagen, astrocytes, salt crystals, blood vessels, nerves and medulla canal
82
What damage can bone ends cause to vessels
Vascular damage - increased cap refill, diminished distal pulses, cool limb temperature, discoloration/ pallor, and paresthesia (pins and needles)
83
What damage can bone ends cause to nerves
Nerve damage - distal paresthesia, anesthesia (complete), paresis (weakness), or paralysis
84
What damage can bone ends cause to muscles and tendons
Muscle / tendon damage - inability to move or decreased ROM; could result in compartment syndrome
85
What is a closed fracture
A broken bone in which the bone ends or forces that caused the break dont penetrate the skin
86
What is open fracture
A broken bone where bone ends or forces that caused break penetrate the surrounding skin
87
What is a risk with open fractures
Infection as now open wound
88
When can open fracture occur with limited force
If bone is close to the surface (like shin)
89
What is another name for open fracture
Compound
90
What is a hairline fracture
Small crack in bone that doesnt disrupt its total structure.
| - painful but maintains position and stays stable
91
What is impacted fracture
Break in bone where bone is compressed on itself
- usually compression / crush injuries
- maintains position
92
What is common between hairline and impacted fractures
Both can become worse with added stress
93
What is a transverse fracture
A break that runs perpendicular to the bones orientation
94
What is oblique fracture
A break in bone running ant angle but at 90°
95
What is comminuted fracture
Fracture where bone is broken into several pieces
96
What is spiral fracture
A curving break in bone; may be caused by rotational forces
| - possibly from a limb caught in machinery or a child's arm being grabbed and twisted by adult
97
What is fatigue fracture
Break in bone associated with prolonged or repeated stress
| - often in metatarsal from extensive walking with inappropriate shoes or running a marathon
98
How can fractures lead to fat embolism and what is the risk
- injury releases fat into damaged vessels of circulatory system (enters venous system and travels to heart)
- emboli moves to lungs
- usually caused by crush injuries and manipulation of a fracture
99
Pediatric considerations for fractures
Pediatric bones have more cartilage and dont fracture the same as adults
- still growing from epiphyseal plate
100
What is greenstick fracture
Partial fracture of child's bone
- disrupts only one side of long bone
- causes angulation and resists alignment
- the injured side grows more as it heals (usually best to break completely to heal evenly)
101
What is epiphyseal fracture
- disruption in the epiphyseal plate of a child's bone
| - if growth plate disrupted, the disruption may lead to reduction or stop in bone growth (usually at proximal tibia)
102
Geriatric considerations for fractures
- bone mass and collagen structures begin decreasing progressively after 40yo
- bones are less flexible, more brittle and more easily fractured
- healing slows down, loss of muscle and coordination makes skeletal injuries more likely
- fractures happen more easily with less force
103
What is osteoporosis
Weakening of bone tissue due to loss of essential minerals (especially calcium)
- accelerated degeneration of bone tissue
- usually affects women more than men( after menopause)
- increased occurrence of fractures, spinal curvatures, structure degeneration
104
What are pathological fractures
- result from disease pathologies that affect bone development
- can be from tumors of the bone, periosteum, articular cartilage; diseases that increase osteoclast activity and osteoporosis
- radiation treatment (kills bone cells, localized bone degeneration, weakened bones and fractures)
- do not heal well if at all
105
What are osteoclasts
Large multinucleated cell responsible for the dissolution and absorption of bone
106
What is diaphysis
Shaft or central part of long bone
107
What is epiphyseal
Rounded end of long bone (joint )
108
Where is largest diameter in long bone
Around midshaft due to placement of skeletal muscle
109
What is best way to understand injury
When concider both muscular and skeletal systems together
| - helps to look for possible nervous and vascular injuries
110
Limited tissue surrounding joint increases risk of
Dislocation, subluxation, sprain, fracture
| - swelling/ deformity compromise the nerve and vasculature
111
Where is nerve and vascular injury less likely
In long bone fracture
112
Where do blood vessels enter long bones and what is the possible consequence of displacement occurs
Blood vessels enter bone at epiphysis
| - if displacement occurs, distal compromise may occur causing tissue death
113
What happens to muscles in long bone fractures
Pain causes surrounding muscle to contract and spasm
| - causes bone ends to cross fracture site, interferes with muscles and causes crepitus
114
What can be damaged to cause bone repair cycle
Trauma fractures a bone
| - tear to periosteum, blood vessels, soft tissue and endosteum
115
What is first step of bone repair
Blood fills injury and forms RBC and collagen clot
116
What is second stage of bone repair cycle
Osteocytes from bone ends multiply and reduce osteoblasts, which put salt crystals in collagen clot - begins to connect bone ends
117
What is a Callus
Thickened area that forms at site of a fracture as part of the repair process
118
What strengthens the callus
Salt crystals and collagen
119
What do osteoclast and osteoblasts do
- Osteoclasts dissolve salt crystals in areas of low stress
| - osteoblasts lay down new collagen and salts in areas of high stress
120
Result of bone repair cycle If bone is well aligned at fracture
It may not result in permanent damage
121
Result of bone repair cycle if bone is displaced
Injury site may never heal properly
| - may cause disability, deformity or persistent issues
122
How can inflammatory and generative issues present
Joint pain, tenderness and fatigue
123
What can be side effects of inflammatory or degenerative issues
Difficulty walking, moving, performing normal daily functions without assistance
124
What is Bursitis
Acute or chronic inflammation of the small synovial sacs that reduce friction and cushion the ligaments/ tendons/ joints
125
What causes burtitis
Repeated trauma, gout and infection
126
Symptoms of burtitis and common areas affected
- localized pain, swelling, and tenderness at joint
| - usually olecranon (elbow), above patella (knee), and shoulder
127
What is tendinitis
Inflammation of a tendon and/ or its protective sheath
| Presents similarly to burtitis
128
What causes tendinitis and common areas affected
- Repeated trauma to a muscle group
| - Usually affects major tendons or upper and lower extremities
129
What is osteoarthritis
Inflammation of a joint resulting from wearing down of the articular cartilage
- most common type of CT disorder (general wear and tear of articular cartilage)
130
What are predisposing factors of osteoarthritis
Trauma, obesity, aging
131
What a symptoms of osteoarthritis
Results in bony overgrowth
| - causing pain, stiffness, decreased movement, joint enlargement (especially fingers)
132
What is rheumatoid arthritis
Chronic disease that causes deterioration of peripheral joint CT
133
What are symptoms/ effects of rheumatoid arthritis
Inflammation of the synovial joints
| - causing immobility, pain (especially with movement), fatigue
134
Who is rheumatoid arthritis more common for
2 - 3 x more comment in women
135
What is gout
Inflammation of joints and CT due to buildup of uric acid crystals
136
Symptoms of gout
Peripheral joint pain, swelling and possible deformity
137
Who does your most frequently affect
Males who have a higher concentration of uric acid in the blood (meta oils end product that is not easily dissolved)
138
Are musculoskeletal injuries usually life threatening
No
| - usually well assessed and managed at the scene
139
Can we diagnose musculoskeletal injuries
Not conclusively without imaging
140
When does serious injury occur
When the energy is transmitted down the bone to the Internal organs
- always concider MOI to evaluate potential for internal injuries
141
What is pattern of assessment for pt with musculoskeletal injuries
Same as any pt
- scene assessment
- primary assessment
- focused history
- focused secondary assessment
142
What should you add to musculoskeletal assessment if there is trauma and altered LOC
Include a rapid trauma assessment and detailed secondary assessment
143
Environmental issues that may arise in assessment to always keep in mind
If MOI on roadway, make sure you are protected from oncoming traffic
- if injury from assault make sure assailant not on scene
- contact appropriate resources when needed
144
Primary assessment of musculoskeletal injuries
- AVPU and ABC's ( same as always)
- ID risk or c-spine/ spinal injuries
- do not tunnel vision on injury no matter how "bad" it looks ( dont want to miss other issues that could be going on)
145
Musculoskeletal injuries are classified in 4 different ways
1. Life and limb threatening
2. Life threatening injuries with minor musculoskeletal injuries
3. Non-life threatening injuries but serious limb-threatening musculoskeletal injuries
4. Non-life threatening injuries and only isolated minor musculoskeletal injuries
146
If pt is 4th classification what is needed
Only focused secondary assessment is needed
147
What assessment should you add to pt with more severe injuries
A detailed secondary as pt may have one distracting injury that does not allow them to give an accurate account of their injuries
148
When do you do Rapid trauma assessment
Any pt with sign/symptoms/mechanism of serious injury
149
How to preform rapid trauma assessment
From head to toe - hands on assessment for any pt who is altered LOC or may have a distracting injury
150
What do you do if there is crepitus, instability or pain in the pelvis
- only palpate once
| - dont want to manipulate pelvis if it could be fractured to avoid causing life-threatening hemorrhage
151
Why is blood loss /swelling possibly difficult to see in femurs
Due to muscle mass
152
What to check on upper and lower extremities in rapid trauma assessment
Stability, sensation, colouration, temperature, circulation
153
How to check on upper and lower extremities in rapid trauma assessment
```
If pt contious - have them show grip strength, joint movement, ROM bilaterally
- check plantar flexion (pushing down on gas pedal)
And dorsiflexion (pulling toes towards nose)
```
154
What accompanies physical assessment
Detailed history
155
What does detailed history and secondary assessment provide
Further info about initial findings in primary assessment
156
When should secondary assessment be preformed
On scene if pt stable
| En route if pt unstable
157
Why remove or cut any restrictive clothing, jewelry or shoes
Want it removed before more inflammation sets in and it's harder to remove
158
Tips for dealing with musculoskeletal I jury in assessment
-Have partner /bystander stabilize injured extremity to avoid movement
- expose all Injury sites and compare to uninjured side
- OPQRST
- Full 5 Ps
Ask pt if heard a snap, crack or pop before or after fall
159
What are 5 p's
```
Pain
Pallor
Pulse
Paralysis
Paresthesia
(Sometimes pressure )
```
160
What is first priority in management of any case
Manage all ABC issues and spinal precautions before worrying about extremity splinting
- with exception of pelvis
161
Goal of management of musculoskeletal
- goal is to prevent further injury
- protect against infection by covering open injuries
- avoid overt manipulation to avoid nerve and vessel damage
162
Tip for managing musculoskeletal injuries
- splint injuries I position found unless circulation is compromised
- manipulate into neutral alignment (1 attempt only)
- explain all actions to pt, warn about pain when you manipulate
- do not reduce a dislocation
163
Tips about realignment of injury
- stop attempt if meet any resistance or intense pain
- do not attempt alignment of I juries within 7cm of a joint (concidered joint injury if within 7cm )
- if unable to secure to joint above and below use body for stability
- place limb in position of function or neutral when possible
164
Immobilization is aimed to prevent: (3)
1. Movement of broken bone ends
2. Dislodging of bone from a joint
3. Reduce further stress on muscles, ligaments, or tendons
165
Why do you secure splinting device above and below the injury
Holds joints in place to prevent transmission of movement through long bone
166
Why do we wrap splint from distal to proximal
- makes sure pressure pushed blood to moved into systemic circulation and not distal limb
- assists venous dressing
167
How tight do you wrap dressing
Tight enough to ensure its secured but you need to be able to at least get a finger under it
168
What is RICE
Rest
Immobilize
Cold
Elevate
169
Change to RICE for muscular and joint injuries
Alternate heat and ice after 48hrs
170
What is rigid splint
Firm and durable supports
| - cardboard, plastic, Metal, synthetic or wood
171
What helps with discomfort of rigid splint
Require added padding to reduce discomfort when applied
172
Side note about rigid splint
- speed splint is brand typically used in prehospital setting in ontario
- other brands available but usually not purchased by EMS
173
What is formable splints
Malleable splint- able to be shaped to fit extremity
174
What are formable splints used for
Hand, wrist (use pt good arm or your arm if similar size to shape)
Also: flail segment in chest
175
What is brand of formable splint usually used by EMS and what is it made from
SAM splint
| - made of foam and mesh or can be "ladder" splints made of soft metal wire
176
What are soft splint
Usually called air or pillow splints - use padding to support injury
- allow for ankle / foot to be wrapped comfortably in position found with triangle bandages to secure it
- not to be used above knee or elbow
177
How to use soft splint
Position limb in aligned position without extreme manipulation and provides pressure to injury - reduce internal/ external hemorrhage
- change in temp can change pressure in air splint
178
What is traction splint
Uses the force against the truck and the tension against the ankle to pull bone ends apart from rubbing
- use cravats after traction is applied to hold extremities together
179
What is traction splint used for
- primarily closed femur fractures
- tibia/ fibula fractures
- sometimes hip fractures
- bilateral femur fractures
180
What is traction splint used for
- primarily closed femur fractures
- tibia/ fibula fractures
- sometimes hip fractures
- bilateral femur fractures
181
How much traction do you apply to traction splint
One femur = 10% body weight (max 15lbs)
Bilat femurs = 20% body weight (max 30lbs)
Tib/ Fib= 5- 7 lbs
182
Contraindications for traction splint
Dont use in femur fractures with knee, tibia or foot injury
183
What are types of pelvis fractures
Involve iliac Crest or pelvic ring
184
What is a usual iliac Crest fracture
Often isolated and stable
| - cared for by simple immobilization
185
What are usual pelvic ring fractures
Often serious, unstable and life threatening due to ring structure = 2 fracture sites
186
Possible risk with pelvic ring fracture
- pelvis is active in blood cell production and adjacent to major blood vessels feeding lower extremities
- > risk of interfering with lower extremity circulation
- > risk of circulatory compromise (vessel can empty into pelvic and retriperitoneal cavities)
- > risk of hip dislocation
187
How to car for pelvic fracture
- cravats or pillow/ blanket padding
- securing pt to scoop stretcher or spinal board
- managing hemodynamic compromise
- rapid transport
188
Is pelvis fracture always load and go
Yes even if pt is deemed stable
189
Cause of femur fractures
- Traumatic = usually extreme discomfort
- non-traumatic = degenerative
- > degenerative (older age, hx of degenerative issues) may have minimal pain and no significant MOI ( older pts can be on alot of pain meds)
190
Proximal fractures (neck and intertrochanteric) of femur
- May appear as hip fx
- or associated with hip/ pelvic trauma (more common in elderly)
- feoot will likely be externally rotated and shortened
191
What are mid-shaft fractures in femur
Caused by higher levels of force and result in greater blood loss
192
What are distal femur fractures (condylar and epicondylar)
Extensive injury and usually involves blood vessels before they enter the knee/lower leg
193
Management of femur fx
Manage obvious femur fractures with traction splint (if fx not compound)
- one femur = stay and play (if stable)
- bilat femur = load and go (stable or not)
194
Tibia fx
- Most common leg bone fx
- often = compound fx
- if fx alone may stay inline but not strong enough to bear weight
195
Fibula fx
- may accompany tibia fx or be related to ankle/knee I jury
| - if only fibula fx, leg may stay inline and be stable with just discomfort when bearing weight
196
Management of tib/fib fx
- if distal circulation is present, use speed splint to immobilize
- if distal circulation is absent, consider safer splint
- 5 p's
- RICE
197
Cause of clavicle fx
- most frequently fx bone in body
| - usually from transmitted force (fall on outstretched arm force goes up arm to clavicle)
198
Main concern with clavicle fx
Very close to upper lungs and vasculature of upper body
| - risk of pneumothorax or hemorrhage
199
Usual presentation of clavicle fx
Pain to clavicle and shoulder, with shoulder rotated forward
200
How to manage clavicle fx
Use a sling and swathe with cold pack to immobilize clavicle
- can also use traction splint (in a figure 8 with traction being twisted and pulled back - use pen or tongue depressor to turn traction)
201
What is difficulty with humerus fx
Due to position of humerus into shoulder, and proximity to axillary artery, traction to humerus is difficult to accomplish without compromising circulation
202
How to manage humerus fx
- use body as splint
- sling and swathe with cold pack
- can wrap a triangle around pt wrist and use countertraction to anchor arm to body
- if pt conscious, have them hold arm in comfortable position
- can use speed splint ( best for mid-shaft or distal humerus injuries)
203
Most common radius fx
Distal end as it meets wrist
- called a Colle's fx (silver fork fx)
- wrist angulates upwards and circulation may be compromised makes hand ashen colour
204
Radius and ulna fx together
Usually not life or limb threatening
| In only 1 fractured may only have minor angulation
205
Management of radius/ ulna fx
- use speed splint or SAM splint to immobilize forearm (secure above and below fx just like all long bone fx)
- pt may be more comfortable with sling and swathe applied after splint
- leave at least fingernail beds exposed for distal pulse check
- if possible leave gap for radial pulse check
206
Two ways hip may dislocate
```
Anterior= foot turned outward and head of femur palpable in inguinal area
Posterior= flexed knee and internally rotated limb; head of femur buried in muscle mass of buttock (not often palpable)
```
207
Management of hip dislocation
- treat same as pelvic fx (padding and careful movement)
- not load and go unless circulation compromised or other serious injuries
- compare circulation in both legs
- compare length and position of both legs for evidence of deformity
208
What is new spinal restriction standard for elderly pt who falls
A collar must be placed for any pt over 65 who had a fall
| - hip dislocations are more common in elderly pts as well
209
What may be included in knee fx
Femur, tibia, patellar dislocation, Frank dislocation of the knee
210
Patella dislocation
Most common
Anterior = angled up
Posterior = angled down
211
Why are knee injuries serious to pt
Could affect quality of life and limit pt mobility in future
- knee is a large joint that bears alot of weight
- could result in popliteal artery damage compromising distal circulation
212
Management of knee fx / dislocation
- immobilize in position found
| - use "A" frame technique (one ridged splint on medial side and one on lateral side )
213
Why should you avoid reducing knee dislocation unless part of your base hospital standards
Multiple ligaments, vessels, nerves, synovial fluid sacs that may become injured
214
Ankle / foot fx
- usually obvious deformity because of smaller diameter of ankle
- typically painful but not usually gross deformity as bones very small not much angulation other than toes
- sprains are common in ankle but more swelling than overt deformity
215
Types of ankle / foot dislocation
```
Anterior = dorsiflexion (upward pointing)
Posterior = lengthen plantar reflex (downward pointing)
Lateral = foot turned outward (most common)
```
216
Management of ankle / foot fx / dislocation
- use pillow splint for gross deformity / foot angulation
- use speed splint for injuries without significant angulation
RICE 5 P's
217
Shoulder fx often involve
Proximal humerus, lateral scapula and distal clavicle
218
Directions of shoulder dislocation
```
Anterior= displaced forward - pt often holding arm against body and pulling across midline
Posterior= elbow and forearm held away from body due to internal rotation of shoulder
Inferior= humoral head is down, pts arm may be locked above head or hanging down immobile
```
219
Management of shoulder fx / dislocation
- sling and swathe when possible
- secure arm against pt body with bulky dressing between arm and body
- cold pack and 5 Ps
- do not reduce
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What increases chances of shoulder dislocation
Prior dislocations
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What is risk with elbow fx
High occurrence of nerve / vascular involvement (especially children)
- brachial artery
- medial, ulnar, and radial nerves
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Causes of elbow fx
Often from falling on outstretched hand
| - in children, common with someone grabbing and pulling arm fordefully
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Management of elbow fx
Use speed splint or sling/swathe to immobilize injury against body
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Wrist/ hand/ fingers fx or dislocation
- commonly from direct trauma
- noticeable deformity is common
- pt may be distressed as use hands for daily life
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Management of wrist/ hand / fingers fx or dislocation
- use SAM splint to immobilize wrist/ hand
- ensure distal circulation
- monitor cap refill
- if finger fx use good finger beside or tongue depressor as rigid splint
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Non- pharmaceutical pain management of musculoskeletal injuries
1. Splinting / immobilization
2. Hot packs - to improve circulation
3. Cold packs - to reduce inflammation
4. Patient position
5. Pt coaching / breathing
6. Oxygen therapy (if needed)
