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PCT > Mucoloskeletal > Flashcards

Mucoloskeletal Flashcards

1
Q

How do musculoskeletal injuries usually occur

A

From application of significant direct or transmitted force

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2
Q

What are 5 common causes of musculoskeletal injuries

A
  1. Penetrating trauma
  2. Sports injuries
  3. Falls
  4. MVC’s
  5. Assault
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3
Q

What is an indicator of significant musculoskeletal trauma, as well as underlying organ injury and internal/ external hemorrhage

A

Multi-system trauma

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4
Q

Are injuries to upper extremities life threatening

A

No usually although painful and debilitating

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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

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6
Q

What 5 parts are included in musculoskeletal system

A 
Bones
Cartilage 
Ligaments 
Muscles 
Tendons
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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
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8
Q

Blood vessels and major nerves run ______ with the bone proximal to distally

A

Parallel

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9
Q

What makes up a joint

A

Arrangement of ligaments, cartilage, synovial fluid ( keeps joint together and allows range of motion)

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10
Q

How is muscle connected to bone

A

By tendons

- direct skeletal movement through fibres and fasciculi along with muscle bodies

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11
Q

Musculoskeletal system is complex arrangement of what tissues

A 
Connective
Skeletal 
Vascular 
Nervous 
Muscular
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12
Q

What are the classification of musculoskeletal injuries

A

Muscular
Joint
Bone

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13
Q

What is included in muscle injuries

A

Contusion, compartment syndrome, penetrating injury, muscle fatigue/cramps/spasm/strain

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14
Q

What is included in joint injuries

A

Sprain, subluxation, dislocation

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15
Q

What is included in bone injuries

A

Fractured

-closed, open, hairline, impacted, transverse, oblique, comminuted, spiral fatigue, greenstick,epiphyseal

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16
Q

Muscle injuries may result from (3)

A

Blunt/ penetrating trauma
Overexertion
Oxygen depletion

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17
Q

When can muscle injury contribute to shock or hypovolemia

A

in cases with large hematomas or penetrating trauma that causes vessel damage

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18
Q

What does bone require constantly

A

Oxygenated circulation as it is living tissue

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19
Q

What is a contusion

A
  • Bruise

- Damage to muscle cells and blood vessels that supply them

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20
Q

What causes a contusion to be painful

A

Small vessels leak blood into interstitial space causing pain, erythema, and ecchymosis

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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

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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

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23
Q

Where can you get contusions

A

Anywhere on body

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24
Q

What is compartment syndrome

A

Internal hemorrhage and swelling (from other injuries)

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25
Q

What happens in compartment syndrome when there is increased pooling of blood

A

Pressure builds up in fascial compartment where injury is

  • obstructs blood flow, nerve impulses and venous return
  • may lead to stop in arterial circulation
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26
Q

What is a signs of compartment syndrome

A

Pt seems to be in more discomfort than external signs indicate
- decreased distal circulation is a late sign

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27
Q

What are symptoms of compartment syndrome

A

Initially May be increased pain with movement, feeling of muscle tension, loss of distal sensation

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28
Q

What is a penetrating injury

A

Injury to deep underlying muscle masses and tendons

- can affect muscle function

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29
Q

What is a sign that penetrating injury has damaged muscle/ tendon

A

Muscle/ tendon Can no longer fight opposing muscles to keep neutral alignment

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30
Q

What interventions are required with damaged muscle or tendon from penetrating injury

A

Surgical intervention

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31
Q

What can penetrating injury lead to

A
  • Infection (from open wound or object that is penetrating)

- ischemia = lack of oxygenated blood flowing to an area ( from decreased blood flow)

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32
Q

When do you remove penetrating objects

A

Never!

Unless it interferes with ABCs (including CPR)

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33
Q

What is 1st degree burn concidered

A

Superficial

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34
Q

What is 2nd degree burn concidered

A

Partial thickness, blistering

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35
Q

What is 3rd degree burn concidered

A

Full thickness, partially or fully charred

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36
Q

What is 4th degree burn concidered

A

Complete thickness, likely into muscle and bone

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37
Q

What are the major concerns with burns

A
  1. Infection
  2. Hypovolemia
  3. Hypothermia
  4. Pain
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38
Q

Rule of 9s adult head

A

Front 4.5%

Back 4.5%

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39
Q

Rule of 9s adult trunk

A

Front 18%
Back 18%
Total 36 %

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40
Q

Rule of 9s adult arms

A

Front 4.5 %
Back 4.5%
Total bilat 18%

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41
Q

Rule of 9s adult legs

A

Front 9%
Back 9%
Total 36%

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42
Q

Rule of 9s adult perineum

A

1 %

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43
Q

Rule of 9s pediatric head

A

Front 9%
Back 9%
Total 18%

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44
Q

Rule of 9s pediatric trunk

A

Front 18%

Back 18%

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45
Q

Rule of 9s pediatric arms

A

Front 4.5%
Back 4.5 %
X 2 arms = 18%

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46
Q

Rule of 9s pediatric trunk

A

Front 18%

Back 18%

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47
Q

Rule of 9s pediatric legs

A

Front 6.7
Back 6.7
X 2 arms 13.4 = 26.8%

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48
Q

Rule of palms

A

Size of pts palm accounts for 1% of their BSA burned

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49
Q

What is fatigued muscle

A

Muscles ability to respond to stimulation is lost or reduced through overactivity

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50
Q

What happens in fatigued muscle when it reaches limits of performance / ability

A

Decreased ability of muscle fibers to contract

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51
Q

What is depleted and roduced in muscle fatigue

A

Oxygen depleted

Lactic acid is produced

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52
Q

What are symptoms of muscle fatigue

A

Decreased strength to muscle

Painful when used

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53
Q

How to treat muscle fatigue

A

Requires restored oxygenation and proper rest

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54
Q

What is a muscle cramp

A

Muscle pain from overactivity, lack of oxygen, and accumulation of waste product
- circulatory system fails to remove waste product

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55
Q

What causes muscle cramp

A

Muscle fatigue from strenuous exercise or if muscle was in unusual position

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56
Q

How to treat muscle cramp

A

Obstructed circulation needs to be restored

- change limbs position or massage the muscle

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57
Q

What is muscle cramps often associated with

A

Muscle spasms

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58
Q

What is a muscle spasm

A

Intermittent or continuous contraction of a muscle

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59
Q

What is clonic and tonic

A 
Clonic = intermittent 
Tonic = continual
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60
Q

What can be a sign of muscle spasm

A
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61
Q

How to treat muscle spasm

A

Rest, rehydration, restoration of circulation

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62
Q

What is rigor mortis

A

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
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63
Q

What is muscle strain

A

Injury from overstretching of muscle fibres from excessive forces, leading to tears in the fibres

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64
Q

How is muscle strain caused

A

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

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65
Q

Symptoms of muscle strain

A
  • pain with any use of muscle involved
  • pain on palpation of area
    Causes limited use of affected area
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66
Q

Signs of muscle strain

A

Usually no outward signs

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67
Q

What are sprains

A

Tearing of a joint capsules CT - usually a ligament

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68
Q

What are signs / symptoms of sprain

A

Acute pain and inflammation/swelling
- ecchymotic discoloration sets in gradually
Can have complete joint failure as ligament tears affect joint function

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69
Q

What is a grade 1 sprain

A

Minor, incomplete tear.
Ligament is painful and swelling is minimal.
Joint is stable

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70
Q

What is grade 2 sprain

A

Significant, incomplete tear
Swelling and pain are moderate- severe
Joint is intact but stable

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71
Q

What is grade 3 sprain

A

Complete tear of ligament
May appear the same as fracture due to pain severity and spasm
Joint unstable

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72
Q

What is subluxation

A

Partial displacement of a bone end from its position in a joint capsule

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73
Q

What causes subluxation

A

Joint stress and stretching of ligaments

- hyperextensio , hyperflexion, lateral rotation beyond normal ranges, or extreme axial force

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74
Q

Symptoms of subluxation

A

More significantly reduces joint t integrity than a sprain

  • increasing pain and swelling rapidly
  • limited range of motion and unstable joi t
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75
Q

What is dislocation

A

Complete displacement of a bone end from its position in joint capsule

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76
Q

Signs of dislocation

A

Noticeable deformity as joint gets stuck in an abnormal position once it is out of the socket

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77
Q

What are symptoms of dislocation

A

Painful, swollen, immobile

- may damage or compress blood vessels and nerves

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78
Q

How does dislocations typically occur and what can it lead to

A

Occurs when the joint moves forcefully beyond it’s normal range of motion
- may lead to ligament damage , socket damage, or associated cartilage damage

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79
Q

What is a fracture

A

Disruption in the continuity of the bone structure

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80
Q

What can cause a fracture

A 
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)
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81
Q

What structures within bone are disrupted during bone fracture

A

Collagen, astrocytes, salt crystals, blood vessels, nerves and medulla canal

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82
Q

What damage can bone ends cause to vessels

A

Vascular damage - increased cap refill, diminished distal pulses, cool limb temperature, discoloration/ pallor, and paresthesia (pins and needles)

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83
Q

What damage can bone ends cause to nerves

A

Nerve damage - distal paresthesia, anesthesia (complete), paresis (weakness), or paralysis

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84
Q

What damage can bone ends cause to muscles and tendons

A

Muscle / tendon damage - inability to move or decreased ROM; could result in compartment syndrome

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85
Q

What is a closed fracture

A

A broken bone in which the bone ends or forces that caused the break dont penetrate the skin

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86
Q

What is open fracture

A

A broken bone where bone ends or forces that caused break penetrate the surrounding skin

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87
Q

What is a risk with open fractures

A

Infection as now open wound

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88
Q

When can open fracture occur with limited force

A

If bone is close to the surface (like shin)

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89
Q

What is another name for open fracture

A

Compound

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90
Q

What is a hairline fracture

A

Small crack in bone that doesnt disrupt its total structure.

- painful but maintains position and stays stable

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91
Q

What is impacted fracture

A

Break in bone where bone is compressed on itself

  • usually compression / crush injuries
  • maintains position
92
Q

What is common between hairline and impacted fractures

A

Both can become worse with added stress

93
Q

What is a transverse fracture

A

A break that runs perpendicular to the bones orientation

94
Q

What is oblique fracture

A

A break in bone running ant angle but at 90°

95
Q

What is comminuted fracture

A

Fracture where bone is broken into several pieces

96
Q

What is spiral fracture

A

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
Q

What is fatigue fracture

A

Break in bone associated with prolonged or repeated stress

- often in metatarsal from extensive walking with inappropriate shoes or running a marathon

98
Q

How can fractures lead to fat embolism and what is the risk

A
  • 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
Q

Pediatric considerations for fractures

A

Pediatric bones have more cartilage and dont fracture the same as adults
- still growing from epiphyseal plate

100
Q

What is greenstick fracture

A

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
Q

What is epiphyseal fracture

A
  • 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
Q

Geriatric considerations for fractures

A
  • 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
Q

What is osteoporosis

A

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
Q

What are pathological fractures

A
  • 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
Q

What are osteoclasts

A

Large multinucleated cell responsible for the dissolution and absorption of bone

106
Q

What is diaphysis

A

Shaft or central part of long bone

107
Q

What is epiphyseal

A

Rounded end of long bone (joint )

108
Q

Where is largest diameter in long bone

A

Around midshaft due to placement of skeletal muscle

109
Q

What is best way to understand injury

A

When concider both muscular and skeletal systems together

- helps to look for possible nervous and vascular injuries

110
Q

Limited tissue surrounding joint increases risk of

A

Dislocation, subluxation, sprain, fracture

- swelling/ deformity compromise the nerve and vasculature

111
Q

Where is nerve and vascular injury less likely

A

In long bone fracture

112
Q

Where do blood vessels enter long bones and what is the possible consequence of displacement occurs

A

Blood vessels enter bone at epiphysis

- if displacement occurs, distal compromise may occur causing tissue death

113
Q

What happens to muscles in long bone fractures

A

Pain causes surrounding muscle to contract and spasm

- causes bone ends to cross fracture site, interferes with muscles and causes crepitus

114
Q

What can be damaged to cause bone repair cycle

A

Trauma fractures a bone

- tear to periosteum, blood vessels, soft tissue and endosteum

115
Q

What is first step of bone repair

A

Blood fills injury and forms RBC and collagen clot

116
Q

What is second stage of bone repair cycle

A

Osteocytes from bone ends multiply and reduce osteoblasts, which put salt crystals in collagen clot - begins to connect bone ends

117
Q

What is a Callus

A

Thickened area that forms at site of a fracture as part of the repair process

118
Q

What strengthens the callus

A

Salt crystals and collagen

119
Q

What do osteoclast and osteoblasts do

A
  • Osteoclasts dissolve salt crystals in areas of low stress

- osteoblasts lay down new collagen and salts in areas of high stress

120
Q

Result of bone repair cycle If bone is well aligned at fracture

A

It may not result in permanent damage

121
Q

Result of bone repair cycle if bone is displaced

A

Injury site may never heal properly

- may cause disability, deformity or persistent issues

122
Q

How can inflammatory and generative issues present

A

Joint pain, tenderness and fatigue

123
Q

What can be side effects of inflammatory or degenerative issues

A

Difficulty walking, moving, performing normal daily functions without assistance

124
Q

What is Bursitis

A

Acute or chronic inflammation of the small synovial sacs that reduce friction and cushion the ligaments/ tendons/ joints

125
Q

What causes burtitis

A

Repeated trauma, gout and infection

126
Q

Symptoms of burtitis and common areas affected

A
  • localized pain, swelling, and tenderness at joint

- usually olecranon (elbow), above patella (knee), and shoulder

127
Q

What is tendinitis

A

Inflammation of a tendon and/ or its protective sheath

Presents similarly to burtitis

128
Q

What causes tendinitis and common areas affected

A
  • Repeated trauma to a muscle group

- Usually affects major tendons or upper and lower extremities

129
Q

What is osteoarthritis

A

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
Q

What are predisposing factors of osteoarthritis

A

Trauma, obesity, aging

131
Q

What a symptoms of osteoarthritis

A

Results in bony overgrowth

- causing pain, stiffness, decreased movement, joint enlargement (especially fingers)

132
Q

What is rheumatoid arthritis

A

Chronic disease that causes deterioration of peripheral joint CT

133
Q

What are symptoms/ effects of rheumatoid arthritis

A

Inflammation of the synovial joints

- causing immobility, pain (especially with movement), fatigue

134
Q

Who is rheumatoid arthritis more common for

A

2 - 3 x more comment in women

135
Q

What is gout

A

Inflammation of joints and CT due to buildup of uric acid crystals

136
Q

Symptoms of gout

A

Peripheral joint pain, swelling and possible deformity

137
Q

Who does your most frequently affect

A

Males who have a higher concentration of uric acid in the blood (meta oils end product that is not easily dissolved)

138
Q

Are musculoskeletal injuries usually life threatening

A

No

- usually well assessed and managed at the scene

139
Q

Can we diagnose musculoskeletal injuries

A

Not conclusively without imaging

140
Q

When does serious injury occur

A

When the energy is transmitted down the bone to the Internal organs
- always concider MOI to evaluate potential for internal injuries

141
Q

What is pattern of assessment for pt with musculoskeletal injuries

A

Same as any pt

  • scene assessment
  • primary assessment
  • focused history
  • focused secondary assessment
142
Q

What should you add to musculoskeletal assessment if there is trauma and altered LOC

A

Include a rapid trauma assessment and detailed secondary assessment

143
Q

Environmental issues that may arise in assessment to always keep in mind

A

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
Q

Primary assessment of musculoskeletal injuries

A
  • 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
Q

Musculoskeletal injuries are classified in 4 different ways

A
  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
Q

If pt is 4th classification what is needed

A

Only focused secondary assessment is needed

147
Q

What assessment should you add to pt with more severe injuries

A

A detailed secondary as pt may have one distracting injury that does not allow them to give an accurate account of their injuries

148
Q

When do you do Rapid trauma assessment

A

Any pt with sign/symptoms/mechanism of serious injury

149
Q

How to preform rapid trauma assessment

A

From head to toe - hands on assessment for any pt who is altered LOC or may have a distracting injury

150
Q

What do you do if there is crepitus, instability or pain in the pelvis

A
  • only palpate once

- dont want to manipulate pelvis if it could be fractured to avoid causing life-threatening hemorrhage

151
Q

Why is blood loss /swelling possibly difficult to see in femurs

A

Due to muscle mass

152
Q

What to check on upper and lower extremities in rapid trauma assessment

A

Stability, sensation, colouration, temperature, circulation

153
Q

How to check on upper and lower extremities in rapid trauma assessment

A 
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
Q

What accompanies physical assessment

A

Detailed history

155
Q

What does detailed history and secondary assessment provide

A

Further info about initial findings in primary assessment

156
Q

When should secondary assessment be preformed

A

On scene if pt stable

En route if pt unstable

157
Q

Why remove or cut any restrictive clothing, jewelry or shoes

A

Want it removed before more inflammation sets in and it’s harder to remove

158
Q

Tips for dealing with musculoskeletal I jury in assessment

A

-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
Q

What are 5 p’s

A 
Pain
Pallor
Pulse
Paralysis 
Paresthesia 
(Sometimes pressure )
160
Q

What is first priority in management of any case

A

Manage all ABC issues and spinal precautions before worrying about extremity splinting
- with exception of pelvis

161
Q

Goal of management of musculoskeletal

A
  • goal is to prevent further injury
  • protect against infection by covering open injuries
  • avoid overt manipulation to avoid nerve and vessel damage
162
Q

Tip for managing musculoskeletal injuries

A
  • 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
Q

Tips about realignment of injury

A
  • 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
Q

Immobilization is aimed to prevent: (3)

A
  1. Movement of broken bone ends
  2. Dislodging of bone from a joint
  3. Reduce further stress on muscles, ligaments, or tendons
165
Q

Why do you secure splinting device above and below the injury

A

Holds joints in place to prevent transmission of movement through long bone

166
Q

Why do we wrap splint from distal to proximal

A
  • makes sure pressure pushed blood to moved into systemic circulation and not distal limb
  • assists venous dressing
167
Q

How tight do you wrap dressing

A

Tight enough to ensure its secured but you need to be able to at least get a finger under it

168
Q

What is RICE

A

Rest
Immobilize
Cold
Elevate

169
Q

Change to RICE for muscular and joint injuries

A

Alternate heat and ice after 48hrs

170
Q

What is rigid splint

A

Firm and durable supports

- cardboard, plastic, Metal, synthetic or wood

171
Q

What helps with discomfort of rigid splint

A

Require added padding to reduce discomfort when applied

172
Q

Side note about rigid splint

A
  • speed splint is brand typically used in prehospital setting in ontario
  • other brands available but usually not purchased by EMS
173
Q

What is formable splints

A

Malleable splint- able to be shaped to fit extremity

174
Q

What are formable splints used for

A

Hand, wrist (use pt good arm or your arm if similar size to shape)
Also: flail segment in chest

175
Q

What is brand of formable splint usually used by EMS and what is it made from

A

SAM splint

- made of foam and mesh or can be “ladder” splints made of soft metal wire

176
Q

What are soft splint

A

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
Q

How to use soft splint

A

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
Q

What is traction splint

A

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
Q

What is traction splint used for

A
  • primarily closed femur fractures
  • tibia/ fibula fractures
  • sometimes hip fractures
  • bilateral femur fractures
180
Q

What is traction splint used for

A
  • primarily closed femur fractures
  • tibia/ fibula fractures
  • sometimes hip fractures
  • bilateral femur fractures
181
Q

How much traction do you apply to traction splint

A

One femur = 10% body weight (max 15lbs)
Bilat femurs = 20% body weight (max 30lbs)
Tib/ Fib= 5- 7 lbs

182
Q

Contraindications for traction splint

A

Dont use in femur fractures with knee, tibia or foot injury

183
Q

What are types of pelvis fractures

A

Involve iliac Crest or pelvic ring

184
Q

What is a usual iliac Crest fracture

A

Often isolated and stable

- cared for by simple immobilization

185
Q

What are usual pelvic ring fractures

A

Often serious, unstable and life threatening due to ring structure = 2 fracture sites

186
Q

Possible risk with pelvic ring fracture

A
  • 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
Q

How to car for pelvic fracture

A
  • cravats or pillow/ blanket padding
  • securing pt to scoop stretcher or spinal board
  • managing hemodynamic compromise
  • rapid transport
188
Q

Is pelvis fracture always load and go

A

Yes even if pt is deemed stable

189
Q

Cause of femur fractures

A
  • 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
Q

Proximal fractures (neck and intertrochanteric) of femur

A
  • May appear as hip fx
  • or associated with hip/ pelvic trauma (more common in elderly)
  • feoot will likely be externally rotated and shortened
191
Q

What are mid-shaft fractures in femur

A

Caused by higher levels of force and result in greater blood loss

192
Q

What are distal femur fractures (condylar and epicondylar)

A

Extensive injury and usually involves blood vessels before they enter the knee/lower leg

193
Q

Management of femur fx

A

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
Q

Tibia fx

A
  • Most common leg bone fx
  • often = compound fx
  • if fx alone may stay inline but not strong enough to bear weight
195
Q

Fibula fx

A
  • 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
Q

Management of tib/fib fx

A
  • if distal circulation is present, use speed splint to immobilize
  • if distal circulation is absent, consider safer splint
  • 5 p’s
  • RICE
197
Q

Cause of clavicle fx

A
  • most frequently fx bone in body

- usually from transmitted force (fall on outstretched arm force goes up arm to clavicle)

198
Q

Main concern with clavicle fx

A

Very close to upper lungs and vasculature of upper body

- risk of pneumothorax or hemorrhage

199
Q

Usual presentation of clavicle fx

A

Pain to clavicle and shoulder, with shoulder rotated forward

200
Q

How to manage clavicle fx

A

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
Q

What is difficulty with humerus fx

A

Due to position of humerus into shoulder, and proximity to axillary artery, traction to humerus is difficult to accomplish without compromising circulation

202
Q

How to manage humerus fx

A
  • 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
Q

Most common radius fx

A

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
Q

Radius and ulna fx together

A

Usually not life or limb threatening

In only 1 fractured may only have minor angulation

205
Q

Management of radius/ ulna fx

A
  • 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
Q

Two ways hip may dislocate

A 
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
Q

Management of hip dislocation

A
  • 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
Q

What is new spinal restriction standard for elderly pt who falls

A

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
Q

What may be included in knee fx

A

Femur, tibia, patellar dislocation, Frank dislocation of the knee

210
Q

Patella dislocation

A

Most common
Anterior = angled up
Posterior = angled down

211
Q

Why are knee injuries serious to pt

A

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
Q

Management of knee fx / dislocation

A
  • immobilize in position found

- use “A” frame technique (one ridged splint on medial side and one on lateral side )

213
Q

Why should you avoid reducing knee dislocation unless part of your base hospital standards

A

Multiple ligaments, vessels, nerves, synovial fluid sacs that may become injured

214
Q

Ankle / foot fx

A
  • 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
Q

Types of ankle / foot dislocation

A 
Anterior = dorsiflexion (upward pointing)
Posterior = lengthen plantar reflex (downward pointing)
Lateral = foot turned outward (most common)
216
Q

Management of ankle / foot fx / dislocation

A
  • use pillow splint for gross deformity / foot angulation
  • use speed splint for injuries without significant angulation
    RICE 5 P’s
217
Q

Shoulder fx often involve

A

Proximal humerus, lateral scapula and distal clavicle

218
Q

Directions of shoulder dislocation

A 
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
Q

Management of shoulder fx / dislocation

A
  • 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
220
Q

What increases chances of shoulder dislocation

A

Prior dislocations

221
Q

What is risk with elbow fx

A

High occurrence of nerve / vascular involvement (especially children)

  • brachial artery
  • medial, ulnar, and radial nerves
222
Q

Causes of elbow fx

A

Often from falling on outstretched hand

- in children, common with someone grabbing and pulling arm fordefully

223
Q

Management of elbow fx

A

Use speed splint or sling/swathe to immobilize injury against body

224
Q

Wrist/ hand/ fingers fx or dislocation

A
  • commonly from direct trauma
  • noticeable deformity is common
  • pt may be distressed as use hands for daily life
225
Q

Management of wrist/ hand / fingers fx or dislocation

A
  • 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
226
Q

Non- pharmaceutical pain management of musculoskeletal injuries

A
  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)

PCT (9 decks)

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