Musculoskeletal Injuries Flashcards
How to assess and treat injuries to the bones, muscles, tendons, and ligaments.
Compartment Syndrome
Swelling within a confined body compartment, like the connective tissue compartments in the leg or inside the skull, that results in ischemia.
Acetaminophen
An analgesic used to treat mild to moderate pain and to reduce fever.
Describe the treatment principles for a stable injury.
Pain Free Activity
Pain Management (RICE, Medications)
Support
Describe how a rescuer can use two classes of drugs in a pain management regimen.
Give 400mg of Ibuprofen every 6 hours and 500mg of Acetaminophen every 6 hours, but stagger. Ibuprofen given at 0, 6, 12, and 18 hours… while Acetaminophen given at 3, 9, 15, 21 hours…
Neurovascular Bundle
An artery, vein, and nerve combination routed through the body together.
What are three different classes of pain medications? Give examples and list common side effects.
NSAIDs
Ibuprofen
Naproxen sodium
Aspirin
Ketorolac
Side Effects: Stomach Irritation/Pain, Increased Bleeding
Non-Opioid Analgesics
Acetaminophen
Side Effects: Nausea
Opioids
Morphine
Hydrocodone
Oxycodone
Fentanyl
Side Effects:
- Increase reaction time
- Drowsiness
- Constipation
- Suppress shivering – makes it difficult to maintain body core temp
- Depressed respiratory drive
Describe the treatment principles for an unstable long bone injury.
- Check CSMs
- Traction into Position if necessary (deformity/angulation)
- Hand stable
- Splint Stable
- Check and continue to the Monitor CSMs
- Pain Management (RICE, Medications)
- Evacuation
Describe the treatment steps for a pelvic fracture.
- Check CSMs
- Hand Stable
- Splint Stable – apply pelvic binder; consider binding feet together w/toes pointing upward
- Check CSMs
- Stabilize patient in litter
- Monitor Patient including CSMs
Describe the principles of spine packaging (i.e. backboard and litters).
- Secure weight centers – hips/shoulders 1st, head last.
- Tie down low; don’t tie where hands grab.
- Make sure straps go across bone and not soft areas (i.e. abdomen); no straps across knee caps.
- If suspect neck injury use a soft collar.
- Pad voids/pressure points – behind knees, low back, behind head, knots.
- No chin strap.
- Tie hands if needed.
Ibuprofen
A NSAID used to treat fever and mild to severe pain.
What responsibility does a rescuer have when carrying and/or providing medications?
Checking medications for expiration, integrity, indications, contraindications.
Checking any drug interactions between medication and medications/supplements patient is taking regularly.
Checking patient’s medications/supplements in pre-trip screening (if applicable).
Getting informed consent from the patient.
Litter
A device used to transport a patient. It is essentially a stretcher with a raised edge.
Opioid
A substance that reduces the brain’s ability to respond to pain impulses from the site of the injury.
Describe the pain management principle a rescuer should initially follow.
Treat problem causing the pain.
Examples:
- Dislocation – Reduce it if indirect and is a shoulder, digit, patella.
- Unstable Extremity – stabilize, loosen splint
- Abscess – Drain it
- Headache 2° Dehydration – Hydrate
Describe the significance of the neurovascular bundle as it relates to musculoskeletal injuries.
The neurovascular bundle consists of blood vessels and nerves that run alongside our bones. Musculoskeletal injuries would kink or tear the neurovascular bundle creating a critical system problem.
What is the maximum daily dosage for Acetaminophen? Ibuprofen?
Acetaminophen = 3,000mg
Ibuprofen = 2,400mg (recommended maximum for pain = 1,200mg – 1,600mg)
Describe the main functions of the musculoskeletal system.
Support, Protection, Movement
List 5 high risk musculoskeletal injuries/conditions and their anticipated problems.
Unstable Femur – volume shock; ischemia
Unstable Pelvis – volume shock; ischemia
Compartment Syndrome – ischemia to infarction
Joint Infection – Systemic Infection; Joint damage
Open Fracture – Ischemia, bleeding, infection, systemic infection
Describe the risks of fully immobilizing a patient.
- Increases time and complexity of evacuation.
- Can delay treatment of other problems.
- Can impair airway control, thermoregulation, and survival efforts.
- Can lead to pressure sores / ischemia.
- Can increase pain.
Spine Board
An extrication tool used to transport a patient.
Describe the treatment steps for a femur fracture.
- Check CSMs
- Traction into Position if necessary (obvious deformity/angulation)
- Hand Stable
- Splint Stable – buddy splint method (refer to p. 38 in field guide)
- Check CSMs
- Stabilize patient in litter
- Monitor Patient including CSMs
How are joint injuries managed differently? Why?
Due the fact that joints are complex (many bones, ligaments, tendons) we leave as is (NO traction into position). We typically will splint in the position found unless CSMs are compromised and/or the position is hindering splinting or the evacuation process. If one or more of these is an issue, rescuers can move the limb into a better position barring no significant increase in pain or no resistance is felt.
Describe the principles of splinting.
Comfortable – no pressure points, can be adjusted
Complete – provides stability and protection; immobilized joint above/below if long bone, long bone above/below if joint;
Compact – not bigger than necessary; allow for CSM checks
Compare/contrast stable and unstable injuries.
What is the purpose of pain?
Signal that limits our movement, so we do not hurt ourselves.
Musculoskeletal System
An organic system consisting of muscles, ligaments, tendons, and bones used to support/provide protection and move the body.
Vacuum Mattress
An extrication tool used to provide rigid support to spine injured patients. Can also be used for other injuries and illnesses.
What is the overall goal of pain management?
To keep pain at tolerable level for an awake patient.
