Musculoskeletal (MSK) injuries

Question 1

Fracture

Answer 1

partial or complete break or disruption in a bone
- can cause hypovolemic shock if there is an associated hemorrhage

Question 2

Dislocation

Answer 2

displacement or separation of a bone from its normal position at a joint
- Close prox. to vessels + nerves = increase risk

Question 3

Sprain

Answer 3

Partial or complete tearing of ligaments + other tissues at a join
- typically not associated w/ emergency (3rd can be)

Question 4

Strain

Answer 4

stretching or tearing of muscle or tendon
- not associated w/ an emergency

Question 5

closed fracture

Answer 5

skin not disrupted at # site

Question 6

open fracture

Answer 6

skin is open/broken at # site

Question 7

complete fracture

Answer 7

discontinuity btwn 2+ bone fragments

Question 8

incomplete fracture

Answer 8

bone is not broken all the way through

Question 9

complicated fracture

Answer 9

broken bone has injured internal organ
- muscular, ligamentous, intra-articular, neurovascular and visceral issues

Question 10

uncomplicated fracture

Answer 10

a fracture that has only a minimal amount of soft tissue injury.

Question 11

Occult

Answer 11

is not visibly demonstrated, but is suspected based on clinical examination

Question 12

MSK s/s

Answer 12

pain
swelling
deformity
discoloration
inability to use affected part (or unwillingness)

Question 13

fracture s/s

Answer 13

significant deformity, crepitus, snap/pop sound at time of injury, MOI is severe trauma, mod-severe swelling and discoloration, unable to move body part

bone protruding out, loss of sensation/circ in extremity, cool to touch, pelvic, tibia, humerus or femoral # = s/s for RTD

Question 14

Principle of Care for MSK injuries

Answer 14

Protect (crutches)
Optimal Loading (massage, strength, and mobilization)
Ice (10 mins max) Compression (helps lymph vessels)
Elevation (reduce swelling)

Question 15

Emergency Care for MSK injuries

Answer 15

• O2 as needed (based on breathing, skin, SpO2)
• control open wound bleeds
• immobilize in position found
• elevate if not cause further injury
• ice for 20min unless distal circ is impaired

Question 16

Immobilizing MSK injuries purpose

Answer 16

-decrease risk of pain, hemorrhage, potential circ loss
-prevent further damage and closed # from opening

stable/support = feel better = decrease shock risk

Question 17

Call EMS for MSK injuries when…

Answer 17

Impaired walking/breaking
multiple major MSKs suspected
Loss of circulation +/or sensation
Severe bleeding
Involves spine/skull

Question 18

upper extremity injuries

Answer 18

most common MOI is FOOSH
- min mvmnt, immobilize, support
- PS checks before and after splint
- patient holding arm against body (Dont Move)

Question 19

Shoulder injuries

Answer 19

clavicle (most common), scapular, humerus

Question 20

Clavicular Injuries

Answer 20

15% lateral, 80% middle (sticks out most), 5% medial
- most frequently broken, often due to a fall
- C/O pain in shoulder radiate to arm
- holds arm to chest

• triangle bandage, 4S, sling and swathe, tubular sling

Question 21

Acromioclavicular Separation

Answer 21

dislocation of the acromioclavicular joint
6 grades of ligament sprains

Question 22

shoulder dislocation

Answer 22

glenohumeral dislocation or subluxation

• post.: humerus head behind scapula and prominent coracoid; hold in add and IR
• ant: see humeral head and divot; hold abd and ER

Question 23

General treatment for shoulder injuries

Answer 23

• Position of comfort
• fill any holes
• sling & swathe is most effective
• PS before & after
  Apply ice
• Treat for shock

Question 24

humeral fracture

Answer 24

1. surgical neck
2. mid-shaft
3. supracondylar

• noticeable deformity and damage vessels + nerves if moved
• control external bleeding + immobilize arm from the shoulder to wrist

Question 25

humeral fracture treatment

Answer 25

- sling and swathe - short board or commercial splint for more stability - PS before and after splint - ice - shock treatment

Question 26

elbow injuries

Answer 26

- sprains, #s, dislocations - be aware of proximity to nerves/blood vessels (median nerve and brachial artery)

Question 27

elbow dislocation

Answer 27

- elbow locked in flexed position - ant: see condyles, not olecranon fossa - post: see olecranon fossa

Question 28

elbow injury treatment

Answer 28

- do not move elbow joint - splint from shoulder to hands in position found - sling and swathe, ice, treat for shock, and PS before/after

Question 29

Forearm, Wrist + Hand Injuries

Answer 29

- # of the ulnar and radius (common together) - can appear in an "S" shape (dinner fork) - Radial artery and nerves (hemorrhage or loss of movement)

Question 30

Treatment of Forearm, Wrist + hand

Answer 30

- control external bleeding - immobilization - soft splint to immobilize hand - buddy tape fingers -PS before/after

Question 31

Wrist-hand position of function

Answer 31

Have to place something in the hand (roll of gauze) in order to keep it in a position of function

Question 32

Fractures of the Humorous

Answer 32

-Close prox to femoral artery = Life-threatening - limb may appear shorter fo to contracture of muscles

Question 33

Fracture vs Dislocation

Answer 33

- limb appears shorter dislocated = internally rotated

Question 34

Posterior vs anterior hip dislocations

Answer 34

Anterior = externally rotated, abducted Posterior = flexed, internally rotated, adducted

Question 35

treatment for femoral fracture

Answer 35

- Mid-shaft # = immobilize from axilla-foot - Femoral # w/ no PS = traction splint - can cause serious internal bleeding - shock: monitor BP, SpO2 - check + re-check PS - Ice, RTD

Question 36

patella dislocation

Answer 36

dislocated laterally - hams and quads muscle guard into flexed position (fill cap when splinting) - (first time) call EMS even if it still goes back in place

Question 37

Knee injury treatments

Answer 37

- control external bleeds, wrap w figure 8 - if knee can ext, splint in ext; if not in position found - ice, RTD, shock

Question 38

Ankle and foot injuries

Answer 38

sprains, strains, fractures - **pain, swell, unable walk 4 steps = red flag - apply Ottawa Ankle Rules (for 18yrs and older)

Question 39

ankle and foot injury treatment

Answer 39

control bleeding, ice (20 minutes max), shock, immobilize, elevate

Question 40

types of splints and principles

Answer 40

rigid (ex: speed splint) anatomic (ex: tie legs together) soft (ex: pillows w triangle bandages) traction (prox femur #; no more 30lbs and 10%BW) - include joints above and below injured cites (rule of 1/3s)