Transcript Document
Chapter 20, Section 1
Musculoskeletal Injuries
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Skeleton
Provides
structure and protection
Axial skeleton – skull, vertebrae, and
thoracic cage
◦ Transfer weight from upper to lower
body
◦ Responsible for upright position
skeleton – shoulder,
arm, pelvis, legs
Appendicular
◦ Responsible for movement
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Skeleton
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Skeleton
Types
of Bones
◦ Long: Humerus, radius, ulna, femur,
tibia, fibula
• Breaks at epiphyseal line (growth plate) can
be serious for growing children
◦ Flat: Skull, scapula, ribs, sternum, pelvis
◦ Irregular: Vertebrae, wrist, hands, ankle,
feet, patella
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Joints
Joint:
Two bones and the connective
tissues that surround, support, and
stabilize it called the joint capsule.
Synovial fluid in the joint capsule
lubricates joints.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Joints
Range/type
of motion depends on
type of joint:
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Ball and socket: shoulder, hip.
Hinge: knee, finger.
Gliding: wrist, ankle.
Pivot: base of thumb.
Suture: pelvis, skull.
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Ligaments and Tendons
Ligaments
connect bone to bone,
form part of joint capsule
◦ Restrict the motion of the joint
◦ Tightness/laxity help determine extent of
movement
Tendons
connect muscle to bone
Both can be stretched or torn
◦ Stability and function suffer
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Muscles
contracts and relaxes – often
work in pairs
Controlled by nervous system – spinal
and peripheral
Three types:
Tissue
◦ Skeletal (voluntary)
◦ Smooth
◦ Cardiac
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physiology of Movement
Skeletal
muscle message is
“contract”
◦ Signal provided by nerves
◦ May be voluntary or involuntary
◦ Pairs work in coordination to flex and
extend joints
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
The Healing Process
Factors
are extent of damage, age,
nutrition, overall health
Bone healing requires nutrients,
oxygen, and immobilization
Muscles and ligaments heal slowly
Tendons need protection during
healing
Cartilage does not heal, it is often
removed
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common
Musculoskeletal Injuries
Sprain
◦ Stretching or tearing of a ligament
• Tears may need surgery
◦ Joint is displaced beyond its normal
alignment
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common
Musculoskeletal Injuries
Strain
◦ Stretched or torn muscle
• Overexertion or poor body mechanics
• May range from minor to severe
◦ Strain versus Sprain
• You strain a muscle or tendon and sprain a
ligament.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common
Musculoskeletal Injuries
Tendon
rupture
◦ Active motion of joint may be lost
◦ Achilles heal and bicep are common
Fracture
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Break in a bone
May be open or closed
May be displaced or non-displaced
May be associated with internal or
external bleeding
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common
Musculoskeletal Injuries
Dislocation
◦ Separation or displacement of bones at
a joint
◦ Usually the result of forceful trauma
Multiple
structures and surrounding
tissues may be injured in a single
event
◦ Soft tissues, nerves, and blood vessels
may be involved
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common
Musculoskeletal Injuries
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Types of Fractures
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Butterfly and Impacted
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Possible Blood Loss from
Fractures
Pelvis
(1300-1500 ml)
Femur (500-1000ml)
Humerus (300-500ml)
Tibia/Fibula (150-250ml)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Jams and Pretzels
Six
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basic anatomical positions
Position 1 – supine, neutral, straight
Position 1a – supine with variations
Position 2 – on one side, neutral, straight
Position 2a – on one side with variations
Position 3 – prone, neutral, head turned
Position 3a – prone with variations
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Jams and Pretzels
posterior reference points –
head, shoulders, hips
Three
◦ The goal is to keep them aligned and in
the same plane during moves
◦ They are secured in all moves (legs too
if 4th rescuer is on scene)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Jams and Pretzels
moves are axial or vertical – never
sideways
Movements are made in short
increments
If straightening of head, neck, or limbs
is needed, do only one at a time
All
◦ Begin with head/neck (for airway)
◦ Stop for major pain or resistance
End
BRADY
in Position 1 on a spine board
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Deal
with life threats
General care has common steps
◦ Use BSI
◦ Plan of action to include help,
equipment, and transport needed
◦ Expose injury to observe for bleeding,
deformity, discoloration, swelling
◦ Control bleeding, bandage wounds
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
General
care has common steps
◦ Immobilize as needed – check CMS
◦ Ice for swelling
◦ Transport to aid room, monitor patient
comfort
◦ Reassess for CMS and bleeding, adjust
treatment as needed
◦ O2 as needed
◦ Transfer to higher level of care
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
assessment procedures –
ABCDs, SAMPLE, and vitals
Standard
◦ Determine number of patients
◦ Use MOI to point to possible injuries
◦ Look for guarding
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
Thorough
physical exam – DCAP-
BTLS
◦ Pain/point
tenderness,
deformity,
swelling are
common signs
and symptoms
◦ Evaluate each
side separately
BRADY
Copyright E. M. Singletary, MD
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
Note
CMS distal to injury
Palpate injured area last
Expose injury site
◦ On scene to control bleeding
◦ In aid room to shield from weather, for
modesty
Formulate
management plan
Reassess vitals/CMS
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Signs and Symptoms of
Common MS Injuries
Sprain,
strain, ruptured tendon
Fracture
◦ Closed? Open?
Dislocation
Signs
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and symptoms
Pain – worsens when moved
Bruising, wounds, skin “gaps” or “tents”
Decreased motion
Crepitus
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Upper Extremity Injuries
Falling
onto outstretched hand, elbow,
shoulder may cause these
Assess from scapula to fingertips
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Scapula – SC joint
Clavicle - AC joint
Shoulder
Humerus – elbow joint
Radius/ulna – wrist joint
Hand, fingers, joints
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Upper Extremity Injuries
Clavicle
is frequently fractured
Sternoclavicular (SC) joint dislocation
(posterior) may be life threatening
Shoulder (AC) separation / dislocation
differ in character and severity
◦ Anterior dislocations more common
Scapula
fractures require severe MOI
continued
Humerus fractures may result in
nerve damage
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Upper Extremity Injuries
Detecting
Injury Type
◦ Patients with A/C injuries, clavicle fractures,
scapular fractures, and humeral head and neck
fractures generally hold their arm against their
abdomen; patients with posterior shoulder
dislocations hold their arm against their abdomen
and will not let you bring the arm away from the
abdomen (external rotation). By contrast, patients
with anterior dislocated shoulders hold their arm
out and up. Thus the position in which a patient
holds the injured arm can help you identify the
continued
possible injury.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Upper Extremity Injuries
fractures involve bones –
dislocations lock joints, CMS issues
Radius and/or ulna may fracture
Wrist fracture may involve distal
radius/ulna (Colles) or carpal bones
Skier’s thumb common ligament
injury
Elbow
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Upper Extremity Injuries
Copyright E. M. Singletary, MD
Copyright E. M. Singletary, MD
continued
Copyright E. M. Singletary, MD
BRADY
Copyright Edward McNamara
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Lower Extremity Injuries
Assess from pelvis to toes
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Hip joint – femur
Knee joint
Tibia/fibula – ankle joint
Foot , toes, joints
Femur connects to pelvis at hip joint – may
dislocate and/or fracture
Femur fractures involve high energy
continued
trauma
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Lower Extremity Injuries
Knee
ligament/cartilage injuries are
common
◦ True dislocation is an emergency
Patellas
may fracture or dislocate
Tib and/or fib may fracture
Ankle may sprain, fracture, dislocate
◦ Location gives clue to injury type
Foot
BRADY
injury takes many forms
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Lower Extremity Injuries
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Splinting
Splint
to:
◦ Prevent further tissue damage
◦ Allow easier transport
◦ Prevent paralysis in spinal injuries
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Principles of Splinting
Splint
before moving patient
Check CMS before and after
Manually stabilize injured area
Use correct type/size, pad as needed
Position, move limb carefully, and
secure
If shock is significant, work quickly
continued
and transport
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Principles of Splinting
If
deformity is present with fracture,
align if possible
If alignment is not possible, secure in
best position for stability/comfort
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Open fracture
Severely angulated or “locked”
Dislocations and/or fracture at joint
Patient who will not allow movement
Injury with impaled object
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Principles of Splinting
Do
not attempt to reduce fractures or
force bone ends back into skin
Remove jewelry before swelling
occurs – account for it
Immobilize above and below injury
site (bones for joint injury, joints for
bone injury)
Advise patient to seek follow-up care
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Quick Splint Replacement
Many
quick splinted injuries are
repackaged in the first aid area
Consider not replacing a quick splint if
there are:
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Serious multiple injuries
Very unstable fractures
Bandaged open fractures
Fractures accompanied by advancing
shock
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
The
most frequent injury in skiing is a
knee sprain.
The most frequent injury while
snowboarding is a distal radius
fracture.
A common upper extremity injury
among skiers is skier’s thumb.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
The
clavicle is the most commonly
broken bone in the body.
For extremity injuries, remove all
rings, bracelets, or other jewelry from
the hand or foot immediately, before
swelling occurs.
Treat all threats to life first, and then
manage musculoskeletal injuries.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ