Transcript SECTION 2

Chapter 24
Principles of
Musculoskeletal
Injuries
Chapter 24: Principles of Musculoskeletal Injuries
Objectives (1 of 3)
• Describe the function of the muscular
system.
• Describe the function of the skeletal system.
• List the major bones or bone groupings of
the spinal column, the thorax, the upper
extremities,and the lower extremities.
• Differentiate between an open and closed
painful, swollen, deformed extremity
(fracture).
2
Chapter 24: Principles of Musculoskeletal Injuries
Objectives (2 of 3)
• State the reasons for splinting.
• List the general rules for splinting.
• List the complications of splinting.
• Explain the rationale for splinting at the
scene versus load and go.
3
Chapter 24: Principles of Musculoskeletal Injuries
Objectives (3 of 3)
• Demonstrate the emergency care
principles for injured extremities.
• Demonstrate the basic principles of
applying the three basic splint types: rigid
fixation, soft fixation, and traction splints.
4
Chapter 24: Principles of Musculoskeletal Injuries
Anatomy and Physiology of
the Musculoskeletal System
5
Chapter 24: Principles of Musculoskeletal Injuries
Types of Muscle
• Skeletal muscles
– Attach to bone by tendons
– Voluntary
• Smooth muscles
– Involuntary
• Cardiac muscle
– Specialized and has separate
regulatory systems
6
Chapter 24: Principles of Musculoskeletal Injuries
Skeletal System
7
Chapter 24: Principles of Musculoskeletal Injuries
Joints
• A joint is formed wherever two bones
come into contact.
• Ligaments hold bones together.
• Articular cartilage allows bone ends to
glide easily.
• Joints are lubricated by synovial fluid.
8
Chapter 24: Principles of Musculoskeletal Injuries
Types of Musculoskeletal Injuries
• Fracture
– Broken bone
• Dislocation
– Disruption of a joint
• Sprain
– Joint injury with tearing of ligaments
• Strain
– Stretching or tearing of a muscle
9
Chapter 24: Principles of Musculoskeletal Injuries
Mechanism of Injury
• Force may be applied in several
ways:
– Direct blow
– Indirect force
– Twisting force
– High-energy injury
10
Chapter 24: Principles of Musculoskeletal Injuries
Fractures
• Closed fracture
– A fracture that does not break the skin
• Open fracture
– External wound associated with fracture
• Nondisplaced fracture
– Simple crack of the bone
• Displaced fracture
– Fracture in which there is actual deformity.
11
Chapter 24: Principles of Musculoskeletal Injuries
Greenstick Fracture
12
Chapter 24: Principles of Musculoskeletal Injuries
Comminuted Fracture
13
Chapter 24: Principles of Musculoskeletal Injuries
Pathologic Fracture
14
Chapter 24: Principles of Musculoskeletal Injuries
Epiphyseal Fracture
15
Chapter 24: Principles of Musculoskeletal Injuries
Signs and Symptoms of a
Fracture (1 of 2)
• Deformity
• Tenderness
• Guarding
• Swelling
• Bruising
16
Chapter 24: Principles of Musculoskeletal Injuries
Signs and Symptoms of a
Fracture (2 of 2)
• Crepitus
• False motion
• Exposed fragments
• Pain
• Locked joint
17
Chapter 24: Principles of Musculoskeletal Injuries
Signs and Symptoms of a
Dislocation
•
•
•
•
•
•
Marked deformity
Swelling
Pain
Tenderness on palpation
Virtually complete loss of joint function
Numbness or impaired circulation to
the limb and digit
18
Chapter 24: Principles of Musculoskeletal Injuries
Signs and Symptoms of a
Sprain
• Point tenderness can be elicited
over injured ligaments.
• Swelling and ecchymosis appear at
the point of injury to the ligaments.
• Instability of the joint is indicated by
increased motion.
• Pain
19
Chapter 24: Principles of Musculoskeletal Injuries
Assessing Musculoskeletal
Injuries (1 of 2)
•
•
•
•
•
•
Assess mechanism of injury.
Perform initial assessment.
Perform focused physical exam.
Follow BSI precautions.
Give oxygen if needed.
Follow DCAP-BTLS.
20
Chapter 24: Principles of Musculoskeletal Injuries
Assessing Musculoskeletal
Injuries (2 of 2)
• If patient critically injured, arrange for
immediate transport.
• Be alert for compartment syndrome.
• Splint injury.
• Transport.
• Monitor neurovascular status during
transport.
21
Chapter 24: Principles of Musculoskeletal Injuries
Evaluating Neurovascular
Function
• Examination of the injured limb should
include assessment of the following:
– Pulse
– Capillary refill
– Sensation
– Motor function
22
Chapter 24: Principles of Musculoskeletal Injuries
Severity of Injury
• Critical injuries can be identified using
musculoskeletal injury grading system.
• Refer to Table 24-1 on page 587.
23
Chapter 24: Principles of Musculoskeletal Injuries
Emergency Medical Care
• Completely cover open wounds.
• Apply appropriate splint.
• If swelling is present, apply ice or cold packs.
• Prepare patient for transport.
• Always inform EMS about wounds that have
been dressed and splinted.
24
Chapter 24: Principles of Musculoskeletal Injuries
Splinting
• Use a flexible or rigid device to
protect extremity.
• Injuries should be splinted prior to
moving the patient, unless patient is
critical.
• Splinting helps prevent further injury.
• Improvise splinting materials when
needed.
25
Chapter 24: Principles of Musculoskeletal Injuries
General Principles of
Splinting (1 of 3)
• Remove clothing from the area.
• Note and record patient’s
neurovascular status.
• Cover all wounds with a dry,
sterile dressing.
• Do not move patient before
splinting.
26
Chapter 24: Principles of Musculoskeletal Injuries
General Principles of
Splinting (2 of 3)
• Immobilize the bones above and below the
injured joint.
• Pad all rigid splints.
• Maintain manual immobilization.
• Use constant, gentle, manual traction if
needed.
• If you find resistance to limb alignment,
splint the limb as is.
27
Chapter 24: Principles of Musculoskeletal Injuries
General Principles of
Splinting (3 of 3)
• Immobilize all suspected spinal
injuries in a neutral in-line position.
• If the patient has signs of shock,
align limb in normal anatomic
position on a backboard and
transport.
• When in doubt, splint.
28
Chapter 24: Principles of Musculoskeletal Injuries
Rigid Fixation Splints
• Firm material applied to fractures that
prevent motion
– Quick splints
– Cardboard
– Wire and ladder splints
– SAM® splint
29
Chapter 24: Principles of Musculoskeletal Injuries
Soft Fixation Splints
•
•
•
•
Air splints
Vacuum splints
Sling and swathe
Blanket/pillow splints
30
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Quick Splint (1 of 2)
• Open the quick splint.
• Assess distal CMS functions of the leg.
• Manually stabilize leg by grasping foot
and leg behind and below the knee.
• Slight longitudinal traction can be used.
• Elevate the extremity carefully.
• The “pant-leg pinch lift” can also be
used.
31
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Quick Splint (2 of 2)
• Have second rescuer slide the
open splint under the leg.
• Lower leg carefully into splint.
• Second rescuer can fold sides
of splint and secure straps,
cords, etc.
• Reassess distal CMS
functions of the leg.
32
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Sling and Swathe
(1 of 2)
• Assess distal CMS functions.
• Carefully bend injured arm to just < 90°
and lay a cravat on the chest under the
arm, with a 90° point at the elbow.
• Bring lower end up and over shoulder on
injured side.
• Bring upper end over opposite, uninjured
shoulder and tie at side of neck.
33
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Sling and Swathe
(2 of 2)
• Secure a second cravat, 3” to 6” wide,
around the chest and injured upper
arm.
• To avoid pressure on the injured
shoulder, alternately, bring lower end
through injured arm’s armpit and tie it
over the scapula.
• Reassess distal CMS functions.
34
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Blanket Roll (1 of 2)
• Fold blanket longitudinally
into thirds.
• Lay two or three cravats
near end of blanket and
roll firmly.
• Assess distal CMS
functions.
35
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Blanket Roll (2 of 2)
• Position roll snugly under injured
shoulder; tie one cravat over
uninjured shoulder. Secure other(s)
around chest and/or waist.
• Secure injured arm with sling and
swathe.
• Reassess distal CMS.
36
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Vacuum Splint
•
•
•
•
Stabilize and support injury.
Place splint and wrap it around limb.
Draw air out of splint and seal valve.
Check and record distal CMS
functions.
37
Chapter 24: Principles of Musculoskeletal Injuries
Improvised Splints
• Use rigid or semi-rigid materials.
Examples:
– Skis, ski poles
– Boards, branches
– Blankets, pillows, camping pads
– Shovels, probes, ice axes
– Uninjured part, ie, finger, leg, chest wall
38
Chapter 24: Principles of Musculoskeletal Injuries
In-line Traction Splinting
• Act of exterting a pulling force on a bony
structure in the direction of its normal
alignment.
• Realigns fracture of shaft of a long bone.
Usually used for femur fractures.
• Use the least amount of force necessary.
• If resistance is met or pain increases, splint
in deformed position.
39
Chapter 24: Principles of Musculoskeletal Injuries
Traction Splints
• Do not use a traction splint under the
following conditions:
– Upper extremity injuries
– Injuries close to or involving the knee
– Pelvis and hip injuries
– Partial amputation or avulsions with
bone separation
– Lower leg or ankle injuries
40
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Traction Splint (1 of 3)
• An angulated fracture will need to be
realigned before a splint can be applied.
• Manually stabilize fracture site.
• Expose site and care for any open
wounds.
• Per local protocol, remove footwear and
assess distal CMS functions.
41
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Traction Splint (2 of 3)
• Prepare splint for application.
• Smoothly realign fracture and maintain
traction.
• Fasten ankle hitch.
• Support fracture and transfer traction to
ankle hitch.
• Position splint; pad and secure ischial strap.
42
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Traction Splint (3 of 3)
• Carefully transfer traction
to splint.
• Secure splint to leg.
• Reassess distal CMS
functions.
• Logroll patient onto
backboard and secure.
43
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Sager Traction
Splint (1 of 2)
• Manually stabilize fracture.
• Assess distal CMS functions.
• Expose site and care for any open
wounds.
• Adjust thigh strap.
• Estimate proper splint length.
• Arrange ankle pads to fit.
• Place splint along inner aspect of thigh.
44
Chapter 24: Principles of Musculoskeletal Injuries
Applying a Sager Traction
Splint (2 of 2)
•
•
•
•
•
•
Secure ankle harness.
Snug cable ring against bottom of foot.
Pull out inner shaft of splint to apply traction.
Secure splint to leg.
Secure patient to backboard.
Reassess CMS function.
45
Chapter 24: Principles of Musculoskeletal Injuries
Hazards of Improper Splinting
• Compression of nerves, tissues, and
blood vessels
• Delay in transport of a patient with a
life-threatening condition
• Reduction of distal circulation
• Aggravation of the injury
• Injury to tissue, nerves, blood vessels,
or muscle
46
Chapter 24: Principles of Musculoskeletal Injuries
Improvised Traction Splints
• Single-ski technique
– Pre-made pockets
– Cravats
• Two ski poles
• Two paddles
• Scoop stretcher
47
Chapter 24: Principles of Musculoskeletal Injuries
Ski Boot Removal (1 of 2)
• Guided by local protocol.
• Many factors can influence protocol.
– Transport time
– Injury
– Type of splint used
– CMS status
• Boot should be removed before patient
arrives at hospital.
48
Chapter 24: Principles of Musculoskeletal Injuries
Ski Boot Removal (2 of 2)
•
•
•
•
Stabilize lower leg.
Loosen all buckles, straps, and laces.
Spread boot shell and pull out boot tongue.
Apply tension to back of boot and pressure
to boot toe with shoulder.
• Rotate the boot off the foot.
• Monitor for pain. Modify as needed.
• Assess distal CMS functions and splint.
49