Prehospital Trauma Life Support

Lesson

10

Musculoskeletal Trauma

Developed by the

National Association of Emergency Medical Technicians

In cooperation with

The Committee on Trauma, American College of Surgeons

This slide presentation is intended for use only in approved PHTLS courses.

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Lesson 10 Objectives
Review

musculoskeletal anatomy and physiology.

Discuss

the pathophysiology of musculoskeletal trauma. the management of musculoskeletal trauma in isolated trauma and multi-system trauma.
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Discuss

Musculoskeletal Trauma
The management of musculoskeletal trauma can take different avenues depending on the situation.

In a simple isolated injury, treatment is aimed at the care of the particular appendage. In the multi-system trauma patient, management is aimed at treating the life-threatening problems and providing supportive care for the simple musculoskeletal injury.
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Any and all bones in the

skeleton are
susceptible to injury in trauma.

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Scenario
Your patient has attempted suicide by cutting his wrist. The police are on the scene and it is safe. On your arrival, you observe an awake and oriented male patient. Your primary survey findings show no life-threatening problems. On secondary survey, you find a longitudinal incision over the radial artery. Bleeding is moderate.
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Discussion
What type of injury does this patient have?

What ways are there to control the bleeding?

Does this injury require rapid packaging and transport? What other types of injuries to the skin are there?

Can these types of injuries be life-threatening?

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Scenario
You are called to a football game for a patient whose thigh was struck by the helmet of another player.

You find an alert, oriented patient complaining of pain in the right thigh.
Primary survey reveals no life-threatening conditions. On secondary survey, you find an angulation of the affected thigh, with swelling in the area.
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Discussion
What type of injury does this patient have?

How much blood can this patient lose from this injury? Could this injury alone cause enough blood loss to produce shock? How would you manage this injury?
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Scenario
You respond to a patient who has been pinned between a pickup truck and a loading dock. On your arrival, the truck has been moved and your patient is lying on the ground. He is complaining of pain in his pelvis. Your primary survey shows early signs and

symptoms of shock.
When you gently stress his pelvis, crepitus is

noted and he screams in pain.

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Discussion
What is this patients problem? Is this patient in need of rapid treatment and transportation? How are you going to treat him?

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Scenario
You respond to a pedestrian who has been struck by a car. On arrival you find a 63-year-old woman unresponsive on the pavement. As you get closer, you see obvious angulation deformities of her legs, including an open fracture.
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Findings
A - Open, clear. B - Rapid, lung sounds clear. C - Pulse rapid & weak with moderate hemorrhage from leg. D - Responsive to pain. Vitals: Pulse 132, RR 30, BP 88/P.
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Discussion
What are your priorities of care?

How are you going to treat this patient?

Is rapid transport indicated?

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Musculoskeletal Summary

continued...

Do not splint simple musculoskeletal trauma before evaluating patients for life-threatening injuries. To do so would result in well-splinted cadavers arriving at emergency departments. In the multi-system trauma patient, most musculoskeletal trauma can be splinted with a long backboard.
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Musculoskeletal Summary
Assess and treat all life-

contd.

threatening trauma before

isolated musculoskeletal trauma!

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