Professional Documents
Culture Documents
Scenario
You respond to a football field for an
“accidental injury.” Your patient is a 23-year
old male who is complaining of severe right
ankle pain. You note gross angulation and
deformity of the ankle and carefully remove
his shoe to assess his distal circulation. Your
examination reveals that there is almost no
perfusion to his foot.
YOUR SCENE
Discussion
What
What exam
exam findings
findings would
would lead
lead you
you to
to believe
believe that
that
perfusion
perfusion to
to the
the extremity
extremity is
is poor?
poor?
Describe
Describe actions
actions that
that should
should be
be taken
taken immediately
immediately to
to
improve
improve blood
blood flow
flow to
to the
the foot.
foot.
How
How will
will you
you determine
determine ifif your
your actions
actions are
are successful?
successful?
What
What anatomical
anatomical structures
structures are
are likely
likely involved
involved in
in this
this
injury?
injury?
Introduction to Musculoskeletal Injuries
Long bones
Short bones
Flat bones
Irregular bones
Anatomy — Skeletal System
Posterior view
Anatomy & Physiology of the
Musculoskeletal System
Bone Aging
– Birth to Adult (18-20)
Transition from flexible to firm bone
– Adult to elderly (40+)
Reduction in collagen matrix and calcium salts
Diminution of bone strength
Spinal curvature
Anatomy & Physiology of the
Musculoskeletal System
Muscular Tissue &
Structure
– 600 muscle groups
– Types of muscles
Smooth
Striated
Cardiac
Skeletal Muscles
Have striations
Greater strength
Referred to as striated
muscle
Conscious control
40% of total body mass
Two attachments
– Origin: More fixed and proximal attachment
– Insertion: More movable and distal attachment
Contractions are rapid and forceful
Smooth Muscles
Myocardium
– Forms middle layer of heart
Innervated by autonomic
nervous system but contracts
spontaneously without any
nerve supply
Reduce friction
Direct force
Indirect force
Twisting force
Pathological
Fatigue
Classifications of Musculoskeletal
Injuries
Injuries include:
– Fractures
– Sprains
– Strains
Joint dislocations
Musculoskeletal Injuries
Direct trauma
– Blunt force applied to an extremity
Indirect trauma
– Vertical fall that produces spinal fracture distant from site
of impact
Pathological conditions
Some forms of arthritis
Malignancy
Pathophysiology — Fractures
Complete or incomplete
– Line of fracture through bone
Open or closed
– Integrity of skin near fracture site
Classification of Fractures
Open
Closed
Comminuted
Greenstick
Spiral
Pathophysiology — Fractures
Impacted
Pathophysiology — Fractures
Compartment Syndrome
Symptoms include:
– Pain
– Tenderness
– Restricted movement of muscle
attached to affected tendon
Treatment
– Nonsteroidal antiinflammatory
drugs (NSAIDs)
– Corticosteroid medications
Arthritis
Joint inflammation
– Pain, swelling, stiffness, and redness
Joint disease
– Involving one or many joints
– Many causes
Varies in severity
– Mild ache and stiffness
– Severe pain and later joint deformity
Arthritis
Osteoarthritis
(degenerative arthritis)
most common
Fractures
Limb -Threatening Injuries
Knee dislocation
Fracture or dislocation of ankle
Subcondylar fractures of elbow
Require rapid transport
Musculoskeletal Injury Management
General Principles
– Protecting Open Wounds
– Positioning the limb
– Immobilizing the injury
– Checking Neurovascular Function
Musculoskeletal Injury Management
Splinting Devices
– Rigid splints
– Formable Splints
– Soft Splints
– Traction Splints
– Other Splinting Aids
Vacuum Splints
Air Sprints
Cravats or Velcro Splints
Fracture Care
Joint Care
Muscular & Connective Tissue Care
Musculoskeletal Injury Management
Care for Specific Fractures
– Pelvis
Scoop Stretcher
PASG
Fluid Resuscitation
– Femur
Traction Splints
PASG
Fracture versus hip doslocation
Musculoskeletal Injury Management
Care Specific Fractures
– Tibia/Fibula
– Clavicle
Most frequently fractured bond in the body
Transmitted to 1st and 2nd rib
Alert for lung injury
– Humerus
– Radius/Ulna
Musculoskeletal Injury Management
Care for Specific Joint Injuries
– Hip
– Knee Joint
– Ankle
– Foot
Injuries
– Shoulder
– Elbow
Alert for
– Wrist/Hand PMS
– Finger Compromis
e
Knee Dislocation/Fracture with No
Distal Pulse
Gentle, steady traction Should be attempted
while moving extremity if transport will be
into normal alignment greater than 2 hours
Successful realignment (even with a pulse)
= “Pop,” loss of Patellar dislocation –
deformity, relief of pain, Not limb threatening
increased mobility
Provide full
immobilization
Dislocation/Fracture Realignment
Never
Never manipulate the elbow!
Musculoskeletal Injury Management
Hot Therapy
– After 24 hour – Increases circulation
Musculoskeletal Injury Management
Medications
Not A Biotel Option
Nitrous Oxide Diazepam
– 50% O2:50% N – Benzodiazepine
– Non-explosive – Antianxiety
– Effects dissipate in 2-5 – Analgesic
minutes – Dose
– Easily diffused into air 5-15 mg titrated
filled spaces in body. – Onset
10-15 minutes
– Dose
Inhaled & self – Duration
administered 15-60 minutes
– Onset – Counter Agent
1-2 minutes Flumazenil
Dislocation of Acromioclavicular
Joint
Humerus Injury
Older adults and children
Difficult to stabilize
Complications
– Radial nerve damage if
fracture in middle or distal
portion of humeral shaft
– Humeral neck fracture may
cause axillary nerve
damage
– Internal hemorrhage into
joint
Posterior Dislocation of the Elbow
Joint with Marked Deformity
Severe Open Fracture of Forearm
Penetration of Forearm Caused by Nail
Gun
Greenstick Fracture With
Marked Deformity
Fracture of the Distal Radius
Hand Injury from a Motorcycle Crash
Femur Injury
Diameter of right thigh
represents increased
blood volume of 2 to 3
L
Open Fracture of the Lower Leg
Subtalar Dislocation
Foot that was Run Over by the Wheel
of a Railway Coach
Musculoskeletal Injury Management
Medications
Oxygen
Nitrous Oxide
Morphine Sulfate
Fluids
Nitrous Oxide
Class: Gaseous Dose: Instruct patient to
Analgesic/Anesthetic inhale deeply through
Route: Inhalation Adult patient-held mask or
Dose: Instruct patient to mouthpiece Drug
inhale deeply through Action: Depresses the
patient-held mask or central nervous system
mouthpiece Pediatric Increases oxygen tension in
the blood thereby reducing
hypoxia Onset:2 minutes -
5 minutes Duration:2
minutes - 5 minutes
Nitrous Oxide
Indications: Adjunct analgesic Contraindications: Any altered
for ischemic chest pain Severe level of consciousness or head
pain or discomfort in all patients injury Chronic obstructive
without contraindications. pulmonary disease Chest
Precautions: Must be self trauma or actual/suspected
administered Check machine pneumothorax Abdominal
gauges daily for proper
concentrations Monitor blood trauma Major facial
pressure and pulse oximetry trauma Acutely psychotic
values during administration patients Pregnancy, other than
Side Effects: active labor Any patient (adult
Hypotension Dizziness Nausea or pediatric) unable to self-
and vomiting administer Decompression
sickness
Morphine Sulfate
Precautions:
Monitor respiratory status and
Indications blood pressure closely.
Notify Biotel prior to
Pain and anxiety administration if patient is
secondary to AMI >65yrs of age, debilitated, has
Chest pain unrelieved altered mental status, or
by Nitroglycerin systolic BP<110mmHg
Pulmonary edema CHF: be prepared to intubate
Pain secondary to Antidote: Naloxone
amputations or (Narcan®)
fractures
Morphine Sulfate
Class: Narcotic Analgesic
Drug Action:
Route: Slow IV push Alleviates pain
Decreases peripheral
Dose: Adult: Administer in vascular resistance -
titrated doses of 2 - 4mg, vasodilator
up to a maximum of 10mg
Pediatric: 0.1mg/kg Decreases cardiac
workload and oxygen
demand on the heart
QUESTIONS?