Professional Documents
Culture Documents
Scenario
You respond to a soccer field for an
“accidental injury.” Your patient is a
33-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.
Discussion
What exam findings would lead you to
believe that perfusion to the extremity is
poor?
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
Are under voluntary control
Also called voluntary muscles
Skeletal Muscles
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
Cardiac Muscles
Have strength of skeletal muscle and endurance
of smooth muscle
Provide for movement of blood through the body
on a continuous basis
Respond to stimulation from the nervous system
Highly sensitive to lack of oxygen
Respond to lack of oxygen with pain in that area
(angina)
Cardiac Muscles
Myocardium
Forms middle layer of
heart
Innervated by
autonomic nervous
system but contracts
spontaneously without
any nerve supply
Contractions are
strong and rhythmic
Tendons
Bands of connective tissue
Bind muscles to bones
Reduce friction
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
Unstable — Proximal and distal ends
move freely in relationship to each
other
Impacted — Jammed together so there is no
movement between proximal and distal
bones
Open — Skin is open, allowing
introduction of bacteria, dirt, and
other foreign bodies
Closed — Skin is intact
Fracture with dislocation — Fracture at
Fractures
Break in continuity of bone or
cartilage
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
Classification of Fractures
Oblique
Transverse
Stress
Pathological
Epiphyseal
Classification of Fractures
Pathophysiology — Fractures
Impacted
Pathophysiology — Fractures
Joint Dislocations
Normal articulating ends of two or more bones
are displaced
Luxation: Complete dislocation
Subluxation: Incomplete dislocation
Graded by severity
First-degree sprain
Second-degree sprain
Third-degree sprain
Strains
Injury to muscle or its tendon
Overexertion or overextension
Treatment
Rest, ice, and analgesics
Tendonitis
Inflammation of tendon
Often caused by injury
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
Instability
Loss of tissue
Nerve damage
Long-term disability
Assessment
Determine if life-threatening
conditions are present
Care for those first
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
Fracture Care
Joint Care
Muscular & Connective Tissue Care
Musculoskeletal Injury Management
Fluid Resuscitation
Femur
Traction Splints
PASG
Humerus
Radius/Ulna
Musculoskeletal Injury Management
Knee
Ankle
Joint
Foot Injuries
Shoulder
Elbow Alert for
Wrist/Hand PMS
Finger
Compromis
Musculoskeletal Injury Management
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
n Nitrous Oxide
n Morphine Sulfate
Fluids
Nitrous Oxide
Class: Gaseous Analgesic/Anesthetic
Route: Inhalation Adult Dose: Instruct
patient to inhale deeply through
patient-held mask or
mouthpiece Pediatric
Dose: Instruct patient to inhale deeply
through patient-held mask or
mouthpiece Drug
Action: Depresses the central nervous
system Increases oxygen tension in the
blood thereby reducing hypoxia Onset:2
minutes - 5 minutes Duration:2 minutes
- 5 minutes
Nitrous Oxide
Indications: Adjunct analgesic for ischemic
chest pain Severe pain or discomfort in all
patients without contraindications.
Precautions: Must be self administered Check
machine gauges daily for proper
concentrations Monitor blood pressure and
pulse oximetry values during administration
Side Effects: Hypotension Dizziness Nausea
and vomiting
Contraindications: Any altered level of
consciousness or head injury Chronic
obstructive pulmonary disease Chest trauma
or actual/suspected pneumothorax Abdominal
trauma Major facial trauma Acutely psychotic
patients Pregnancy, other than active
labor Any patient (adult or pediatric) unable to
self-administer Decompression sickness
Morphine Sulfate
Indications Pain and anxiety secondary to AMI
Chest pain unrelieved by Nitroglycerin
Pulmonary edema
Pain secondary to amputations or fractures