Chapter 20 Section 2 Musculoskeletal Injuries Assessment BRADY

Chapter 20, Section 2 Musculoskeletal Injuries: Assessment BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Objectives 20. 2. 1 Describe the general assessment of MS injuries. 20. 2. 2 Describe the signs and symptoms of MS injuries. 20. 2. 3 List specific injuries involving the arm and leg. 20. 2. 4 Describe and demonstrate how to assess each specific arm or leg injury. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Topics l Assessment l Upper Extremity Injuries l Lower Extremity Injuries l Axial Skeleton Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Case Update What do the vitals tell you about the patient’s current condition? What actions might you take for the pulseless arm? Why was the traction splint called for? What transportation options would be used at your area? BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment l Standard assessment procedures – ABCDs, SAMPLE, and vitals ◦ Determine number of patients ◦ Use MOI to point to possible injuries ◦ Look for guarding continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment l 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, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment l Note CMS distal to injury l Palpate injured area last l Expose injury site ◦ On scene to control bleeding ◦ In aid room to shield from weather, for modesty l Formulate management plan l Reassess vitals/CMS BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Assessment Copyright Mike Halloran BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Signs and Symptoms of Common MS Injuries l Sprain, strain, ruptured tendon l Fracture ◦ Closed? Open? l Dislocation l Signs ◦ ◦ BRADY and symptoms Pain – worsens when moved Bruising, wounds, skin “gaps” or “tents” Decreased motion Crepitus National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Signs and Symptoms of Common MS Injuries Copyright E. M. Singletary, MD BRADY Copyright E. M. Singletary, MD Copyright John Dobson National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Upper Extremity Injuries l Falling onto outstretched hand, elbow, shoulder may cause these l Assess from scapula to fingertips ◦ ◦ ◦ BRADY Scapula – SC joint Clavicle - AC joint Shoulder Humerus – elbow joint Radius/ulna – wrist joint Hand, fingers, joints continued National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Upper Extremity Injuries l Clavicle is frequently fractured l Sternoclavicular (SC) joint dislocation (posterior) may be life threatening l Shoulder (AC) separation / dislocation differ in character and severity ◦ Anterior dislocations more common l Scapula fractures require severe MOI continued l Humerus fractures may result in nerve damage BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Upper Extremity Injuries l 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 possible continued injury. BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Upper Extremity Injuries l Elbow fractures involve bones – dislocations lock joints, CMS issues l Radius and/or ulna may fracture l Wrist fracture may involve distal radius/ulna (Colles) or carpal bones l Skier’s thumb common ligament injury continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Upper Extremity Injuries Copyright E. M. Singletary, MD continued BRADY Copyright E. M. Singletary, MD Copyright Edward Mc. Namara National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Upper Extremity Injuries l Hand bones may fracture or dislocate l Amputations may occur BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lower Extremity Injuries l Assess from pelvis to toes ◦ ◦ Hip joint – femur Knee joint Tibia/fibula – ankle joint Foot , toes, joints Femur connects to pelvis at hip joint – may dislocate and/or fracture l Femur fractures involve high energy trauma l continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lower Extremity Injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lower Extremity Injuries l Knee ligament/cartilage injuries are common ◦ True dislocation is an emergency l Patellas may fracture or dislocate l Tib and/or fib may fracture l Ankle may sprain, fracture, dislocate ◦ Location gives clue to injury type l Foot BRADY injury takes many forms National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Lower Extremity Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ

Axial Skeleton Injuries l Take precedence over extremity injuries ◦ Severe extremity bleeding treated in primary exam l Details BRADY are in the next chapter National Ski Patrol, Outdoor Emergency Care, 5 th Ed. © 2012 by Pearson Education, Inc. , Upper Saddle River, NJ