Musculoskeletal Injuries Mosby items and derived items 2007

Outline • Review of the Musculoskeletal System • Injuries to Muscles and Bones Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. • Spinal Injuries • Head Injuries • Splinting

Musculoskeletal Function • Provides shape • Protection of internal organs • Movement Mosby items

Can you identify: • • Skull Face Vertebrae Ribs Pelvis Lower extremities Upper extremities

Spinal Column Cervical (7) Thoracic (12) Lumbar (5) Sacral (5) Mosby items and derived

Thorax Manubrium Sternum Xiphoid process Mosby items and derived items © 2007, 2004 by

Pelvis Ilium Pubic symphysis Ischium Acetabulum Mosby items and derived items © 2007, 2004

Muscles • Voluntary, or skeletal Mosby items and derived items © 2007, 2004 by

Muscles • Involuntary, or smooth • Cardiac Mosby items and derived items © 2007,

Musculoskeletal Injuries • Injuries to muscles, bones, and their associated ligaments – Are not usually life threatening • Goal injuries is to prevent further damage, which is important in minimizing permanent disability and reducing pain Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Fracture Classification • Open • Closed Mosby items and derived items © 2007, 2004

Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate

Open Fracture Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Musculoskeletal Injury Signs and Symptoms • Deformity/Angulation • Pain/Tenderness • Grating • Swelling • Bruising • Exposed bone ends • Locked joint Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Stabilization Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. • When in doubt, stabilize • Provide support above and below the site of the injury • Cover open wounds with a dry, sterile dressing • Pad the area to prevent pressure

Angulated Extremities • Do not attempt to straighten an angulated extremity • Never replace protruding bone ends back into wound • If in doubt…STABILIZE!! Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Musculoskeletal Injury Management • Stabilize the extremity • If no threats to life or possibility of spinal injury, allow the patient to assume a comfortable position • Apply a cold pack to the injury site Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Spinal Injuries • May cause permanent disability or even death • Critical to recognize mechanisms of injury that can produce spinal trauma Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Mechanisms of Spinal Injury • Any mechanism that produces violent impact on head, neck, torso or pelvis • Incidents that produce sudden forces to neck or torso • Any fall Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc. • Ejection or fall from motorized or otherwise powered transportation device • Shallow-water diving incidents • Assume spinal injury with any unresponsive trauma patient

Signs and Symptoms • Altered mental status/unresponsive • Pain/tenderness in neck/back • Loss of sensation/movement in any extremity • “Pins and needles” feeling • Difficulty breathing • Loss of bowel/bladder control Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Responsive Patient • Consider the MOI • Maintain manual stabilization of the head and neck • Ask: – What happened? – Does your neck or back hurt? • If yes, then where does it hurt? – Are you able to move your hands and feet Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Unresponsive Patient • Use jaw-thrust maneuver • Assist breathing if needed – Primary complications is ineffective breathing and paralysis • Obtain information from witnesses Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Spinal Injuries • Use jaw-thrust • Assess all 4 extremities for pulse, ability to

Scalp Injuries • Can bleed significantly Mosby items and derived items © 2007, 2004

Head Injuries • Classified as either open or closed – Open when there is a laceration or penetrating wound to the forehead or scalp • May have significant external bleeding – Usually can be controlled Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Traumatic Brain Injury (TBI) • Often immediately life threatening • May cause – – – Altered mental status Unresponsiveness with loss of airway control Abnormal breathing or respiratory arrest Vomiting Changes in blood pressure and pulse rate Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Head Injury Management • Maintain the airway with jaw-thrust maneuver • Assess breathing and assist ventilations as needed • Control bleeding • Monitor mental status Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Splinting • Manual stabilize Mosby items and derived items © 2007, 2004 by Mosby,

Splinting • Check distal circulation, motion, and sensation Mosby items and derived items ©

Splinting • Apply splint • Re-check circulation, motion, and sensation after splint is applied

Ankle Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Knee Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Lower Leg Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc.

Finger Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Forearm Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Traction Splint Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Shoulder Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Elbow Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc. ,

Sling and Swathe Mosby items and derived items © 2007, 2004 by Mosby, Inc.

Summary • Most musculoskeletal injuries are painful, but not life threatening, but there are exceptions – Fractures of the femur and pelvis – Cervical spine injury • Proper care of musculoskeltal injuries is important to minimize risk of further injury and permanent disability and to minimize pain Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.

Summary • In caring for a patient with a musculoskeletal injury, remember the priority of care is “life over limb” – Treat life-threatening airway, breathing, and circulation problems first, then manage musculoskeletal trauma Mosby items and derived items © 2007, 2004 by Mosby, Inc. , an affiliate of Elsevier Inc.