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Musculoskeletal Emergencies Emergency Nursing Core Curriculum Acknowledgement is made to the following expert for the development of this module: Karen.

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Presentation on theme: "Musculoskeletal Emergencies Emergency Nursing Core Curriculum Acknowledgement is made to the following expert for the development of this module: Karen."— Presentation transcript:

1 Musculoskeletal Emergencies Emergency Nursing Core Curriculum Acknowledgement is made to the following expert for the development of this module: Karen Belotti, RN, BSN 2007 Reviewed 2010

2 Musculoskeletal Emergencies Objectives For selected musculoskeletal emergencies the participant will be able to: Compare the etiology Describe assessment findings Identify the clinical management

3 Musculoskeletal Emergencies Always remember…..

4 Musculoskeletal Emergencies The basics Bleeding control Immobilization Neurovascular assessment

5 Musculoskeletal Emergencies

6 The result of over stretching a muscle at the point of attachment to the tendon Musculoskeletal Emergencies Strains - definition

7 Musculoskeletal Emergencies Sprains - definition A wrenching or twisting injury to a ligament with hyperextension, hyperflexion or torsion of a joint

8 The most commonly sprained or strained joint is the ankle Musculoskeletal Emergencies Sprains

9 Mild to severe pain with disability and loss of function. May describe a snapping or popping sound Point tenderness Musculoskeletal Emergencies Strains & Sprains – signs & symptoms

10 Mild to severe edema Ecchymosis Mild to marked deformity Musculoskeletal Emergencies Strains & Sprains – signs & symptoms

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12 Immobilization Elevation Ice Rest Analgesia Musculoskeletal Emergencies Strains & Sprains - treatment

13 Musculoskeletal Emergencies Strains & Sprains - Pneumonic: PRICE Protect Rest Ice Compression Elevation

14 Musculoskeletal Emergencies Fractures Disruption in the normal continuity of the bone, cartilage or both

15 Musculoskeletal Emergencies Fractures - types Oblique Spiral Comminuted Impacted Compression Greenstick Avulsion Depressed Open vs. Closed

16 Musculoskeletal Emergencies Fractures - Oblique Oblique: Fracture resulting from a twisting force

17 Musculoskeletal Emergencies Fractures - Spiral Spiral: Twisting force while foot firmly planted

18 Musculoskeletal Emergencies Fractures - Comminuted Comminuted: Severe direct force causes more than two bone fragments

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20 Musculoskeletal Emergencies Fractures - Impacted Impacted: Fractured bone ends jam together

21 Musculoskeletal Emergencies Fractures - Compression Compression: Severe force jams vertebrae together

22 Musculoskeletal Emergencies Fractures - Greenstick Greenstick: Compression force, most commonly seen in children

23 Musculoskeletal Emergencies Fractures - Avulsion Avulsion: Forceful contraction of muscle mass causes bone to break away from insertion point

24 Musculoskeletal Emergencies Fractures - Depressed Depressed: Blunt trauma to flat bone usually associated with significant soft tissue damage

25 Musculoskeletal Emergencies Fractures – open vs. closed Open: Much higher incidence of infection - contaminated Considered surgical emergency Can cause significant blood loss

26 Musculoskeletal Emergencies Fractures - signs & symptoms Tenderness or pain Deformity Decreased mobility Swelling Ecchymosis

27 Musculoskeletal Emergencies Fractures - signs & symptoms Crepitus Muscle spasm Inability to bear weight Decreased or absent pulses Pallor, shock pelvic fractures femur fractures

28 Immobilize Remove jewelry or constrictive clothing from injured extremity Musculoskeletal Emergencies Fractures - treatment

29 Apply ice to reduce swelling and pain Elevate extremity above the level of the heart Musculoskeletal Emergencies Fractures - treatment

30 Prepare for: closed reduction splinting or casting If open fracture prepare for surgery Cover with sterile, saline- soaked dressing Musculoskeletal Emergencies Fractures

31 Occurs when a joint exceeds its normal range of motion and the articular surfaces are no longer in direct contact. Musculoskeletal Emergencies Dislocation & Subluxations

32 Result: Impaired circulation Ligament injury Nerve damage Disruption of muscle insertions Musculoskeletal Emergencies Dislocation & Subluxations

33 Fracture are often associated with dislocation injuries Common areas of dislocations include the shoulder, elbow, hip and knee Musculoskeletal Emergencies Dislocation & Subluxations

34 Signs & Symptoms Localized pain, moderate to severe Point tenderness Joint deformity Musculoskeletal Emergencies Dislocation & Subluxations

35 Signs & Symptoms Decreased or absent range of motion Edema Diminished or absent distal pulses and sensation Musculoskeletal Emergencies Dislocation & Subluxations

36 Interventions: Keep NPO! Remove jewelry or constrictive clothing from injured extremity Apply ice to reduce swelling and pain Musculoskeletal Emergencies Dislocation & Subluxations

37 Prepare reduction procedures Monitor neurovascular status of injured extremity Immobilize joint post reduction Musculoskeletal Emergencies Dislocation & Subluxations

38 Radial head subluxation Causes: lifting by the hand swinging while holding the hands pulling arms through the sleeves catching by the hand to prevent a fall pulling along when in a hurry Musculoskeletal Emergencies Nursemaids Elbow

39 Treatment: Provider manipulation of affected extremity X-rays not always indicated Prone to recurrences

40 The separation of skin and subcutaneous tissue from the underlying musculofascial planes Musculoskeletal Emergencies Degloving Injuries

41 Signs & Symptoms Area of skin is torn away from underlying vascular supply Pain Hemorrhage Musculoskeletal Emergencies Degloving Injuries

42 Control bleeding Irrigate and cleanse area Administer medications and evaluate effectiveness analgesics antibiotics tetanus immunization Musculoskeletal Emergencies Degloving Injuries - treatment

43 Occurs when increasing interstitial pressure inside the fascial compartment results in neurovascular compromise causing soft tissue damage to the confined space Musculoskeletal Emergencies Compartment Syndrome

44 Causes: Crush injuries Contusions Snake bites Circumferential extremity burns Onset 4 to 8 hours after injury Musculoskeletal Emergencies Compartment Syndrome

45 Increasingly severe pain at rest or with passive movement Tense, swollen area Diminished sensation Musculoskeletal Emergencies Compartment Syndrome

46 Progressive loss of muscle or motor function Loss of pulses (late sign) Increased compartment pressures Musculoskeletal Emergencies Compartment Syndrome

47 Interventions: Maintain extremity in neutral position, at the level of the heart. Must not be left dependent Musculoskeletal Emergencies Compartment Syndrome

48 Remove all casts, splints or appliances Assist with obtaining compartment measurements Monitor extremity perfusion every 15 minutes Musculoskeletal Emergencies Compartment Syndrome

49 Prepare for surgical release of affected area Fasciotomy Musculoskeletal Emergencies Compartment Syndrome

50 Case Scenario Which of the following is not a symptom of compartment syndrome? A.pain upon passive movement B.petechiae C.paraesthesia of the affected extremity D.decreased capillary filling time

51 Case Scenario Which of the following is not a symptom of compartment syndrome? A.pain upon passive movement B.petechiae C.paraesthesia of the affected extremity D.decreased capillary filling time

52 Case Scenario Which of the following findings indicates successful reduction of nursemaids elbow? A.the arm is immobile B.the radial pulse is strong C.the elbow moves freely D.the patient cries when the arm is examined

53 Case Scenario Which of the following findings indicates successful reduction of nursemaids elbow? A.the arm is immobile B.the radial pulse is strong C.the elbow moves freely D.the patient cries when the arm is examined

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