Presentation on theme: "Musculoskeletal Emergencies"— Presentation transcript:
1Musculoskeletal Emergencies Emergency Nursing Core CurriculumAcknowledgement is made to the following expert for the development of this module: Karen Belotti, RN, BSN2007Reviewed 2010
2Musculoskeletal Emergencies Objectives For selected musculoskeletal emergencies the participant will be able to:Compare the etiologyDescribe assessment findingsIdentify the clinical management
3Musculoskeletal Emergencies Always remember….. First priority of cares
4Musculoskeletal Emergencies The basics Bleeding controlImmobilizationNeurovascular assessmentOrthopedic injuries can look really ugly – but most of the time the patient will NOT die as a result of an extremity fracture.Neurovascular assessments (more than one) imperative to the preservation of limbs
6Musculoskeletal Emergencies Strains - definition The result of over stretching a muscle at the point of attachment to the tendonIs often caused by overuse, force, or stretching.
7Musculoskeletal Emergencies Sprains - definition A wrenching or twisting injury to a ligament with hyperextension, hyperflexion or torsion of a jointMost common sites are ankles, knees and shoulders.Generally more traumatic in nature than a strain.
8Musculoskeletal Emergencies Sprains The most commonly sprained or strained joint is the ankleAnkle SprainsApproximately 1 million ankle injuries occur each year, and 85 percent of them are sprains.Ankle sprains can occur during competitive sports or during routine daily activities (walking).The length of recovery can be as long as a fracture (6-10 weeks), and it is important to wait for healing and rehabilitation to be complete prior to returning to his/her sport.
9Musculoskeletal Emergencies Strains & Sprains – signs & symptoms Mild to severe pain with disability and loss of function.May describe a snapping or popping soundPoint tenderness
10Musculoskeletal Emergencies Strains & Sprains – signs & symptoms Mild to severe edemaEcchymosisMild to marked deformity
11Need to know pregnancy status of women before radiological studies
12Musculoskeletal Emergencies Strains & Sprains - treatment ImmobilizationElevationIceRestAnalgesiaelevation (above level of heart) for 24 to 72 hoursice pack for 24 to 48 hours (protect the skin! Never apply ice packs directly to skin. Tissue damage may result.)rest - light to no weight-bearing with crutchesDegree of immobilization dependent on severity of injury:compression bandage (ace wrap)splintstirrup ankle bracecast
14Musculoskeletal Emergencies Fractures Disruption in the normal continuity of the bone, cartilage or both
15Musculoskeletal Emergencies Fractures - types ObliqueSpiralComminutedImpactedCompressionGreenstickAvulsionDepressedOpen vs. Closed
16Musculoskeletal Emergencies Fractures - Oblique Oblique: Fracture resulting from a twisting forcethese types of fractures are one of rarest forms.an oblique break in the bone is very unstablebreak at an anglethey can easily be misdiagnosed as spiral fractures
17Musculoskeletal Emergencies Fractures - Spiral Twisting force while foot firmly plantedbone broken due to a twisting type motion.highly unstablemay be diagnosed as a oblique fracture unless the correct x-ray has been ordered.will appear like a corkscrew which runs parallel with the axis of the broken bone
18Musculoskeletal Emergencies Fractures - Comminuted Severe direct force causes more than two bone fragmentsfracture in which bone is broken, splintered or crushed into a number of pieces.considered comminuted when at least 3 bone fragments.highly unstable
20Musculoskeletal Emergencies Fractures - Impacted Fractured bone ends jam togetherends are driven into each othercommonly seen in pediatric arm fracturesalso known as a ‘buckle’ fracture.generally occurs after a fall in which the vertebral column is compressed:extreme pressure causes cracks or breaks.may also be referred to as a compression fracture.
21Musculoskeletal Emergencies Fractures - Compression Severe force jams vertebrae togethercaused by Injuries that forces the vertebrae together ( fall landing on head or sacrum)may also be referred to as a impact fracture.
22Musculoskeletal Emergencies Fractures - Greenstick Compression force, most commonly seen in childrenan incomplete fracture in which only one side of the bone has been broken.bone usually is "bent" and only broken on the outside of the bend.mostly seen in childrenconsidered a stable fracture due to the fact that the whole bone has not been broken.if bone kept rigid healing is usually rapid.
23Musculoskeletal Emergencies Fractures - Avulsion Forceful contraction of muscle mass causes bone to break away from insertion pointinjury to the bone in a place where a tendon or ligament attachesavulsion fracture pulls a piece of tendon or ligament off the bone.more common in children than adults:weak point called the growth platearea of bone that is actively growing.tendons or ligaments near growth plate can pull hard enough to cause the growth plate to fracture.can also occur when a muscle-tendon unit exerts such traction force on the bone it is attached to, it avulses off a piece of bone.
24Musculoskeletal Emergencies Fractures - Depressed Blunt trauma to flat bone usually associated with significant soft tissue damageserious group of fracturesusually the result of slow impact with a large solid impactsection of the bone becomes ‘dented’.Secondary injuries:laceration of cerebral arteries from bone fragmentsneurological complications:seizurechronic headaches
25Musculoskeletal Emergencies Fractures – open vs. closed Much higher incidence of infection - contaminatedConsidered surgical emergencyCan cause significant blood lossopen - formerly known as compoundclosed - formerly known as simple fracturean open fracture occurs when the broken bone punctures the skinalways considered contaminated, prophylactic antibiotics givensometimes visible on an X-rayopen fractures, whether obvious or subtle, always communicate with the environment.infection and poor healing are common following open fractures
27Musculoskeletal Emergencies Fractures - signs & symptoms CrepitusMuscle spasmInability to bear weightDecreased or absent pulsesPallor, shockpelvic fracturesfemur fractures
28Musculoskeletal Emergencies Fractures - treatment ImmobilizeRemove jewelry or constrictive clothing from injured extremityremove and secure jewelry or any other item distal or lateral to injury that may create constrictionfollow institution proceduredocument.
29Musculoskeletal Emergencies Fractures - treatment Apply ice to reduce swelling and painElevate extremity above the level of the heart
30Musculoskeletal Emergencies Fractures Prepare for:closed reductionsplinting or castingIf open fracture prepare for surgeryCover with sterile, saline-soaked dressingclosed reductions are routinely done in the ED utilizing conscious sedation agentssurgical intervention is necessary if closed reduction unsuccessful or open fracture is present
31Musculoskeletal Emergencies Dislocation & Subluxations Occurs when a joint exceeds it’s normal range of motion and the articular surfaces are no longer in direct contact.
33Musculoskeletal Emergencies Dislocation & Subluxations Fracture are often associated with dislocation injuriesCommon areas of dislocations include the shoulder, elbow, hip and knee
34Musculoskeletal Emergencies Dislocation & Subluxations Signs & SymptomsLocalized pain, moderate to severePoint tendernessJoint deformityClick to next slide for more signs & symptoms
35Musculoskeletal Emergencies Dislocation & Subluxations Signs & SymptomsDecreased or absent range of motionEdemaDiminished or absent distal pulses and sensation
36Musculoskeletal Emergencies Dislocation & Subluxations Interventions:Keep NPO!Remove jewelry or constrictive clothing from injured extremityApply ice to reduce swelling and painInitiate prompt treatment to minimize complicationsWhy NPO????conscious sedation required to attempt closed reduction.closed reduction efforts may fail and patient may end up in operating roomClick to next slide for more interventions
37Musculoskeletal Emergencies Dislocation & Subluxations Prepare reduction proceduresMonitor neurovascular status of injured extremityImmobilize joint post reduction
38Musculoskeletal Emergencies Nursemaids Elbow Radial head subluxationCauses:lifting by the handswinging while holding the handspulling arms through the sleevescatching by the hand to prevent a fallpulling along when in a hurryoccurs when the radial head slipscommon condition in children younger than 4 years of age.caused by a sudden pull or traction on the hand or forearm.Symptoms:immediate pain in the injured armrefusal or inability to move the injured armanxiety, crying
39Musculoskeletal Emergencies Nursemaids Elbow Treatment:Provider manipulation of affected extremityX-rays not always indicatedProne to recurrencestreatment consists of provider manipulation of arm so that ligament and radial head return to their normal position.if successful, a click or snap can be felt at the radial head.reduction of the elbow, without and x-ray, should not be done if the possibility of fracture or dislocation exists.x rays are not always obtained when the findings are consistent with nursemaid's elbowx rays may appear normal even when the radial head is subluxed.teach parents how to prevent and treat recurrences.
40Musculoskeletal Emergencies Degloving Injuries The separation of skin and subcutaneous tissue from the underlying musculofascial planesexternal forces shear the skin from underlying tissues.most frequent affects extremitiessevere degloving injuries are classically associated with roller type machinery or vehicle rolloverscan result in tissue necrosis, sepsis, death
41Musculoskeletal Emergencies Degloving Injuries Signs & SymptomsArea of skin is torn away from underlying vascular supplyPainHemorrhage
42Musculoskeletal Emergencies Degloving Injuries - treatment Control bleedingIrrigate and cleanse areaAdminister medications and evaluate effectivenessanalgesicsantibioticstetanus immunization
43Musculoskeletal Emergencies Compartment Syndrome Occurs when increasing interstitial pressure inside the fascial compartment results in neurovascular compromise causing soft tissue damage to the confined spaceincreased pressure within closed soft tissue compartments can result in serious consequenceselevated compartment pressures commonly follow significant injuries to the forearm and leg and should be diagnosed early with careful monitoring.
44Musculoskeletal Emergencies Compartment Syndrome Causes:Crush injuriesContusionsSnake bitesCircumferential extremity burnsOnset 4 to 8 hours after injurymost commonly occurs in the lower leg or forearmonset 4 – 8 hours after injurycan be delayed up to 48 to 96 hours.
45Musculoskeletal Emergencies Compartment Syndrome Increasingly severe pain at rest or with passive movementTense, swollen areaDiminished sensationPain is the earliest and most reliable indicator(especially with passive movement)Also:pallorparalysisparasthesiapulselessness (late sign) are also indicative of elevated pressures.
46Musculoskeletal Emergencies Compartment Syndrome Progressive loss of muscle or motor functionLoss of pulses (late sign)Increased compartment pressures
47Musculoskeletal Emergencies Compartment Syndrome Interventions:Maintain extremity in neutral position, at the level of the heart.Must not be left dependent
48Musculoskeletal Emergencies Compartment Syndrome Remove all casts, splints or appliancesAssist with obtaining compartment measurementsMonitor extremity perfusion every 15 minutesClick to next slide for more interventions
49Musculoskeletal Emergencies Compartment Syndrome Prepare for surgical release of affected areaFasciotomyIf untreated can result in irreversible tissue necrosis and paralysis
50Case ScenarioWhich of the following is not a symptom of compartment syndrome?pain upon passive movementpetechiaeparaesthesia of the affected extremitydecreased capillary filling timeClick to next slide for answer
51Case Scenario petechiae Which of the following is not a symptom of compartment syndrome?pain upon passive movementpetechiaeparaesthesia of the affected extremitydecreased capillary filling time
52Case ScenarioWhich of the following findings indicates successful reduction of nursemaid’s elbow?the arm is immobilethe radial pulse is strongthe elbow moves freelythe patient cries when the arm is examinedClick to next slide for answer
53Case Scenario the elbow moves freely Which of the following findings indicates successful reduction of nursemaid’s elbow?the arm is immobilethe radial pulse is strongthe elbow moves freelythe patient cries when the arm is examined