Presentation on theme: "Injuries to Muscles and Bones"— Presentation transcript:
1Injuries to Muscles and Bones Chapter 14Injuries to Muscles and Bones
2National EMS Education Standard Competencies (1 of 3) TraumaUses simple knowledge to recognize and manage life threats based on assessment findings for an acutely injured patient while awaiting additional emergency medical response.
3National EMS Education Standard Competencies (2 of 3) Orthopaedic TraumaRecognition and management of:Open fracturesClosed fracturesDislocationsAmputations
4National EMS Education Standard Competencies (3 of 3) Head, Facial, Neck, and Spine TraumaRecognition and management of:Life threatsSpine trauma
5Introduction (1 of 2)EMRs will encounter many types of musculoskeletal injuries:FracturesDislocationsSprains and strainsHead injuriesSpinal cord injuriesChest injuries
6Introduction (2 of 2)Understanding the basic anatomy and functioning of the musculoskeletal system will you help you treat these injuries.You must be able to recognize signs and symptoms of various musculoskeletal injuries.Providing proper care at the scene can prevent additional injury or disability.
7Patient Assessment of Injuries to Muscles and Bones (1 of 2)
8Patient Assessment of Injuries to Muscles and Bones (2 of 2) Complete all five parts of the patient assessment sequence.Follow standard precautions to protect you and the patient from infectious diseases.Perform a complete primary assessment.Immediately follow with the secondary assessment.Perform a thorough SAMPLE medical history.Continue to reassess the patient.
9The Skeletal System (1 of 9) Consists of 206 bonesActs as the supporting framework for the bodyFunctions of the skeletal system:To support the bodyTo protect vital structuresTo assist in body movementTo manufacture red blood cells
10The Skeletal System (2 of 9) Divided into seven areas:Head, skull, and faceSpinal columnShoulder girdleUpper extremitiesRib cage (thorax)PelvisLower extremities
12The Skeletal System (4 of 9) The bones of the head include the skull and the lower jawbone.The skull is actually many bones fused together to form a hollow sphere that contains and protects the brain.The jawbone is a movable bone attached to the skull.
13The Skeletal System (5 of 9) The spine consists of a series of separate bones called vertebrae.Primary support structure for the entire bodyThe spine has five sections:Cervical spine (neck)Thoracic spine (upper back)Lumbar spine (lower back)SacrumCoccyx (tailbone)
15The Skeletal System (7 of 9) Each shoulder girdle supports an arm.Consists of the collarbone (clavicle) and the shoulder blade (scapula)The upper extremities consist of three major bones plus the wrist and hand.The arm has one bone (humerus).The forearm has two bones (radius and ulna).
16The Skeletal System (8 of 9) The 12 sets of ribs protect the heart, lungs, liver, and spleen.All of the ribs are attached to the spine.The sternum is located in the front of the chest.
17The Skeletal System (9 of 9) The pelvis links the body and the lower extremities.The lower extremities consist of the thigh and the leg.The thigh bone (femur) is the longest and strongest bone in the body.The leg consists of the tibia and fibula, plus the ankle and foot.
18The Muscular System (1 of 3) The muscles of the body provide support and movement.Muscles are attached to bones by tendons and cause movement by alternately contacting and relaxing.Movement occurs at joints, where two bones come together.The bones are held together by ligaments.
19The Muscular System (2 of 3) Three types of musclesVoluntary (skeletal) muscles are attached to bones and can be contracted and relaxed by a person at will.Involuntary (smooth) muscles are found on the inside of the digestive tract and other internal organs.Cardiac muscle is found only in the heart.
21Mechanism of Injury (1 of 2) Musculoskeletal injuries are caused by three types of MOIs:Direct forceIndirect forceTwisting forceUse the information provided by the dispatcher and gathered from the scene to identify the possible MOI.
22Mechanism of Injury (2 of 2) There are many different ways to describe a patient’s injuries.Use your senses of sight and touch.Listen to the information the patient gives you.The most important part of your job is to provide the best assessment and treatment.
23Types of Injuries (1 of 4) Fractures A fracture is a broken bone. It most often occurs as a result of a significant force.In a closed fracture, the bone is broken but there is no break in the skin.In an open fracture, the bone is broken and the overlying skin is lacerated.Both result in bleeding at the fracture site.
24Types of Injuries (2 of 4) Dislocations A dislocation is a disruption that tears the supporting ligaments of the joint.The bone ends separate completely from each other and can lock in one position.Any attempt to move a dislocated joint is very painful.A dislocation can damage nearby nerves and blood vessels.
25Types of Injuries (3 of 4) Sprains and strains A sprain is a joint injury caused by excessive stretching of the supporting ligaments.A strain is caused by stretching or tearing of a muscle.
26Types of Injuries (4 of 4) Signs and symptoms of extremity injuries Pain at the injury siteAn open woundSwelling and discolorationThe patient’s inability or unwillingness to move the extremityDeformity or angulationTenderness at the injury site
27Standard Precautions and Musculoskeletal Injuries Assume that trauma patients have open wounds that pose a threat of infection.Always wear approved gloves.When you respond to a motor vehicle crash, wear heavy rescue gloves.If the patient has active bleeding that may splatter, you should have protection for your eyes, nose, and mouth.
28Examination of Musculoskeletal Injuries (1 of 6) General patient assessmentAll the steps in the patient assessment process must be carried out before focusing on any injured limb.Limb injuries are not life threatening unless there is excessive bleeding.Stabilize the patient’s ABCs first.
29Examination of Musculoskeletal Injuries (2 of 6) Examination of the injured limbInspect the injured limb and compare it to the opposite, uninjured limb.When you examine the limb, you may find any one of the following:Open woundDeformitySwellingBruising
30Examination of Musculoskeletal Injuries (3 of 6) Examination of the injured limb (cont’d)Tenderness is the best indicator of an underlying fracture, dislocation, or sprain.Start at the top of each limb and using both hands, squeeze the entire limb in a systematic, firm manner.
31Examination of Musculoskeletal Injuries (4 of 6) Examination of the injured limb (cont’d)As you conduct the hands-on examination, ask the patient where it hurts most.The location of greatest pain is probably the injury site.If the patient shows no sign of injury, ask the patient to move the limb carefully.
32Examination of Musculoskeletal Injuries (5 of 6) Evaluation of circulation, sensation, and movementAny injury may have associated blood vessel or nerve damage.Check circulation and sensation after any movement of the limb.Follow the steps in Skill Drill 14-1 to check circulation, sensation, and movement.
33Examination of Musculoskeletal Injuries (6 of 6)
34Treatment of Musculoskeletal Injuries All limb injuries are treated the same way in the field.Cover open wounds with dry, sterile dressings.Apply firm but gentle pressure to control bleeding.Apply a cold pack to painful, swollen, or deformed extremities.Splint the injured limb.
35General Principles of Splinting (1 of 4) Advantages of splintingPrevents the movement of broken bone ends, a dislocated joint, or damaged soft tissuesHelps to control bleedingDecreases the risk of additional damagePrevents closed fractures from becoming open fractures during movement or transport
36General Principles of Splinting (2 of 4) Remove clothing from the injured limb to inspect for open wounds, deformity, swelling, bruising, and capillary refill.Note and record the pulse, capillary refill, sensation, and movement distal to the point of injury.Cover all open wounds with a dry, sterile dressing before applying the splint.
37General Principles of Splinting (3 of 4) Do not move the patient before splinting, unless there is an immediate danger.Immobilize the joint above and the joint below the injury site.Pad all rigid splints.Support the injury site and minimize movement of the limb until splinting is completed.
38General Principles of Splinting (4 of 4) Splint the limb without moving it unnecessarily.When in doubt, splint.
39Materials Used for Splinting (1 of 6) Rigid splintsMade from firm materialApplied to the sides, front, or back of an injured extremityCommon types: padded board splints, molded plastic or aluminum splints, padded wire ladder splints, SAM splints, and folded cardboard splints
41Materials Used for Splinting (3 of 6) Soft splintsThe most commonly used soft splint is the inflatable, clear plastic air splint.Disadvantages:The zipper can stick, clog with dirt, or freeze.The splint can be punctured by sharp objects.Temperature and altitude changes can increase or decrease the pressure in the air splint.
43Materials Used for Splinting (5 of 6) Traction splintsA traction splint holds a lower extremity fracture in alignment by applying a constant, steady pull on the extremity.Proper application of a traction splint requires two trained EMTs working together.
45Splinting Specific Injury Sites (1 of 14) Shoulder girdle injuriesApply a sling made of a triangular bandage and secure it to the patient’s body with swathes.
46Splinting Specific Injury Sites (2 of 14) Shoulder dislocationPlace a pillow or a rolled blanket in the space between the upper arm and the chest wall.Apply the sling and swathe as for other shoulder injuries.Elbow injuriesDo not move an injured elbow from the position in which you find it.
47Splinting Specific Injury Sites (3 of 14) Elbow injuries (cont’d)Wrap the elbow in a pillow, add padding, and secure the pillow.Transport the patient in a sitting position with the splinted elbow resting on his or her lap.
48Splinting Specific Injury Sites (4 of 14) Forearm injuriesSeveral splints can be used:Air splintCardboard splintSAM splintFollow the steps in Skill Drill 14-2 to apply a SAM splint.Follow the steps in Skill Drill 14-3 to apply a zippered air splint.
49Splinting Specific Injury Sites (5 of 14) Forearm injuries (cont’d)To apply an air splint without a zipper:Place the air splint over your hand and lower arm and grasp the patient’s hand.Have a second person support the patient’s elbow.Apply slight pull in the long axis of the forearm.Slip the air splint off your arm and onto the patient’s injured forearm.
50Splinting Specific Injury Sites (6 of 14) Hand, wrist, and finger injuriesUse a bulky hand dressing and a short splint.Place any amputated parts in a sealed plastic bag and send them to the hospital.Cover all wounds with a dry, sterile dressing.Place the hand into the position of function.Place soft roller dressings into the palm.Apply a splint and secure it with a soft roller bandage.
51Splinting Specific Injury Sites (7 of 14) Pelvic fracturesTreat the patient for shock, but do not raise the legs until the patient is on a backboard.Feel for tenderness when you use both hands to firmly compress the patient’s pelvis.
52Splinting Specific Injury Sites (8 of 14) Hip injuriesDislocations and fractures are most common.Both may result from high-energy trauma.Fractures occur in elderly persons because bone weakens and become more fragile with age.Immobilize the hip in the position found.Use several pillows and rolled blankets.Place the patient on a long backboard.
53Splinting Specific Injury Sites (9 of 14) Thigh injuriesA fractured femur is very unstable.Place the patient in a comfortable position, treat for shock, and call for additional personnel and equipment.Traction splints are the most effective way to splint a unilateral fractured femur.Follow the steps in Skill Drill 14-4 to apply a Hare traction splint.
55Splinting Specific Injury Sites (11 of 14) Knee injuriesImmobilize an injured knee in the same position that you find it.If the knee is straight, use long, padded board splints or a long-leg air splint.
56Splinting Specific Injury Sites (12 of 14) Knee injuries (cont’d)If there is significant deformity:Place pillows, blankets, or clothing beneath the knee.Secure the splint materials to the leg with bandages, swathes, or cravats.Secure the injured leg to the uninjured leg.Place the patient on a backboard.
57Splinting Specific Injury Sites (13 of 14) Leg injuriesFractures of the leg can be splinted with air splints, cardboard splints, and magazines and newspapers.Follow the steps in Skill Drill 14-5 to apply an air splint to the leg.
58Splinting Specific Injury Sites (14 of 14) Ankle and foot injuriesFractures can be splinted with either a pillow or an air splint.Place the pillow splint around the injured ankle and foot, and tie or pin it in place.Follow the steps in Skill Drill 14-6 to apply a pillow splint to the ankle or foot.
59Additional Considerations Practice splinting until you can quickly and competently apply the principles in any situation.It takes two people to splint most limb injuries adequately.One person to stabilize and support the extremityOne person to apply the splint
60Injuries to the Head (Skull and Brain) (1 of 10) Head and spinal cord injuries are common causes of death.Can also lead to irreversible paralysis and permanent brain damageThe human skull has two primary parts:The craniumThe facial bones
61Injuries to the Head (Skull and Brain) (2 of 10)
62Injuries to the Head (Skull and Brain) (3 of 10) Mechanisms of injuryBetween the skull and the brain, cerebrospinal fluid (CSF) cushions the brain.A direct force can injure the skull and brain.An indirect force can also cause injury.
63Injuries to the Head (Skull and Brain) (4 of 10) Types of head injuriesIn a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to brain damage and death.An open head injury usually bleeds profusely.Examine the nose, eyes, and the wound itself to see if any blood or CSF is seeping out.Brain tissue or bone may be visible.
64Injuries to the Head (Skull and Brain) (5 of 10)
65Injuries to the Head (Skull and Brain) (6 of 10) Signs and symptoms of head injuriesConfusionUnusual behaviorUnconsciousnessNausea or vomitingBlood from an earDecreasing consciousnessUnequal pupils
66Injuries to the Head (Skull and Brain) (7 of 10) Signs and symptoms (cont’d)ParalysisSeizuresExternal head trauma (bleeding, bumps, bruises)A serious head injury may produce raccoon eyes and Battle’s sign.
67Injuries to the Head (Skull and Brain) (8 of 10)
68Injuries to the Head (Skull and Brain) (9 of 10) Treatment of head injuriesImmobilize the head in a neutral position.Maintain an open airway with the jaw-thrust maneuver.Support the patient’s breathing with oxygen.Monitor circulation; be prepared to perform CPR if necessary.
69Injuries to the Head (Skull and Brain) (10 of 10) Treatment of head injuries (cont’d)Determine whether blood or CSF is seeping from a wound or from the nose or ears.Control bleeding from all head wounds with dry, sterile dressings.Examine and treat other serious injuries.Arrange for prompt transport.
70Injuries of the Face (1 of 4) Facial injuries commonly result from the following types of injuries:Motor vehicle crashes in which the patient’s face hits the steering wheel or windshieldAssaultsFalls
71Injuries of the Face (2 of 4) Airway obstruction is the primary danger in severe facial injuries.If the patient has facial injuries, suspect a spinal injury.Treatment of facial injuriesImmobilize the head in a neutral position.Maintain an open airway with the jaw-thrust maneuver.
72Injuries of the Face (3 of 4) Treatment of facial injuries (cont’d)Support breathing.Monitor circulation.Control bleeding by covering any wound with a dry, sterile dressing and applying direct pressure.Look for and stabilize other serious injuries.Arrange for prompt transport.
73Injuries of the Face (4 of 4) Treatment of facial injuries (cont’d)If these measures do not keep the airway clear or if you are unable to control severe bleeding, log roll the patient onto the side.
74Injuries of the Spine (1 of 8) Mechanisms of injuryA displaced vertebra, swelling, or bleeding may put pressure on the spinal cord and damage it.In severe cases, the spinal cord may be severed.
75Injuries of the Spine (2 of 8) Mechanisms of injury (cont’d)Injury to the spinal cord high in the neck paralyzes the diaphragm and results in death.Gunshot wounds to the chest or abdomen may produce spinal cord injury at that level.Falls, motor vehicle crashes, and stabbings are other common MOIs.Suspect a spinal injury if the patient has sustained high-energy trauma.
76Injuries of the Spine (3 of 8) Signs and symptoms of spinal cord injuryLaceration, bruise, or other sign of injury to the head, neck, or spineTenderness over any point on the spine or neckPain in the neck or spine or pain radiating to an extremityExtremity weakness, numbness, paralysis, or loss of movement
77Injuries of the Spine (4 of 8) Signs and symptoms (cont’d)Loss of sensation or movement, or tingling/ burning sensation in any part of the body below the neckLoss of bowel or bladder controlTreatment of spinal injuriesPlace the head and neck in a neutral position.Stabilize the head and prevent movement of the neck.
78Injuries of the Spine (5 of 8) Treatment of spinal injuries (cont’d)Maintain an open airway with the jaw-thrust maneuver.Support the patient’s breathing by administering oxygen and by keeping the airway open.Monitor circulation.Assess the pulse, movement, and sensation in all extremities.
79Injuries of the Spine (6 of 8) Treatment of spinal injuries (cont’d)Examine and treat other serious injuries.Immobilize the patient on a long or short backboard.Arrange for prompt transport.Stabilizing the cervical spineFollow the steps in Skill Drill 14-7.
80Injuries of the Spine (7 of 8) Motorcycle and football helmetsHelmets often do not need to be removed.Remove part or all of a helmet only under two circumstances:When the face mask or visor interferes with adequate ventilation or with your ability to restore an adequate airwayWhen the helmet is so loose that securing it to the spinal immobilization device will not provide adequate immobilization of the head
81Injuries of the Spine (8 of 8) Motorcycle and football helmets (cont’d)Follow the steps in Skill Drill 14-8 to remove the mask on a sports helmet.Follow the steps in Skill Drill 14-9 to remove a helmet.
82Injuries of the Chest (1 of 7) Fractures of the ribsEven a simple fracture produces pain at the site and difficulty breathing.Rib fractures may be associated with injury to the underlying organs.
83Injuries of the Chest (2 of 7) Fractures of the ribs (cont’d)To determine whether a rib is bruised or broken, apply some pressure to another part of the rib.Be alert for signs and symptoms of internal injury, particularly shock.Place a pillow against the injured ribs to splint them.
84Injuries of the Chest (3 of 7) Fractures of the ribs (cont’d)Prevent excessive movement of the patient.Administer oxygen if it is available.Flail chestIf three or more ribs are broken in at least two places, the injured portion of the chest wall does not move with the rest of the chest.
85Injuries of the Chest (4 of 7) Flail chest (cont’d)A flail chest decreases the amount of oxygen and carbon dioxide exchanged in the lungs.
86Injuries of the Chest (5 of 7) Flail chest (cont’d)Firmly place a pillow on the flail section of the chest to stabilize it.In severe cases, it may be necessary to support the patient’s breathing.Monitor and support the patient’s ABCs.Arrange for prompt transport.
87Injuries of the Chest (6 of 7) Penetrating chest woundsIf an object penetrates the chest wall, air and blood escape into the space between the lungs and the chest wall.The air and blood may cause the lung to collapse.
88Injuries of the Chest (7 of 7) Penetrating chest wounds (cont’d)Blood loss into the chest cavity can produce shock.Quickly seal an open chest wound with an occlusive dressing.Administer oxygen if it is available.If a knife or other object is impaled in the chest, do not remove it.Arrange for prompt transport.
89Summary (1 of 4)Musculoskeletal injuries are caused by three types of mechanism of injury: direct force, indirect force, and twisting force.Fractures can be closed (the bone is broken but there is no break in the skin) or open (the bone is broken and the overlying skin is lacerated).
90Summary (2 of 4)A dislocation is a disruption that tears the supporting ligaments of the joint.A sprain is a joint injury caused by excessive stretching of the supporting ligaments.The three basic types of splints are rigid, soft, and traction.
91Summary (3 of 4)In a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to irreversible brain damage. An open injury of the head usually bleeds profusely.Airway obstruction is the primary danger in severe facial injuries.
92Summary (4 of 4)When you suspect a spinal injury, do not move the patient during the examination.The most common chest injuries are rib fractures, flail chest, and penetrating wounds.
93Review The musculoskeletal system refers to the: involuntary muscles of the nervous system.connective tissue that supports the skeleton.bones and voluntary muscles of the body.nervous system’s control over the muscles.I capitalized the answers.93
94ReviewAnswer:C. bones and voluntary muscles of the body.
95Review When examining an injured extremity, you should be sure to: manipulate it in different directions to determine where fractures might exist.keep it elevated at all times.splint it to reduce movement before conducting any assessments.squeeze the entire limb starting from the top in a systematic, firm manner.I capitalized the answers.95
96ReviewAnswer:D. squeeze the entire limb starting from the top in a systematic, firm manner.
97ReviewFacial injuries should be identified and treated as soon as possible because:bleeding is more obvious on the face.patients are always concerned about their faces.swelling may mask hidden injuries.of the risk for airway problems.I capitalized the answers.97
98ReviewAnswer:D. of the risk for airway problems.