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Chapter 14: Injuries to Muscles and Bones

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1 Chapter 14: Injuries to Muscles and Bones

2 Cognitive Objectives 5-3.1 Describe the function of the musculoskeletal system. 5-3.2 Differentiate between an open and a closed painful, swollen, deformed injury. 5-3.3 List the emergency medical care for a patient with a painful, swollen, deformed extremity. 5-3.4 Relate mechanism of injury to potential injuries of the head and spine. (1 of 2)

3 Cognitive Objectives 5-3.5 State the signs and symptoms of a potential spine injury. 5-3.6 Describe the method of determining if a responsive patient may have a spine injury. 5-3.7 List the signs and symptoms of injury to the head. 5-3.8 Describe the emergency medical care for injuries to the head. (2 of 2)

4 Affective Objectives 5-3.9 Explain the rationale for the feeling patients who have need for immobilization of the painful, swollen, deformed extremity. Demonstrate a caring attitude towards patients with a musculoskeletal injury who request emergency medical services. (1 of 2)

5 Affective Objectives Place the interests of the patient with a musculoskeletal injury as the foremost consideration when making any and all patient care decisions. Communicate with empathy to patients with a musculoskeletal injury, as well as with family members and friends of the patient. (2 of 2)

6 Psychomotor Objectives
Demonstrate the emergency medical care of a patient with a painful, swollen, deformed extremity. Demonstrate opening the airway in a patient with suspected spinal cord injury. Demonstrate evaluating a responsive patient with a suspected spinal cord injury. Demonstrate stabilizing of the cervical spine.

7 Knowledge and Attitude Objectives
Describe the mechanisms of injury for musculoskeletal injuries. Describe the need for body substance isolation techniques when examining or treating patients with musculoskeletal injuries. (1 of 4)

8 Knowledge and Attitude Objectives
Explain how to splint the following sites and injuries: Shoulder girdle Dislocation of the shoulder Elbow injury Injury to the forearm Injury to the hand, wrist, or fingers Pelvic fracture Hip injury Injury to the thigh Knee injury Leg injury Injury to the ankle or foot (2 of 4)

9 Knowledge and Attitude Objectives
Explain the two types of head injuries. Describe the treatment of facial injuries. Explain the mechanism of spine injuries. (3 of 4)

10 Knowledge and Attitude Objectives
Describe the signs, symptoms, and treatment of the following injuries: Fractured ribs Flail chest Penetrating chest wound (4 of 4)

11 Skill Objectives Perform body substance isolation techniques when treating a patient with musculoskeletal injuries. Examine a patient with musculoskeletal injuries. Evaluate the circulation and sensation of a patient with an extremity injury. Treat injuries of the face. (1 of 2)

12 Skill Objectives Treat the following injuries of the chest:
Fractured ribs Flail chest Penetrating chest injuries (2 of 2)

13 Injuries to Muscles and Bones
First responders encounter many types of musculoskeletal injuries. Providing proper care at the scene can prevent additional injury and disability. © Jones and Bartlett Publishers. Courtesy of MIEMSS.

14 The Skeletal System Consists of 206 bones Four functions:
Supports the body Protects vital structures Assists in body movement Manufactures red blood cells

15 Divisions of the Skeletal System
Head Spinal column Shoulder girdle Upper extremity Rib cage Pelvis Lower extremity (1 of 2)

16 Divisions of the Skeletal System

17 Spine Consists of a series of separate bones called vertebrae
Spinal cord Nerves that carry messages to and from brain Passes through hole in center of each vertebra Primary support structure for the entire body

18 Muscular System Provides support and movement
Muscles are attached to bones by tendons. Body has three types of muscles: Voluntary (skeletal): Controlled by person Involuntary (smooth): Cannot be controlled by person Cardiac: Found only in the heart

19 Mechanism of Injury How injuries occur
Causes of musculoskeletal injuries: Direct force Indirect force Twisting force PSDE = Painful, swollen, deformed extremity

20 Fractures Two types: Open Closed
Both kinds injure adjacent soft tissues. Can result in bleeding

21 Dislocations and Sprains
A disruption tears the supporting ligaments of the joint. Very painful to move Sprains Joint injury caused by excessive stretching of supporting ligaments A partial dislocation

22 Body Substance Isolation
Patients with musculoskeletal injuries may have open wounds. Wear approved gloves. Use heavy rescue gloves if responding to scene involving broken glass.

23 Signs and Symptoms of Extremity Injuries
Pain at injury site Open wound Swelling and discoloration (bruising) Inability to move extremity Deformity or angulation Tenderness at injury site

24 Exam of an Injured Limb Check an injured limb for: Open wounds
Bleeding Swelling Deformity Bruising (1 of 2)

25 Exam of an Injured Limb Check the extremity for: Pulse
Capillary refill Sensation Movement (2 of 2)

26 Treatment of Musculoskeletal Injuries
All limb injuries are treated the same way in the field: Cover open wounds. Control bleeding if necessary. Splint limb.

27 Principles of Splinting
Remove clothing. Assess limb. Cover all open wounds with dressing. Do not attempt to move before splinting. Immobilize joint above and below injury.

28 Splints Rigid splints Made from firm material (padded boards)
Soft splints Inflatable, clear plastic Traction splints Holds a lower extremity fracture in alignment

29 Elbow Injuries Do not move an injured elbow from the position in which you find it. Pillow splints help stabilize injured elbows.

30 Hip Injuries Hip fractures Occur at the upper end of the femur
Osteoporosis causes bones to become more fragile. Dislocated hips Extremely painful

31 Injuries of the Thigh A fractured femur is very unstable and usually produces significant deformity. Often much bleeding and swelling Treat for shock and help prevent further injury.

32 Injuries to the Head Common causes of death, paralysis, and permanent brain injury May occur from many different kinds of trauma Types: Closed head injury Open head injury

33 Signs and Symptoms of Head Injuries
Confusion Unusual behavior Unconsciousness Decreasing consciousness Nausea or vomiting Unequal pupils Paralysis Seizures External head trauma: Bleeding Bumps Contusions

34 Treatment of Head Injuries
Stabilize head in a neutral position. Maintain an open airway using the jaw-thrust technique. Support patient’s breathing. Monitor circulation. (1 of 2)

35 Treatment of Head Injuries
Check to see if CSF or blood is seeping from wound, nose, or ears. Control bleeding. Examine and treat other serious injuries. Arrange for prompt transport. (2 of 2)

36 Treatment of Facial Injuries
Stabilize head in a neutral position. Maintain an open airway. Support breathing as needed. Monitor circulation. Control bleeding. Look for and stabilize other serious injuries. Arrange for prompt transport.

37 Injuries to the Spine Mechanisms of injury
Pressure on spinal cord from displaced vertebrae, swelling, or bleeding Cord is severed, resulting in paralysis. Gunshot wounds Falls, motor vehicle collisions, and stabbing (1 of 2)

38 Injuries to the Spine (2 of 2)

39 Signs and Symptoms of Spinal Injuries
Laceration, bruise, or other sign of injury to head, neck, or spine Tenderness Extremity weakness, paralysis, or loss of movement Loss of sensation or tingling in any part of the body below neck

40 Treatment of Spinal Injuries
Stabilize head and neck in neutral position. Maintain an open airway. Support patient’s breathing. Monitor circulation. Assess pulse, movement, and sensation in all extremities. (1 of 2)

41 Treatment of Spinal Injuries
Examine and treat other serious injuries. Do not move patient. Assist in immobilizing patient onto a longboard. Arrange for prompt transport to an appropriate medical facility. (2 of 2)

42 Motorcycle and Football Helmets
In most instances, helmets do not have to be removed. Only remove helmet if: Face mask or visor interferes with adequate ventilation or airway management. Helmet is too loose, making immobilization inadequate. (1 of 2)

43 Motorcycle and Football Helmets
If you remove a football helmet, you should also remove the shoulder pads. You may have to provide extra padding to maintain neutral position. (2 of 2)

44 Injuries to the Chest Chest cavity contains lungs, heart, and several major blood vessels. Chest cavity is protected by chest wall. Chest wall is made up of the ribs, cartilage, and chest muscles. Common chest injuries include rib fractures, flail chest, and penetrating wounds.

45 Treatment of Rib Fractures
Place a pillow against injured ribs. Prevent excessive movement. Administer high-flow oxygen. Arrange for transport to hospital.

46 Flail Chest Three or more ribs are broken in at least two places.
Injured part moves opposite chest wall. Place a pillow firmly over flail section. Monitor breathing. Monitor and support ABCs.

47 Penetrating Chest Wounds
Results from penetration of chest wall by an object Introduces air and blood between lung and chest wall May result in lung collapse Severe blood loss into chest cavity can produce hemorrhagic shock. (1 of 2)

48 Penetrating Chest Wounds
(2 of 2)

49 Treatment of Penetrating Chest Wounds
Quickly seal an open chest wound with an occlusive dressing. Administer high-flow oxygen. Monitor breathing. Stabilize any impaled object. Prepare for transport.


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