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Musculosketal Trauma Chapter 30. Objectives Review Musculoskeletal System Injuries to bones and joints Critical Fractures Basics of Splinting.

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Presentation on theme: "Musculosketal Trauma Chapter 30. Objectives Review Musculoskeletal System Injuries to bones and joints Critical Fractures Basics of Splinting."— Presentation transcript:

1 Musculosketal Trauma Chapter 30

2 Objectives Review Musculoskeletal System Injuries to bones and joints Critical Fractures Basics of Splinting

3 The Muscles Voluntary – control at will Voluntary make deliberate movement like walking, chewing, and frowning Attached to the skeleton at one or both ends Form the major muscle mass of the body Tissue contracts when stimulated by a nerve impulse Give out bodies their distinctive shapes

4 Muscles can be injured in many ways Broken fibers from overextension Bruises Crushing Cuts Tears Painful swelling and weakness

5 Tendons and Ligaments Glue that holds the body together Composed of specialized connective tissue – Tendons – connect muscle to bone – Ligaments – connect bone to bone Can be crushed, bruised, cut or torn

6 Cartilage Extension of the bone Comprised of connective tissue Strong, smooth, flexible, compressible, slippery substance Found at the point of articulation of two bones Protects bones in motion from friction Acts as shock absorber between bone surfaces Leads to joint pain when injured

7 Joints allow for types of motion Flexion – Bending, moves the extremity toward the body Extension – Moves extremity away from body Adduction – Toward midline of the body Abduction – Movement of a body part away from the midline Rotation – Turning along the axis of the bone or joint Circumduction – Movement through an arc of a circle or in a circular motion from a central point

8 The Skeletal System Upper Extremity – shoulder girdle, arm, forearm, hand Clavicle (collar bone) Scapula (shoulder) Humerus (upper arm) Radius (lower arm) Ulna (includes olecranon, lower arm and elbow Carpal bones (wrist) Metacarpals (hand) Phalanges (fingers)

9 Lower extremity Pelvis, thigh, leg, foot Pelvis (including ilium, ischium, pubis) Femur (thigh) Patella (kneecap) Tibia (lower leg) Fibula (lower leg) Calcaneus (heel) Tarsals (ankle) Metatarsals (foot) Phalanges (toes)

10 Types of Injuries Fracture Strain Sprain Dislocation General injury considerations

11 Fractures A break in the continuity of a bone Caused by direct, indirect, or twisting force Open – Associated with an open wound Closed – Skin is not broken

12 Fractures Type can only be distinguished by x-ray Hairline – Small crack in bone, does not create instability Pathologic – Result of a degenerative disease such as osteoporosis Various complications – Hemorrhage from the bone – Instability of the extremity – Surrounding tissue damage – Infection (open fracture) – Interruption of distal blood supply Pathologic Fracture Epiphyseal Fracture

13 Strain Injury to a muscle or tendon Often due to overextension (overstretching) Can be caused by extreme muscle stress or fatigue associate with overuse No edema or discoloration Pain or weakness with use of the muscle

14 Sprain Injury to a joint capsule Damage to or tearing of the connective tissue Usually involves ligaments Usually occurs in shoulder, knee, or ankle Immediate pain and tenderness, followed by inflammation and swelling

15 Dislocation Displacement of bone from normal position in joint Caused by joint being forced beyond normal range of motion Obvious deformity and swelling; pain and tenderness May occur at shoulder, elbow, wrist, hand, hip, knee, ankle, or foot

16 General Injury Considerations Similar signs and symptoms; swelling, pain, or deformity Usually associated with external forces (fall, vehicle collision) May occur through degenerative disease, particularly in elderly patients Force may cause injuries to surrounding soft tissues and other body areas

17 Mechanism of Injury Direct force – injury occurs at the point of impact Indirect force – force impacts on one end of a limb, causing injury some distance away from point of impact Twisting force – One part of extremity remains stationary while the rest twists

18 Critical Fractures: Femur Symptoms Bone bleeds heavily – Up to 1.5 liters of blood Tension on thigh muscles is lost so thigh diameter increases, allowing more blood to housed within thigh Goals of Treatment Immobilize bone ends Reduce bleeding Effect of traction splint Bone ends are realigned, preventing further injury and reducing pain Diameter of thigh is decreased, allowing less blood to accumulate

19 Critical Fractures: Pelvis Bone itself bleeds heavily – Up to 2 liters of blood Application of PASG/MAST will stabilize fracture and may help tamponade bleeding pelvis Whatcom Co. Protocol page 17, recommends the pelvic sling in place of the PASG/MAST

20 Assessment based approach Bone or Joint Injuries Scene size-up/Primary Assessment BSI Consider MOI Ask bystanders what caused the injury Imagine the forces to which the patient’s body was subjected. Check for signs of severe hemorrhage Look for signs of shock and treat If injury has caused a life-threatening condition, immobilize injured extremity and transport immediately

21 Secondary Assessment If patient has life- threatening injury, not directly related to injury, initiate transport, immobilize enroute to hospital if time and patient’s condition allows Patient is responsive and oriented, inspect and gently palpate bone or joint Be gentle and reassuring Check injury site for signs/symptoms of injury (deformity, contusions, tenderness) Check for Crepitis Assess baseline vitals and obtain a history Greenstick Fracture

22 Secondary Assessment Evaluate the 6 “Ps” Pain Pallor Paralysis – May indicate nerve, muscle, tendon or ligament damage Paresthesia – May indicate nerve damage (Numbness, prickly feeling, or tingling) Pressure – May indicate damaged tissue or internal blood loss Pulse – Decreased or absence of distal pulse may indicate arterial damage

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24 Emergency Care Life-threatening, immobilize injured extremity during primary/secondary assessments if appropriate and does not delay transport If patient has other life-threatening condition, initiate transport, then immobilize enroute Immobilize suspected fracture – BSI – Oxygen – Maintain in-line stabilization if spine injury suspected – Splint bone and joint – Apply cold packs to painful, swollen, or deformed extremity – Elevate extremity (No spine injury) – Transport – Reassess vital signs, splinting – Check distal pulses, motor function and sensation after immobilizing

25 General rules to Splinting Before and after splinting, assess pulse, motor function, and sensation distal to the injury Immobilize joints above and below a long bone injury Remove or cut away clothing and jewelry around the injury site Cover all wounds with sterile dressings and gently bandage before splinting If there is severe deformity or the distal extremity is cyanotic or lacks pulses, align injured limb with gentle manual traction before splinting

26 General rules to Splinting continued Never intentionally replace protruding bones or push them back below the skin Pad each splint to prevent pressure and discomfort Apply the splint before trying to move the patient When in doubt, splint the injury If patient shows signs of shock, do not apply splint first; align patient in normal anatomical position, treat for shock, transport immediately

27 Splinting equipment Rigid splints Commercially manufactured Made of wood, wood fiber, plastic or cardboard Designed to fit specific limbs, or can be molded to fit any appendage May come with washable pads

28 Pressure (air/pneumatic) splints Soft and pliable before inflation; rigid once applied and inflated Cannot be sized May impair circulation May interfere with ability to assess pulses May lose or gain pressure with changes in temperature/altitude Seek medical direction regarding use

29 Traction Splints Provide a counterpull that alleviates pain, reduces blood loss, and minimizes further injury Purpose is to immobilize bone ends, reduce diameter of thigh, and prevent further injury Many types available

30 Formable splints & Vacuum splints Formable Rigid but made to be shaped to fit deformed extremity Can fixed in place with cravats or Velcro Typically composed of wire, aluminum or other flexible metal Vacuum Splint Soft and pliable Easily formed to deformed extremities When air is sucked out, splint becomes rigid

31 Sling and swathe Provides stability to injured shoulder, elbow or upper humerus Sling support arm; swathe holds arm against chest Minimizes pain and further injury

32 Spine board Considered a full body splint Use in cases of critical injury to provide stability where extremity fractures cannot be splinted at scene

33 Improvised splints Light in weight but firm and rigid As wide as thickest part of fractured limb Long enough to extend past joints and prevent movement Padded well so inner surfaces are not in contact with skin Possible materials include cane, cardboard, umbrella, pillow, blanket

34 Hazards of Improper splinting Compression of nerves, tissues, and blood vessels Delay in patient’s transport Reduction of distal circulation Aggravation of bone or joint injury Aggravation or cause of damage to tissue, nerves, blood vessels, or muscles

35 Splinting long bone injuries Look for exposed bone ends, joints locked in position, paresthesia (tingling), paralysis, and pallor Assess pulse, motor function, and sensory below the injury site If limb severely deformed, cyanotic, or lacks distal pulses, align with gentle traction

36 Splinting joint injuries Look for paresthesia or paralysis Assess the pulse, motor and sensory function below the injury site If distal extremity is cyanotic, or lacks distal pulses, align with gentle traction; stop if pain or crepitus increases

37 Traction Splinting Use for fractured femur Reduces diameter of thigh Decreases space in which bleeding can occur Do not use in the following instances; – Injury is within one to two inches of the knee or ankle – Knee itself is injured – Hip is injured – Pelvis is injured – There is partial amputation or avulsion with bone separation

38 Splinting Specific Injuries Special techniques may be applied to the splinting of suspected bone and joint injuries to specific sites Review splinting techniques for the shoulder, upper arm, elbow, forearm, wrist, hand, fingers, pelvis, hip, thigh, knee, lower leg, ankle, and foot

39 Pelvic Fracture PASG can splint pelvis and decrease compartment size to reduce bleeding Commercial pelvic splint is another method Improvised pelvic wrap may be applied if necessary – Fold a sheet lengthwise to 8” width – Slide it under the small of the back, then down under the pelvis until centered. Ends of the sheet must be of equal length on both sides of patient – Cross tail ends over patient and twist until sheet is tightly secured around pelvis – Tuck sheet ends under patient or tie into square knot – Place patient on backboard or rigid device

40 Compartment Syndrome May occur when fracture or injury to an extremity has occurred May occur in buttock or abdomen Occurs when pressure in space around capillaries exceed pressure needed to perfuse tissues; blood flow is cut off and cells become hypoxic Usually develops over time as edema around injured area increases Commonly associated with fractures, bleeding from trauma, crush injuries, and high-energy trauma

41 Compartment Syndrome Signs/Symptoms Severe pain or burning sensation Decreased strength in extremity Paralysis of extremity Pain with movement Extremity feeling hard to palpitation Distal pulses, motor, and sensory function possibly normal Treatment Immobilize and splint affected extremity Elevate extremity and apply cold pack to ice Transport ASAP

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43 Questions ????


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