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Copyright © 2004, Mosby Inc. All rights reserved..

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Presentation on theme: "Copyright © 2004, Mosby Inc. All rights reserved.."— Presentation transcript:

1 Copyright © 2004, Mosby Inc. All rights reserved.

2 Musculoskeletal Care Chapter 28 Copyright © 2004, Mosby Inc. All rights reserved. Slide 1

3 Case History You respond to a call for a man who fell from a roof. On arrival, you find the patient screaming in pain. You notice lacerations on both legs and bone ends protruding from one leg. He also has a deformity in the middle of his left arm. You respond to a call for a man who fell from a roof. On arrival, you find the patient screaming in pain. You notice lacerations on both legs and bone ends protruding from one leg. He also has a deformity in the middle of his left arm. Copyright © 2004, Mosby Inc. All rights reserved. Slide 2

4 Skeletal System Function Gives the body shape Protects vital organs Provides body movement Copyright © 2004, Mosby Inc. All rights reserved. Slide 3

5 Bones and Other Connective Tissues 206 bones Bones are a form of connective tissue. Other forms of connective tissue   Cartilage   Ligaments   Tendons Copyright © 2004, Mosby Inc. All rights reserved. Slide 4

6 Skeletal System Copyright © 2004, Mosby Inc. All rights reserved. Slide 5

7 Upper Extremities Copyright © 2004, Mosby Inc. All rights reserved. Slide 6

8 Lower Extremities Copyright © 2004, Mosby Inc. All rights reserved. Slide 7

9 Types of Joints Copyright © 2004, Mosby Inc. All rights reserved. Slide 8

10 Types of Muscles Voluntary Involuntary Cardiac Copyright © 2004, Mosby Inc. All rights reserved. Slide 9

11 Skeletal Muscles Copyright © 2004, Mosby Inc. All rights reserved. Slide 10

12 Definitions FractureFracture  A break in the continuity of bone SprainSprain  Injury to ligaments, usually resulting from stretching forces StrainStrain  Injury to muscles or their tendons, usually from overstretching or violent contractions DislocationDislocation  A displacement of bones in a joint from their normal anatomic position Copyright © 2004, Mosby Inc. All rights reserved. Slide 11

13 Direct Force Copyright © 2004, Mosby Inc. All rights reserved. Slide 12

14 Direct Force Copyright © 2004, Mosby Inc. All rights reserved. Slide 13

15 Indirect Force Copyright © 2004, Mosby Inc. All rights reserved. Slide 14

16 Indirect Force Copyright © 2004, Mosby Inc. All rights reserved. Slide 15

17 Indirect Force – Twisting Copyright © 2004, Mosby Inc. All rights reserved. Slide 16

18 Average Blood Loss with Closed Fracture Site of Fracture Amount of Blood Loss Radius or ulna250-500 ml Humerus500-750 ml Pelvis1500-3000 ml Femur1000-2000 ml Tibia and fibula500-1000 ml Copyright © 2004, Mosby Inc. All rights reserved. Slide 17

19 Signs and Symptoms Pain and tendernessPain and tenderness Deformity or angulationDeformity or angulation Swelling and discolorationSwelling and discoloration Loss of useLoss of use Grating or crepitusGrating or crepitus Exposed boneExposed bone Joint locked into position or dislocationJoint locked into position or dislocation BleedingBleeding Copyright © 2004, Mosby Inc. All rights reserved. Slide 18

20 Vascular Injuries Vessels can be compressed or torn.Vessels can be compressed or torn. Dislocations are at high risk for vessel compression or injury.Dislocations are at high risk for vessel compression or injury. Loss of blood flow to extremityLoss of blood flow to extremity Copyright © 2004, Mosby Inc. All rights reserved. Slide 19

21 Vascular Injuries – Signs and Symptoms Loss of distal pulsesLoss of distal pulses Pale, cool skinPale, cool skin Delayed or absent capillary refillDelayed or absent capillary refill PainPain NumbnessNumbness Tingling or pricklingTingling or prickling Sensory lossSensory loss ParalysisParalysis Copyright © 2004, Mosby Inc. All rights reserved. Slide 20

22 Vascular Injuries Memory Device – The “5 Ps” PainPain PallorPallor PulselessnessPulselessness Paresthesia (tingling)Paresthesia (tingling) ParalysisParalysis Copyright © 2004, Mosby Inc. All rights reserved. Slide 21

23 Peripheral Nerve Injury Injuries can cause compression or complete tearing of nerve.Injuries can cause compression or complete tearing of nerve. Violent forces can cause direct damage.Violent forces can cause direct damage. Nerve injury occurs commonly in joints.Nerve injury occurs commonly in joints. Copyright © 2004, Mosby Inc. All rights reserved. Slide 22

24 Signs and Symptoms Pain and tendernessPain and tenderness Deformity or angulationDeformity or angulation Loss of useLoss of use GratingGrating SwellingSwelling Bruising (discoloration)Bruising (discoloration) Exposed bone endsExposed bone ends Joint locked into positionJoint locked into position Copyright © 2004, Mosby Inc. All rights reserved. Slide 23

25 Emergency Medical Care Use personal protection measures.Use personal protection measures. Administer oxygen.Administer oxygen. After life threats have been controlled, splint injuries in preparation for transport.After life threats have been controlled, splint injuries in preparation for transport. Apply a cold pack.Apply a cold pack. Elevate the extremity.Elevate the extremity. Copyright © 2004, Mosby Inc. All rights reserved. Slide 24

26 Splinting ReasonsReasons  Prevent motion of bone fragments  Minimize the following complications: »Damage to muscles, nerves, or blood vessels »Conversion of a closed fracture to an open fracture »Restriction of blood flow »Excessive bleeding »Increased pain »Paralysis of extremities due to a damaged spine »Injury to viscera Copyright © 2004, Mosby Inc. All rights reserved. Slide 25

27 General Rules of Splinting Assess pulse, motor function, and sensation.Assess pulse, motor function, and sensation.  Before and after splint application  Record findings. Immobilize the joint above and below the injury.Immobilize the joint above and below the injury. Copyright © 2004, Mosby Inc. All rights reserved. Slide 26

28 General Rules of Splinting Remove or cut away clothing.Remove or cut away clothing. Cover open wounds with a sterile dressing.Cover open wounds with a sterile dressing. Severe deformity, cyanotic distal extremity, or lack of pulsesSevere deformity, cyanotic distal extremity, or lack of pulses  Align with gentle traction before splinting. Copyright © 2004, Mosby Inc. All rights reserved. Slide 27

29 General Rules of Splinting Do not intentionally replace the protruding bones.Do not intentionally replace the protruding bones. Pad each splint to prevent pressure and discomfort to the patient.Pad each splint to prevent pressure and discomfort to the patient. Splint the patient before moving when feasible and no life threats.Splint the patient before moving when feasible and no life threats. Copyright © 2004, Mosby Inc. All rights reserved. Slide 28

30 General Rules of Splinting When in doubt, splint the injury.When in doubt, splint the injury. If patient has signs of shockIf patient has signs of shock  Align in normal anatomic position  Transport on backboard Copyright © 2004, Mosby Inc. All rights reserved. Slide 29

31 Equipment Rigid splintsRigid splints Traction splintsTraction splints Pneumatic splints (air, vacuum)Pneumatic splints (air, vacuum) Improvised splints, pillowImprovised splints, pillow Pneumatic antishock garment (as a splint)Pneumatic antishock garment (as a splint) Copyright © 2004, Mosby Inc. All rights reserved. Slide 30

32 Hazards of Improper Splinting Compression of nerves, tissues, and blood vesselsCompression of nerves, tissues, and blood vessels Delay in transport of patient with life- threatening injuryDelay in transport of patient with life- threatening injury Copyright © 2004, Mosby Inc. All rights reserved. Slide 31

33 Hazards of Improper Splinting Splint applied too tightSplint applied too tight Aggravation of bone or joint injuryAggravation of bone or joint injury Cause or aggravate tissue, nerve, vessel, or muscle damageCause or aggravate tissue, nerve, vessel, or muscle damage  From excessive bone or joint movement Copyright © 2004, Mosby Inc. All rights reserved. Slide 32

34 Long Bone Splinting Use personal protection measures.Use personal protection measures. Apply manual stabilization.Apply manual stabilization. Assess pulse, motor and sensory function before and after splinting.Assess pulse, motor and sensory function before and after splinting. Severe deformity, cyanotic distal extremity, or lack of pulsesSevere deformity, cyanotic distal extremity, or lack of pulses  Align with gentle traction before splinting. Apply splint.Apply splint. Immobilize hand/foot in position of function.Immobilize hand/foot in position of function. Copyright © 2004, Mosby Inc. All rights reserved. Slide 33

35 Traction Splinting – Indications Mid-thigh injuryMid-thigh injury No joint or lower leg injuryNo joint or lower leg injury Copyright © 2004, Mosby Inc. All rights reserved. Slide 34

36 Contraindications Injury close to the kneeInjury close to the knee Injury to the kneeInjury to the knee Injury to the hipInjury to the hip Injured pelvisInjured pelvis Copyright © 2004, Mosby Inc. All rights reserved. Slide 35

37 Contraindications Partial amputation or avulsion with bone separationPartial amputation or avulsion with bone separation  Distal limb is connected only by marginal tissue.  Traction would risk separation. Lower leg or ankle injuryLower leg or ankle injury Copyright © 2004, Mosby Inc. All rights reserved. Slide 36

38 Traction Splinting – Procedure Use personal protection measures.Use personal protection measures. Assess pulse, motor function, and sensation before and after splinting.Assess pulse, motor function, and sensation before and after splinting. Perform manual stabilization of the injured leg.Perform manual stabilization of the injured leg. Apply splint.Apply splint. Copyright © 2004, Mosby Inc. All rights reserved. Slide 37

39 Traction Splinting – Procedure Reevaluate proximal/distal securing devices.Reevaluate proximal/distal securing devices. Reassess pulse, motor and sensory function.Reassess pulse, motor and sensory function. Secure torso to the long board.Secure torso to the long board. Secure splint to the long board to prevent movement of splint.Secure splint to the long board to prevent movement of splint. Copyright © 2004, Mosby Inc. All rights reserved. Slide 38

40 Specific Splinting Techniques — Upper Body ClavicleClavicle ShoulderShoulder Upper armUpper arm ElbowElbow Forearm/wristForearm/wrist HandHand PelvisPelvis Sling and swathe Sling and swathe with splint Rigid splint/sling Sling and swathe with splint Rigid splint and sling Long spine board/PASG Copyright © 2004, Mosby Inc. All rights reserved. Slide 39

41 Specific Splinting Techniques — Lower Body Dislocated hipDislocated hip Hip injuryHip injury FemurFemur KneeKnee Lower legLower leg Ankle and footAnkle and foot Anatomic/spine board Traction splint/PASG Rigid splint Pillow splint Copyright © 2004, Mosby Inc. All rights reserved. Slide 40

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