Musculoskeletal Trauma

Sections  Introduction to Musculoskeletal Trauma  Anatomy and Physiology of the Musculoskeletal System  Pathophysiology of the Musculoskeletal System  Musculoskeletal Injury Assessment  Musculoskeletal Injury Management  Introduction to Musculoskeletal Trauma  Anatomy and Physiology of the Musculoskeletal System  Pathophysiology of the Musculoskeletal System  Musculoskeletal Injury Assessment  Musculoskeletal Injury Management

 Millions of Americans experience annually.  Multiple MOI  Falls, Crashes, Violence, etc  Multi-system trauma  Millions of Americans experience annually.  Multiple MOI  Falls, Crashes, Violence, etc  Multi-system trauma Introduction to Musculoskeletal Injuries

 Skeletal Tissue & Structure  Protects organs  Allows for efficient movement  Stores salts and other materials needed for metabolism  Produces RBC’s  Skeletal Tissue & Structure  Protects organs  Allows for efficient movement  Stores salts and other materials needed for metabolism  Produces RBC’s Anatomy & Physiology of the Musculoskeletal System

Musculoskeletal System  Bone Structure  Diaphysis  Epiphysis  End of a long bone  Metaphysis  Between epiphysis and diaphysis  Growth plate  Medullary Canal  Contains bone marrow  Periosteum  Fibrous covering of diaphysis  Cartilage  Connective tissue that provides a smooth articulation surface for other bones.  Bone Structure  Diaphysis  Epiphysis  End of a long bone  Metaphysis  Between epiphysis and diaphysis  Growth plate  Medullary Canal  Contains bone marrow  Periosteum  Fibrous covering of diaphysis  Cartilage  Connective tissue that provides a smooth articulation surface for other bones. Figure 7-1

 Joint Structure  Joint  Where bones interact  Synarthrosis  A joint that does not permit movement  Diarthroses (Synovial Joints)  Monaxial: hinge or pivot joints  Biaxial: gliding, sliding, or saddle joints  Triaxial: Ball & socket joints  Ligaments  Joint Capsule  Synovial fluid  Joint Structure  Joint  Where bones interact  Synarthrosis  A joint that does not permit movement  Diarthroses (Synovial Joints)  Monaxial: hinge or pivot joints  Biaxial: gliding, sliding, or saddle joints  Triaxial: Ball & socket joints  Ligaments  Joint Capsule  Synovial fluid Anatomy & Physiology of the Musculoskeletal System

 Skeletal Organization  206 Bones  Axial Skeleton  Head, Thorax & Spine  Appendicular Skeleton  Upper Extremities  Lower Extremities  Skeletal Organization  206 Bones  Axial Skeleton  Head, Thorax & Spine  Appendicular Skeleton  Upper Extremities  Lower Extremities Anatomy & Physiology of the Musculoskeletal System

 Bone Aging  Birth to Adult (18-20)  Transition from flexible to firm bone  Adult to elderly (40+)  Reduction in collagen matrix and calcium salts  Diminution of bone strength  Spinal curvature  Bone Aging  Birth to Adult (18-20)  Transition from flexible to firm bone  Adult to elderly (40+)  Reduction in collagen matrix and calcium salts  Diminution of bone strength  Spinal curvature Anatomy & Physiology of the Musculoskeletal System

 Muscular Tissue & Structure  600 muscle groups  Muscular Tissue & Structure  600 muscle groups Anatomy & Physiology of the Musculoskeletal System (continued)

 Types of muscles  Smooth  Striated  Cardiac  Types of muscles  Smooth  Striated  Cardiac Anatomy & Physiology of the Musculoskeletal System

 Muscular Injury  Contusion  Compartment Syndrome  Penetrating Injury  Fatigue  Muscle Cramp  Muscle Spasm  Strain  Muscular Injury  Contusion  Compartment Syndrome  Penetrating Injury  Fatigue  Muscle Cramp  Muscle Spasm  Strain Pathophysiology of the Musculoskeletal System

 Joint Injury  Sprain  Subluxation  Dislocation  Bone Injury  Open Fracture  Closed Fracture  Hairline Fracture  Impacted Fracture  Joint Injury  Sprain  Subluxation  Dislocation  Bone Injury  Open Fracture  Closed Fracture  Hairline Fracture  Impacted Fracture Pathophysiology of the Musculoskeletal System

 Pediatric Considerations  Flexible nature  Geriatric Considerations  Osteoporosis  Pathological Fractures  Pathological diseases  Pediatric Considerations  Flexible nature  Geriatric Considerations  Osteoporosis  Pathological Fractures  Pathological diseases Pathophysiology of the Musculoskeletal System

 General Considerations with musculoskeletal injuries  Neurological compromise  Decreased stability  Muscle spasm  Bone Repair Cycle  Osteocytes produce osteoblasts  Deposition of salts  Increasing strength of matrix  General Considerations with musculoskeletal injuries  Neurological compromise  Decreased stability  Muscle spasm  Bone Repair Cycle  Osteocytes produce osteoblasts  Deposition of salts  Increasing strength of matrix Pathophysiology of the Musculoskeletal System

 Inflammatory & Degenerative Conditions  Bursitis  Tendinitis  Arthritis  Osteoarthritis Degenerative  Rheumatoid Arthritis Chronic, systemic, progressive, debilitating  Gout Inflammation of joints produced by accumulation of uric acid crystals  Inflammatory & Degenerative Conditions  Bursitis  Tendinitis  Arthritis  Osteoarthritis Degenerative  Rheumatoid Arthritis Chronic, systemic, progressive, debilitating  Gout Inflammation of joints produced by accumulation of uric acid crystals Pathophysiology of the Musculoskeletal System

 Scene Size-up  Initial Assessment  Categories of urgency  Life & Limb threatening injury  Life threatening injury and minor musculoskeletal injury  Non-life threatening injuries but serious musculoskeletal injuries  Non-life threatening injuries and only isolated minor musculoskeletal injuries  Rapid Trauma Assessment  Focused H&P  6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses  Detailed Physical Exam  Ongoing Assessment  Sports Injury Consideration  Scene Size-up  Initial Assessment  Categories of urgency  Life & Limb threatening injury  Life threatening injury and minor musculoskeletal injury  Non-life threatening injuries but serious musculoskeletal injuries  Non-life threatening injuries and only isolated minor musculoskeletal injuries  Rapid Trauma Assessment  Focused H&P  6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses  Detailed Physical Exam  Ongoing Assessment  Sports Injury Consideration Musculoskeletal Injury Assessment

 General Principles  Protecting Open Wounds  Positioning the limb  Immobilizing the injury  Checking Neurovascular Function  General Principles  Protecting Open Wounds  Positioning the limb  Immobilizing the injury  Checking Neurovascular Function Musculoskeletal Injury Management

 Splinting Devices  Rigid splints  Formable Splints  Soft Splints  Traction Splints  Other Splinting Aids  Vacuum Splints  Air Sprints  Cravats or Velcro Splints  Fracture Care  Joint Care  Muscular & Connective Tissue Care  Splinting Devices  Rigid splints  Formable Splints  Soft Splints  Traction Splints  Other Splinting Aids  Vacuum Splints  Air Sprints  Cravats or Velcro Splints  Fracture Care  Joint Care  Muscular & Connective Tissue Care Musculoskeletal Injury Management

 Care for Specific Fractures  Pelvis  Scoop Stretcher  PASG  Fluid Resuscitation  Femur  Traction Splints  PASG  Fracture versus hip dislocation  Care for Specific Fractures  Pelvis  Scoop Stretcher  PASG  Fluid Resuscitation  Femur  Traction Splints  PASG  Fracture versus hip dislocation Musculoskeletal Injury Management

 Care Specific Fractures  Tibia/Fibula  Clavicle  Most frequently fractured bone in the body  Transmitted to 1 st and 2 nd rib  Alert for lung injury  Humerus  Radius/Ulna  Care Specific Fractures  Tibia/Fibula  Clavicle  Most frequently fractured bone in the body  Transmitted to 1 st and 2 nd rib  Alert for lung injury  Humerus  Radius/Ulna Musculoskeletal Injury Management

 Care for Specific Joint Injuries  Hip  Knee  Ankle  Foot  Shoulder  Elbow  Wrist/Hand  Finger  Care for Specific Joint Injuries  Hip  Knee  Ankle  Foot  Shoulder  Elbow  Wrist/Hand  Finger Musculoskeletal Injury Management Joint Injuries Alert for neurological Compromise

 Soft & Connective Tissue Injuries  Tendon  Ligament  Muscle  Soft & Connective Tissue Injuries  Tendon  Ligament  Muscle Musculoskeletal Injury Management

 Nitrous Oxide  50% O 2 :50% N 2 O  Non-explosive  Effects dissipate in 2-5 minutes  Easily diffused into air filled spaces in body.  Dose  Inhaled & self administered  Onset  1-2 minutes  Nitrous Oxide  50% O 2 :50% N 2 O  Non-explosive  Effects dissipate in 2-5 minutes  Easily diffused into air filled spaces in body.  Dose  Inhaled & self administered  Onset  1-2 minutes Musculoskeletal Injury Management Medications  Diazepam  Benzodiazepine  Antianxiety  Analgesic  Dose  5-15 mg titrated  Onset  minutes  Duration  minutes  Counter Agent  Flumazenil  Diazepam  Benzodiazepine  Antianxiety  Analgesic  Dose  5-15 mg titrated  Onset  minutes  Duration  minutes  Counter Agent  Flumazenil

 Morphine Sulfate  Opiate alkaloid  Reduces vascular volume and cardiac preload  Do not administer to hypovolemic patients  Dose  2mg IVP slow  Counter Agent  Narcan  Morphine Sulfate  Opiate alkaloid  Reduces vascular volume and cardiac preload  Do not administer to hypovolemic patients  Dose  2mg IVP slow  Counter Agent  Narcan Musculoskeletal Injury Management Medications (continued)

Musculoskeletal Injury Management Medications  Meperidine  Demerol  Narcotic Analgesic  Dose  mg  Counter Agent  Narcan  Meperidine  Demerol  Narcotic Analgesic  Dose  mg  Counter Agent  Narcan

 Nalbuphine  Nubain  Narcotic Analgesic  Equivalent to Morphine  Dose  2-5 mg  Onset  2-3 minutes  Duration  3-6 hours  Nalbuphine  Nubain  Narcotic Analgesic  Equivalent to Morphine  Dose  2-5 mg  Onset  2-3 minutes  Duration  3-6 hours Musculoskeletal Injury Management Medications

 Other Injury Consideration  Pediatric Musculoskeletal Injury  Athletic Musculoskeletal Injury  Patient Refusals & Referral  Psychological Support  Other Injury Consideration  Pediatric Musculoskeletal Injury  Athletic Musculoskeletal Injury  Patient Refusals & Referral  Psychological Support Musculoskeletal Injury Management