1. Musculoskeletal Injuries: Management
Chapter 20, Section 3
Musculoskeletal Injuries: Management
Discussion Points: You will likely spend many hours practicing the skills that accompany this topic – far more time than you will spend talking about them. This set of slides is only a brief overview.

2. Objectives
Explain the general management of a patient with an MS injury.
List and demonstrate the use of the following types of splints:
sling and swathe
Quick Splint
soft splint
rigid splint
traction splint
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3. Objectives
Demonstrate how to care for specific injuries to the arm or leg.
Demonstrate how to remove a boot, including a ski boot.
Describe and demonstrate placing a patient in the anatomical position using the principles of “jams and pretzels.”

4. Topics
Management
Boot Removal
Chapter Summary

5. Management Deal with life threats General care has common steps
Use BSI
Plan of action to include help, equipment, and transport needed
Expose injury to observe for bleeding, deformity, discoloration, swelling
Control bleeding, bandage wounds
Discussion Points:
Note that these are general principles. Most have been covered in previous chapters or courses.
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6. Management General care has common steps
Immobilize as needed – check CMS
Ice for swelling
Transport to aid room, monitor patient comfort
Reassess for CMS and bleeding, adjust treatment as needed
O2 as needed
Transfer to higher level of care
Discussion Point:
Emphasize reassessment, since a situation can change as the patient is brought in, or as they warm up in the first aid area.

7. Splinting Splint to: Decrease movement of broken bone ends
Allow clotting, prevent further blood loss
Decrease pain at injury site
Help with muscle spasms, place in anatomic position
Prevent closed fracture bone ends from penetrating the skin
Discussion Point:
Mention each as this is mostly straightforward material.
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8. Splinting continued Copyright Edward McNamara
Some examples of the many different types of commercial splints.
Copyright Edward McNamara
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9. Splinting Splint to: Prevent further tissue damage
Allow easier transport
Prevent paralysis in spinal injuries
Discussion Point:
Mention each as this is mostly straightforward material.

10. Types of Splints Soft splints Sling and swathe Air splint
Vacuum splint
Blanket roll/pillow splint
Pelvic binders
Discussion Points:
Have on hand the splints available at your area.
Note the splints that are only found in your toboggans, or only in the aid room.
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11. Types of Splints continued Copyright Edward McNamara
A sling and swathe is used primarily to immobilize injured upper extremities.
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Copyright Edward McNamara

12. Types of Splints
A vacuum splint in use on an injured arm.
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13. Types of Splints continued
A pillow splint can be used on wrist and hand injuries when rigid splints are not available.
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14. Types of Splints continued Copyright Candace Horgen
A SAM™ pelvic sling.
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Copyright Candace Horgen

15. Types of Splints Rigid splints Cardboard Wood Quick splint
Airplane splint
Malleable metal splints
Traction splint
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16. Types of Splints
An example of a rigid splint.
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17. Types of Splints continued Copyright Edward McNamara
A cardboard splint.
Copyright Edward McNamara
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18. Types of Splints continued Copyright Edward McNamara
An airplane splint being applied.
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Copyright Edward McNamara

19. Types of Splints
A SAM™ splint.
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Copyright John Dobson, M.D.

20. Types of Splints
Commercially available traction splints.
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21. Types of Splints
Commercially available traction splints.
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22. Types of Splints Improvised splints
i.e., Popsicle™ stick for finger splint
Only use if the one commonly used is unavailable
Discussion Points:
Improvised splints may have to be used if a limb cannot be aligned; show students the materials available for them to use.
Mention improvised splints for “civilian” situations in which convenient toboggan or aid room supplies are unavailable.

23. Types of Splints
The use of a magazine as a splint.

24. Types of Splints
A variety of items can be used as splints.

25. Principles of Splinting
Splint before moving patient
Check CMS before and after
Manually stabilize injured area
Use correct type/size, pad as needed
Position, move limb carefully, and secure
If shock is significant, work quickly and transport
Discussion Points:
The information on the next three slides will become much of the mantra of your practice sessions, as well as the backbone of the treatment of many of your patients:
Checking CMS
Manual stabilization
Correct size and type of splint
Care in moving injured limbs
All of the above are second nature to OEC techs, and applies to your students as well.
Note the last bullet: When a patient’s general condition is deteriorating, it may be more important to transport than to spend time splinting MS injuries.
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26. Principles of Splinting
If deformity is present with fracture, align if possible
If alignment is not possible, secure in best position for stability/comfort
Open fracture
Severely angulated or “locked”
Dislocations and/or fracture at joint
Patient who will not allow movement
Injury with impaled object
Discussion Points:
Alignment is mentioned several times in the chapter:
In relation to straightening a long bone fracture before splinting (efficiency and improving patient comfort)
To re-establish distal CMS
Joint splinting in position found (if CMS is compromised AND a 2+ hour wait for hospital care)
Increased pain and resistance may be cause to abandon alignment of a long bone and splint in position found (improvised splinting)
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27. Principles of Splinting
Splint an injured knee in the position found.
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28. Principles of Splinting
Do not attempt to reduce fractures or force bone ends back into skin
Remove jewelry before swelling occurs – account for it
Immobilize above and below injury site (bones for joint injury, joints for bone injury)
Advise patient to seek follow-up care
Discussion Points:
Ensure students understand the difference between aligning and reducing a fracture.
The chapter mentions that bones may pull back into the skin with alignment, especially in relation to traction splinting. This is different from forcing the bone ends back in.
If jewelry is removed, ensure that the patient has it with them when they leave to avoid accusations of theft related to our care.
The last two bullets on the slide are not mentioned specifically in the principles of splinting section of the chapter, but appear in the various descriptions of splinting specific injuries.

29. Caring for Specific Extremity Injuries
Upper Extremity Injuries
Shoulder, clavicle, scapula
Sling and swathe
Figure eight splint option for clavicle
Blanket roll
Posterior sternoclavicular dislocation
Reduce if vascular/respiratory life threat
Humerus
Splint, sling and swathe
Discussion Points:
Note that the chapter includes many details regarding the methods and variations used for splinting each of the various upper extremity parts.
The basics are listed here as these are primarily practical skills.
Encourage students to use the chapter descriptions and skill guides to practice the various splinting methods. As such, no additional discussion points will be added to most of the next several slides.
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30. Caring for Specific Extremity Injuries
To align the humerus, place the patient in a supine position and apply gentle longitudinal tension.
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Copyright Edward McNamara

31. Caring for Specific Extremity Injuries
Upper Extremity Injuries
Elbow
Sling and swathe in position found
Stabilize above and below the joint
Option to use malleable / rigid splint
If CMS compromise AND care is 2+ hours away, may attempt 1 axial alignment
If elbow I straight, secure arm to body with swathes
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32. Caring for Specific Extremity Injuries
Splint elbow injuries in children in the position the injury was found.
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33. Caring for Specific Extremity Injuries
Application of a splint for a straight arm in a child.
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34. Caring for Specific Extremity Injuries
Application of a splint for a straight arm in an adult.
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35. Caring for Specific Extremity Injuries
Upper Extremity Injuries
Forearm
Immobilize elbow and wrist
Prevent rotation at the elbow
Wrist, hand, fingers
Position of function/comfort
Immobilize forearm
Digits may use tongue blade
Secure impaled objects
Send amputated parts with patient
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