Chapter 15: Injuries to Muscles and Bones

Chapter 15: Injuries to Muscles and Bones

National EMS Education Standard Competencies (1 of 3)
Trauma Uses simple knowledge to recognize and manage life threats based on assessment findings for an acutely injured patient while awaiting additional emergency medical response. Trauma Uses simple knowledge to recognize and manage life threats based on assessment findings for an acutely injured patient while awaiting additional emergency medical response.

Orthopedic Trauma Recognition and management of Open fractures Closed fractures Dislocations Amputations Orthopedic Trauma Recognition and management of • Open fractures (pp ) • Closed fractures (pp ) • Dislocations (p 308; pp ; pp ) • Amputations (p 318)

Head, Facial, Neck, and Spine Trauma Recognition and management of Life threats Spine trauma Head, Facial, Neck, and Spine Trauma Recognition and management of • Life threats (pp ) • Spine trauma (pp )

Introduction (1 of 2) Emergency medical responders (EMRs) will encounter many types of musculoskeletal injuries: Fractures Dislocations Sprains and strains Head injuries Spinal cord injuries Chest injuries I. Introduction A. As an emergency medical responder (EMR), you will encounter many types of musculoskeletal injuries: 1. Fractures 2. Dislocations 3. Sprains 4. Strains 5. Head injuries 6. Spinal cord injuries 7. Chest injuries

Introduction (2 of 2) Understanding the basic anatomy and functioning of the musculoskeletal system will you help you treat these injuries. You must be able to recognize signs and symptoms of various musculoskeletal injuries. Providing proper care at the scene can prevent additional injury or disability. B. Understanding the basic anatomy and functioning of the musculoskeletal system will help you treat these injuries. C. You must be able to recognize signs and symptoms of various musculoskeletal injuries. D. Providing proper care at the scene can prevent additional injury or disability.

Patient Assessment of Injuries to Muscles and Bones (1 of 2)
Figure: Patient assessment sequence. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Patient Assessment of Injuries to Muscles and Bones (2 of 2)
Complete all five parts of the patient assessment sequence. Follow standard precautions to protect you and the patient from infectious diseases. Perform a complete primary assessment. Immediately follow with the secondary assessment. Perform a thorough SAMPLE medical history. Continue to reassess the patient. II. Patient Assessment of Injuries to Muscles and Bones A. When assessing a patient who has sustained an injury to the muscles and bones, you need to complete all five of the parts of the patient assessment sequence. 1. Perform a thorough size-up of the scene. a. Do not get tunnel vision because the patient has an obvious injury. b. You need to complete all parts of the scene size-up to render the scene safe and to gain as much information as you can about the mechanism of injury (MOI). c. Be especially careful about following standard precautions to protect you and the patient from infectious diseases. 2. Perform a complete primary assessment to determine whether the patient has any life-threatening problems related to the airway, breathing, or circulation. 3. It is often more efficient and helpful to perform the primary assessment, and then immediately follow with the secondary assessment, holding off on obtaining the patient’s medical history. a. Be thorough and systematic in examining all parts of the patient. 4. Perform a thorough SAMPLE medical history to determine whether the patient has any medical conditions that require attention. 5. Continue to reassess the patient. a. Every 15 minutes for stable patients b. Every 5 minutes for unstable patients

The Skeletal System (1 of 9)
Consists of 206 bones Acts as the supporting framework for the body Functions of the skeletal system: To support the body To protect vital structures To assist in body movement To manufacture red blood cells III. The Anatomy and Function of the Musculoskeletal System A. The skeletal system 1. The skeletal system consists of 206 bones and is the supporting framework for the body. 2. The four functions of the skeletal system: a. To support the body b. To protect vital structures c. To assist in body movement d. To manufacture red blood cells

Divided into seven areas: Head, skull, and face Spinal column Shoulder girdle Upper extremities Rib cage (thorax) Pelvis Lower extremities 3. The skeletal system is divided into seven areas: a. Head, skull, and face b. Spinal column c. Shoulder girdle d. Upper extremities e. Rib cage (thorax) f. Pelvis g. Lower extremities

The bones of the head include the skull and the lower jawbone. The skull is actually many bones fused together to form a hollow sphere that contains and protects the brain. The jawbone is a movable bone attached to the skull. 4. The bones of the head include the skull and the lower jawbone. a. The skull is actually many bones fused together to form a hollow sphere that contains and protects the brain. b. The jawbone is a movable bone attached to the skull that completes the structure of the face.

The spine consists of a series of separate bones called vertebrae. Primary support structure for the entire body The spine has five sections: Cervical spine (neck) Thoracic spine (upper back) Lumbar spine (lower back) Sacrum Coccyx (tailbone) 5. The spine consists of a series of separate bones called vertebrae. a. The spinal cord—a group of nerves that carry messages to and from the brain—passes through a hole in the center of each vertebra. b. The spine is the primary support structure for the entire body. c. The spine has five sections: i. Cervical spine (neck) ii. Thoracic spine (upper back) iii. Lumbar spine (lower back) iv. Sacrum v. Coccyx (tailbone)

Figure: The five sections of the spine. © Jones & Bartlett Learning.

Each shoulder girdle supports an arm. Consists of the collarbone (clavicle) and the shoulder blade (scapula) The upper extremities consist of three major bones plus the wrist and hand. The arm has one bone (humerus). The forearm has two bones (radius and ulna). 6. Each shoulder girdle supports an arm and consists of the collarbone (clavicle) and the shoulder blade (scapula). 7. The upper extremities consist of three major bones plus the wrist and hand. a. The arm has one bone (the humerus). b. The forearm has two bones (the radius and the ulna). i. The radius is located on the thumb side of the arm. ii. The ulna is located on the side of the little finger. c. The wrist and hand consist of several bones.

The 12 sets of ribs protect the heart, lungs, liver, and spleen. All of the ribs are attached to the spine. The sternum is located in the front of the chest. © Jones & Bartlett Learning. 8. The rib cage or chest (thorax) a. The 12 sets of ribs protect the heart, lungs, liver, and spleen. b. All of the ribs are attached to the spine. i. The upper five rib sets connect directly to the sternum (breastbone). ii. A bridge of cartilage connects the ends of the 6th through 10th rib sets to each other and to the sternum. iii. The 11th and 12th rib sets are called floating ribs because they are not attached to the sternum. c. The sternum is located in the front of the chest. The pointed structure at the bottom of the sternum is called the xiphoid process. Figure: The rib cage.

The pelvis links the body and the lower extremities. The lower extremities consist of the thigh and the leg. The thigh bone (femur) is the longest and strongest bone in the body. The leg consists of the tibia and fibula, plus the ankle and foot. 9. The pelvis links the body and the lower extremities. a. The pelvis protects the reproductive organs and the other organs located in the lower abdominal cavity. 10. The lower extremities consist of the thigh and the leg. a. The thighbone (femur) is the longest and strongest bone in the entire body. b. The leg consists of two major bones, the tibia and fibula, plus the ankle and foot. The kneecap (patella) is a small, relatively flat bone that protects the front of the knee joint. 11. A protective bony structure surrounds each of the body’s essential organs. 12. Red blood cells are manufactured primarily within the spaces inside the bone called the marrow.

The Muscular System (1 of 3)
The muscles of the body provide support and movement. Muscles are attached to bones by tendons and cause movement by alternately contacting and relaxing. Movement occurs at joints, where two bones come together. The bones are held together by ligaments. B. The muscular system 1. The muscles of the body provide both support and movement. 2. Muscles are attached to bones by tendons and cause movement by alternately contracting (shortening) and relaxing (lengthening). 3. The musculoskeletal system gets its name from the coordination between the muscular system and the skeletal system that produces movement. a. Movement occurs at joints, where two bones come together. b. The bones are held together by ligaments—thick bands that arise from one bone, span the joint, and insert into the adjacent bone.

Three types of muscles Voluntary (skeletal) muscles are attached to bones and can be contracted and relaxed by a person at will. Involuntary (smooth) muscles are found on the inside of the digestive tract and other internal organs. Cardiac muscle is found only in the heart. 4. The body has three types of muscles. a. Voluntary (skeletal) muscles are attached to bones and can be contracted and relaxed by a person at will. i. They are responsible for the movement of the body. b. Involuntary (smooth) muscles are found on the inside of the digestive tract and other internal organs of the body. i. They are not under conscious control and perform their functions automatically. c. Cardiac muscle is found only in the heart.

Figure: Three types of muscle in the human body. © Jones & Bartlett Learning.

Mechanism of Injury (1 of 2)
Musculoskeletal injuries are caused by three types of mechanisms of injury (MOIs): Direct force Indirect force Twisting force IV. Mechanism of Injury A. You must understand the various [MOIs]—that is, how injuries occur. B. Musculoskeletal injuries are caused by three types of MOIs: 1. Direct force 2. Indirect force 3. Twisting force Figure: Three types of mechanisms of in jury cause musculoskeletal injuries. (Left) Direct force and indirect force. (Right) Twisting force. © Jones & Bartlett Learning. © Jones & Bartlett Learning.

Mechanism of Injury (2 of 2)
Use the information provided by the dispatcher and gathered from the scene to identify the possible MOI. There are many different ways to describe a patient’s injuries. Use your senses of sight and touch. Listen to the information the patient gives you. The most important part of your job is to provide the best assessment and treatment. C. Use the information provided by the dispatcher and gathered from your size-up of the scene to identify the possible MOI. D. A word about terminology 1. There are many different ways to describe a patient’s injuries. a. Use your senses of sight and touch to determine the type of injury. b. Listen to the information that the patient gives you. c. You do not have the training or tools to diagnose an injury as a physician can. 2. Although you are not expected to diagnose these injuries, the patient’s signs and symptoms will lead you to suspect that a certain injury is most probable. 3. The most important part of your job is to provide the best assessment and treatment for the patient.

Types of Injuries (1 of 4) Fractures A fracture is a broken bone.
It most often occurs as a result of a significant force. In a closed fracture, the bone is broken but there is no break in the skin. In an open fracture, the bone is broken and the overlying skin is lacerated. Both result in bleeding at the fracture site. V. Types of Injuries A. All three types of musculoskeletal extremity injuries are serious, and all must be identified so that appropriate medical treatment can be provided. B. Fractures 1. A fracture is a broken bone. 2. A variety of mechanisms can cause a fracture, but a fracture most often occurs as a result of a significant force. 3. Fractures are classified as either closed or open. a. In the more common closed fracture, the bone is broken but there is no break in the skin. b. In an open fracture, the bone is broken and the overlying skin is lacerated. i. The open wound can be caused by a penetrating object or by the fractured bone end itself protruding through the skin. ii. Contamination by dirt and bacteria may lead to infection. 4. Both open and closed fractures injure adjacent soft tissues, resulting in bleeding at the fracture site. 5. Fractures can injure nearby nerves and blood vessels.

Types of Injuries (2 of 4) Dislocations
A dislocation is a disruption that tears the supporting ligaments of the joint. The bone ends separate completely from each other and can lock in one position. Any attempt to move a dislocated joint is very painful. A dislocation can damage nearby nerves and blood vessels. C. Dislocations 1. A dislocation is a disruption that tears the supporting ligaments of the joint. 2. The bone ends that make up the joint separate completely from each other and can lock in one position. 3. Any attempt to move a dislocated joint is very painful. 4. A dislocation can damage nearby nerves and blood vessels.

Types of Injuries (3 of 4) Sprains and strains
A sprain is a joint injury caused by excessive stretching of the supporting ligaments. A strain is caused by stretching or tearing of a muscle. D. Sprains and strains 1. A sprain is a joint injury caused by excessive stretching of the supporting ligaments. a. It can be thought of as a partial dislocation. 2. Strains are caused by stretching or tearing of a muscle.

Types of Injuries (4 of 4) Signs and symptoms of extremity injuries
Pain at the injury site An open wound Swelling and discoloration The patient’s inability or unwillingness to move the extremity Deformity or angulation Tenderness at the injury site E. Signs and symptoms of extremity injuries include 1. Pain at the injury site 2. An open wound 3. Swelling and discoloration (bruising) 4. The patient’s inability or unwillingness to move the extremity 5. Deformity or angulation 6. Tenderness at the injury site

Standard Precautions and Musculoskeletal Injuries
Assume that trauma patients have open wounds that pose a threat of infection. Always wear approved gloves. When you respond to a motor vehicle crash, wear heavy rescue gloves. If the patient has active bleeding that may splatter, you should have protection for your eyes, nose, and mouth. VI. Standard Precautions and Musculoskeletal Injuries A. Patients with musculoskeletal injuries may have open wounds. 1. Assume that trauma patients have open wounds that pose a threat of infection. 2. Always wear approved gloves. B. When you are responding to motor vehicle crashes or to other situations that may present a hazard from broken glass or other sharp objects, wear heavy rescue gloves. 1. Some EMRs wear latex or nitrile gloves under the heavy rescue gloves for added protection from infectious body fluids. C. If the patient has active bleeding that may splatter, you should have protection for your eyes, nose, and mouth.

Examination of Musculoskeletal Injuries (1 of 5)
General patient assessment All the steps in the patient assessment process must be carried out before focusing on any injured limb. Limb injuries are not life threatening unless there is excessive bleeding. Stabilize the patient’s ABCs first. VII. Examination of Musculoskeletal Injuries A. General patient assessment 1. All the steps in the patient assessment process must be carried out before focusing your attention on any injured limb. 2. Limb injuries are not life threatening unless there is excessive bleeding from an open wound. a. Stabilize the patient’s airway, breathing, and circulation first. 3. Treat the patient with the same care and consideration that you would give to a close member of your own family.

Examination of the injured limb Inspect the injured limb and compare it to the opposite, uninjured limb. When you examine the limb, you may find any one of the following: Open wound Deformity Swelling Bruising B. Examination of the injured limb 1. Inspect the injured limb and compare it to the opposite, uninjured limb. a. Gently and carefully cut away any clothing covering the wound, if necessary. 2. When you examine the limb, you may find any one of the following: a. Open wound b. Deformity c. Swelling d. Bruising

Examination of the injured limb (cont’d) Tenderness is the best indicator of an underlying fracture, dislocation, or sprain. Start at the top of each limb and using both hands, squeeze the entire limb in a systematic, firm manner. 3. Gently feel the injured limb for points of tenderness. a. Tenderness is the best indicator of an underlying fracture, dislocation, or sprain. 4. To detect limb injury, start at the top of each limb and using both hands, squeeze the entire limb in a systematic, firm manner, moving down the limb and away from the body. Figure: Examine the extremities. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Examination of the injured limb (cont’d) As you conduct the hands-on examination, ask the patient where it hurts most. The location of greatest pain is probably the injury site. If the patient shows no sign of injury, ask the patient to move the limb carefully. 5. As you conduct the hands-on examination, ask the patient where it hurts most. a. The location of greatest pain is probably the injury site. b. Ask if the patient feels tingling or numbness in the extremity; this finding may indicate nerve damage or lack of circulation. 6. After you have made a careful visual and hands-on examination, and if the patient shows no sign of injury, ask the patient to move the limb carefully. a. If there is an injury, the patient will report pain and refuse to move the limb.

Evaluation of circulation, sensation, and movement Any injury may have associated blood vessel or nerve damage. Check circulation and sensation after any movement of the limb. Follow the steps in Skill Drill 15-1 to check circulation, sensation, and movement. C. Evaluation of circulation, sensation, and movement 1. Once you suspect limb injury, you must evaluate the circulation and sensation in that limb. 2. Any injury may have associated blood vessel or nerve damage. 3. It is essential to check circulation and sensation after any movement of the limb. 4. Follow the steps in Skill Drill 15-1 to check circulation, sensation, and movement in an injured extremity.

Treatment of Musculoskeletal Injuries
All limb injuries are treated the same way in the field. Cover open wounds with dry, sterile dressings. Apply firm but gentle pressure to control bleeding. Apply a cold pack to painful, swollen, or deformed extremities. Splint the injured limb. VIII. Treatment of Musculoskeletal Injuries A. All limb injuries are treated in the same way in the field. 1. Cover open wounds with dry, sterile dressings. 2. Apply firm but gentle pressure to control bleeding, if necessary. 3. Apply a cold pack to painful, swollen, or deformed extremities. 4. Splint the injured limb.

General Principles of Splinting (1 of 4)
Advantages of splinting Prevents the movement of broken bone ends, a dislocated joint, or damaged soft tissues Helps to control bleeding Decreases the risk of additional damage Prevents closed fractures from becoming open fractures during movement or transport B. General principles of splinting 1. All limb injuries should be splinted before the patient is moved, unless the environment prevents effective splinting or threatens the patient’s life. 2. Splinting prevents the movement of broken bone ends, a dislocated joint, or damaged soft tissues, thereby reducing pain. 3. Splinting helps to control bleeding and decreases the risk of additional damage. 4. Splinting prevents closed fractures from becoming open fractures during movement or transport.

Remove clothing from the injured limb to inspect for open wounds, deformity, swelling, bruising, and capillary refill. Note and record the pulse, capillary refill, sensation, and movement distal to the point of injury. Cover all open wounds with a dry, sterile dressing before applying the splint. 5. Adhere to the following general principles of splinting: a. Remove clothing from the injured limb to inspect for open wounds, deformity, swelling, bruising, and capillary refill. b. Note and record the pulse, capillary refill, sensation, and movement distal to the point of injury, both before and after splinting. c. Cover all open wounds with a dry, sterile dressing before applying the splint.

Do not move the patient before splinting, unless there is an immediate danger. Immobilize the joint above and the joint below the injury site. Pad all rigid splints. Support the injury site and minimize movement of the limb until splinting is completed. d. Do not move the patient before splinting, unless there is an immediate danger to the patient or the EMR. e. Immobilize the joint above and the joint below the injury site. f. Pad all rigid splints. g. When applying the splint, support the injury site and minimize movement of the limb until splinting is completed.

Splint the limb without moving it unnecessarily. When in doubt, splint. h. Splint the limb without moving it unnecessarily. i. When in doubt, splint.

Materials Used for Splinting (1 of 5)
Rigid splints Made from firm material Applied to the sides, front, or back of an injured extremity Common types: padded board splints, molded plastic or aluminum splints, padded wire ladder splints, SAM splints, and folded cardboard splints C. Materials used for splinting 1. Rigid splints a. Rigid splints are made from firm material and are applied to the sides, front, or back of an injured extremity. b. Common types of rigid splints include i. Padded board splints ii. Molded plastic or aluminum splints iii. Padded wire ladder splints iv. SAM splints v. Folded cardboard splints

Figure: (Left) Rigid cardboard splints. (Right) SAM splints. © American Academy of Orthopaedic Surgeons. © American Academy of Orthopaedic Surgeons.

Soft splints The most commonly used soft splints are vacuum splints and inflatable, clear plastic air splints. Vacuum splints consist of an inner and outer layer of airtight fabric that is shaped to fit around an arm or a leg. Follow the steps in Skill Drill 15-2 to apply a vacuum splint Air splints are constructed of a clear flexible plastic material. 2. Soft splints a. The most commonly used soft splints are vacuum splints and inflatable, clear plastic air splints b. Vacuum splints consist of an inner and outer layer of airtight fabric that is shaped to fit around an arm or a leg. i. Between the inner and outer layers of fabric are small beads of a hard foam material surrounded by air. ii. When you remove the air with a vacuum pump, it becomes rigid and provides support for the injured limb. iii. Vacuum splints are not transparent. iv. You must monitor the pulse, movement, and sensation of the injured limb and the status of the vacuum splint itself. v. Follow the steps in Skill Drill 15-2 to apply a vacuum splint. c. Air splints are constructed of a clear flexible plastic material. i. This splint is available in a variety of sizes and shapes, with and without zippers. ii. After it is applied, the splint is inflated by mouth. iii. The air splint is comfortable for the patient and provides uniform pressure to a bleeding wound. iv. Air splints are transparent, so you can monitor the appearance of the injured limb after splinting. v. Protect air splints from sharp objects that could puncture them. vi. You must monitor the pulse, movement, and sensation of the injured limb after splinting. d. Changes in altitude and temperature can affect the rigidity of both vacuum splints and air splints.

Figure: (Left) A zippered air splint. (Right) An unzippered air splint. © Jones & Bartlett Learning. Courtesy of MIEMSS. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Traction splints A traction splint holds a lower extremity fracture in alignment by applying a constant, steady pull on the extremity. Proper application of a traction splint requires two trained emergency medical technicians (EMTs) working together. 3. Traction splints a. A traction splint holds a lower extremity fracture in alignment by applying a constant, steady pull on the extremity. Properly applying a traction splint requires two trained emergency medical technicians (EMTs) working together. D. Splinting specific injury sites 1. Most splinting techniques require two people. a. One person stabilizes and supports the injured limb while the other person applies the splint.

Splinting Specific Injury Sites (1 of 14)
Shoulder girdle injuries Apply a sling made of a triangular bandage and secure it to the patient’s body with swathes. 2. Shoulder girdle injuries a. The easiest way to splint most shoulder injuries is to apply a sling made of a triangular bandage and to secure the sling to the patient’s body with swathes. b. Apply the sling by tying a knot in the point of the triangular bandage, placing the elbow into the cup formed by the knot, and passing the two ends of the bandage up and around the patient’s neck. Figure: (Left) Sling. (Right) Sling and swathe. © Jones & Bartlett Learning. Courtesy of MIEMSS. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Shoulder dislocation Place a pillow or a rolled blanket in the space between the upper arm and the chest wall. Apply the sling and swathe as for other shoulder injuries. Elbow injuries Do not move an injured elbow from the position in which you find it. 3. Shoulder dislocation a. Place a pillow or a rolled blanket in the space between the upper arm and the chest wall. b. Apply the sling and swathe as for other shoulder injuries. 4. Elbow injuries a. Do not move an injured elbow from the position in which you find it. i. The elbow must be splinted as it lies because any movement can cause nerve or blood vessel damage.

Elbow injuries (cont’d) Wrap the elbow in a pillow, add padding, and secure the pillow. Transport the patient in a sitting position with the splinted elbow resting on his or her lap. b. An effective splint for an injured elbow is a pillow splint. i. Wrap the elbow in a pillow, add padding to keep the elbow in the position found, and secure the pillow. c. The patient is usually transported in a sitting position with the splinted elbow resting on his or her lap. Figure: Pillow splint. © American Academy of Orthopaedic Surgeons.

Forearm injuries Several splints can be used Air splint Cardboard splint SAM splint Rolled newspapers and magazines 5. Forearm injuries a. Several splints can be used to stabilize the forearm: i. Air splint ii. Cardboard splint iii. SAM splint iv. Rolled newspapers and magazines

Forearm injuries (cont’d) Follow the steps in Skill Drill 15-3 to apply a SAM splint. Follow the steps in Skill Drill 15-4 to apply a zippered air splint. Follow the steps in Skill Drill 15-5 to apply an unzippered air splint. b. Follow the steps in Skill Drill 15-3 to apply a SAM splint. c. Be sure to pad all rigid splints adequately. d. An air splint can be applied quickly, and it immobilizes the forearm quite well. i. The air splint with a full length-zipper is easiest to use. ii. Follow the steps in Skill Drill 15-4 to apply a zippered air splint. iii. Follow the steps in Skill Drill 15-5 to apply an unzippered air splint.

Hand, wrist, and finger injuries Use a bulky hand dressing and a short splint. Place any amputated parts in a sealed plastic bag and send them to the hospital. Cover all wounds with a dry, sterile dressing. Place the hand into the position of function. Place soft roller dressings into the palm. Apply a splint and secure it with a soft roller bandage. 6. Hand, wrist, and finger injuries a. The functions of the fingers and hand are so complex that any injury, if poorly or inadequately treated, may result in permanent deformity and disability. b. You can use a bulky hand dressing and a short splint to immobilize all injuries of the wrist, hand, and fingers. c. Send any amputated parts to the hospital with the patient by placing them in a sealed plastic bag. d. To treat injuries of the hand, wrist, or fingers i. Cover all wounds with a dry, sterile dressing. ii. Place the injured hand and wrist into the position of function. iii. Place one or two soft roller dressings into the palm of the patient’s hand. iv. Apply a splint and secure it with a soft roller bandage.

Pelvic fractures Treat the patient for shock, but do not raise the legs until the patient is on a backboard. Feel for tenderness when you use both hands to firmly compress the patient’s pelvis. 7. Pelvic fractures a. Fractures of the pelvis often involve severe blood loss because the broken bones can easily lacerate large blood vessels. b. Pelvic fractures commonly cause shock. c. Treat the patient for shock, but do not raise the patient’s legs until he or she is secured on a backboard. d. The most definitive sign of a pelvic fracture is tenderness when you use both your hands to firmly compress the patient’s pelvis. e. Immobilize pelvic fractures with a long backboard. f. EMTs may apply a pneumatic antishock garment to stabilize the fracture and treat shock. Figure: Examining the patient for pelvic fracture. (Left) Push down. (Right) Push in. © Jones & Bartlett Learning. © Jones & Bartlett Learning.

Hip injuries Dislocations and fractures are most common. Both may result from high-energy trauma. Fractures occur in elderly persons because bone weakens and become more fragile with age. Immobilize the hip in the position found. Use several pillows and rolled blankets. Place the patient on a long backboard. 8. Hip injuries a. Two types of hip injuries are commonly seen: dislocations and fractures. i. Both injuries may result from high-energy trauma. b. Hip fractures occur at the upper end of the femur, rather than in the hip joint itself. i. These fractures often occur in elderly patients because bone weakens and becomes more fragile with age (osteoporosis). ii. Fractures of the hip region usually cause the injured limb to become shortened and externally rotated. c. A dislocated hip is extremely painful. i. The joint is usually locked with the thigh flexed and rotated inward. ii. The knee joint is often flexed as well. d. Treat all hip injuries by immobilizing the hip in the position found. i. Use several pillows and/or rolled blankets. ii. Place the patient on a long backboard for transportation. e. Any elderly person who has fallen and reports pain in the hip, thigh, or knee should be splinted and transported to the hospital.

Thigh injuries A fractured femur is very unstable. Place the patient in a comfortable position, treat for shock, and call for additional personnel and equipment. Traction splints are the most effective way to splint a unilateral fractured femur. Follow the steps in Skill Drill 15-6 to apply a Hare traction splint. 9. Thigh injuries a. A fractured femur is very unstable and usually produces significant thigh deformity, with much bleeding and swelling. b. Place the patient in as comfortable a position as possible, treat him or her for shock, and call for additional personnel and equipment. c. After a motor vehicle crash i. You may have to move patients quickly. ii. Secure both of the patient’s legs together with swathes, cravats, or bandages so that the two lower extremities are immobilized as one unit. d. Traction splints are the most effective way to splint a unilateral fractured femur. i. They were designed specifically for this purpose. ii. You should know how to use traction splints so you can assist other EMS personnel in their application. iii. Before applying a traction splint, trained EMTs align deformed fractures by applying manual longitudinal traction. iv. Skill Drill 15-6 illustrates the steps for applying a Hare traction splint.

© Jones & Bartlett Learning. © Jones & Bartlett Learning. Courtesy of MIEMSS. Figure: Straightening an injured leg for splinting. (Top left) The first rescuer grasps the injured leg at the knee and applies traction in the long axis of the body. (Top right) The second rescuer grasps the ankle. (Bottom left) The second rescuer straightens the leg. (Bottom right) The second rescuer maintains traction by leaning back. © Jones & Bartlett Learning. Courtesy of MIEMSS. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Knee injuries Immobilize an injured knee in the same position that you find it. If the knee is straight, use long, padded board splints or a long-leg air splint. 10. Knee injuries a. Immobilize an injured knee in the same position that you find it. b. If the knee is straight, use long, padded board splints or a long-leg air splint. Figure: Immobilizing an injured knee. © Jones & Bartlett Learning.

Knee injuries (cont’d) If there is significant deformity Place pillows, blankets, or clothing beneath the knee. Secure the splint materials to the leg with bandages, swathes, or cravats. Secure the injured leg to the uninjured leg. Place the patient on a backboard. c. If there is significant deformity: i. Place pillows, blankets, or clothing beneath the knee. ii. Secure the splint materials to the leg with bandages, swathes, or cravats. iii. Secure the injured leg to the uninjured leg. iv. Place the patient on a backboard.

Leg injuries Fractures of the leg can be splinted with air splints, cardboard splints, and magazines and newspapers. Follow the steps in Skill Drill 15-7 to apply an air splint to the leg. 11. Leg injuries a. Fractures of the leg can be splinted using air splints, cardboard splints, and magazines and newspapers. b. Skill Drill 15-7 shows how to apply an air splint to the leg. i. It takes two trained people to perform this skill—one person supports the leg with both hands, while the other person applies the splint.

Ankle and foot injuries Fractures can be splinted with either a pillow or an air splint. Place the pillow splint around the injured ankle and foot, and tie or pin it in place. Follow the steps in Skill Drill 15-8 to apply a pillow splint to the ankle or foot. 12. Ankle and foot injuries a. Fractures of the ankle and foot can be splinted with either a pillow or an air splint. b. Place the pillow splint around the injured ankle and foot, and tie or pin it in place. c. Skill Drill 15-8 shows how to apply a pillow splint to the ankle or foot.

Additional Considerations
Practice splinting until you can quickly and competently apply the principles in any situation. It takes two people to splint most limb injuries adequately. One person to stabilize and support the extremity One person to apply the splint E. Additional considerations 1. Extremity injuries are not, by themselves, life threatening unless excessive bleeding is present. 2. Sometimes you may be the only trained person at the scene of an accident. 3. Practice splinting until you can quickly and competently apply the principles in any situation. a. Practice splinting both a sitting person and a prone volunteer. 4. It takes two people to splint most limb injuries adequately: one person to stabilize and support the extremity and one person to apply the splint. 5. Learn how the team functions as a unit during stressful situations and be prepared to work with any member of the EMS team who arrives to assist you.

Injuries to the Head (Skull and Brain) (1 of 10)
Head and spinal cord injuries are common causes of death. Can also lead to irreversible paralysis and permanent brain damage The human skull has two primary parts: The cranium The facial bones IX. Injuries of the Head (Skull and Brain) A. Severe head and spinal cord injuries can result from many different kinds of trauma. 1. These injuries are common causes of death. 2. If not fatal, they may lead to irreversible paralysis and permanent brain damage. 3. The human skull has two primary parts: a. The cranium, a tough four-bone shell that protects the brain b. The facial bones, which give form to the face and furnish frontal protection for the brain

Figure: Cranium and face of the human skull. © Jones & Bartlett Learning.

MOI Between the skull and the brain, cerebrospinal fluid (CSF) cushions the brain. A direct force can injure the skull and brain. An indirect force can also cause injury. B. MOI 1. Head injuries are common with certain types of trauma. 2. Between the skull and the brain, the cerebrospinal fluid (CSF) cushions the brain from direct blows. a. A direct force can injure the skull and the brain inside. b. An indirect force can also cause injury. 3. Spinal injury is often associated with head injury. a. The force of direct blows to the head is often transmitted to the spine, producing a fracture or dislocation. 4. All patients with head injuries must have the cervical spine immobilized to protect the spinal cord. Figure: The brain. © Jones & Bartlett Learning.

Types of head injuries In a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to brain damage and death. An open head injury usually bleeds profusely. Examine the nose, eyes, and the wound itself to see if any blood or CSF is seeping out. Brain tissue or bone may be visible. C. Types of head injuries 1. In a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to irreversible brain damage and death. 2. An open head injury usually bleeds profusely. a. Severe open head injuries are serious but not always fatal. 3. Examine the nose, eyes, and the wound itself to see if any blood or CSF is seeping out. 4. In severe cases of open head injury, brain tissue or bone may be visible.

Figure: Open and closed head injuries. (Left) A head injury may occur in conjunction with a cervical spine injury. (Center) A closed head injury. (Right) An open head injury. © Jones & Bartlett Learning. © Jones & Bartlett Learning. © Jones & Bartlett Learning.

Signs and symptoms of head injuries Confusion Unusual behavior Unconsciousness Nausea or vomiting Blood from an ear Decreasing consciousness Unequal pupils D. Signs and symptoms of head injuries 1. A patient who sustained a head injury may exhibit some or all of the following signs and symptoms: a. Confusion b. Unusual behavior c. Unconsciousness d. Nausea or vomiting e. Blood from an ear f. Decreasing consciousness g. Unequal pupils

Signs and symptoms (cont’d) Paralysis Seizures External head trauma (bleeding, bumps, bruises) A serious head injury may produce raccoon eyes and Battle’s sign. h. Paralysis i. Seizures j. External head trauma: bleeding, bumps, and contusions 2. A serious head injury may produce raccoon eyes and Battle’s sign. a. Raccoon eyes look like the black eyes that develop after a fistfight. b. Battle’s sign appears as a bruise behind one or both ears.

Figure: Signs of head injury. (Left) Raccoon eyes. (Right) Battle sign. © American Academy of Orthopaedic Surgeons. © American Academy of Orthopaedic Surgeons.

Treatment of head injuries Immobilize the head in a neutral position. Maintain an open airway with the jaw-thrust maneuver. Support the patient’s breathing with oxygen. Monitor circulation; be prepared to perform cardiopulmonary resuscitation (CPR) if necessary. E. Treatment of head injuries 1. Immobilize the head in a neutral position. 2. Maintain an open airway. a. Use the jaw-thrust maneuver. b. Be prepared to suction if the patient vomits. 3. Support the patient’s breathing. a. As soon as oxygen becomes available, it should be administered to the patient. 4. Monitor circulation. a. Be prepared to perform full cardiopulmonary resuscitation (CPR) if the patient’s heart stops.

Treatment of head injuries (cont’d) Determine whether blood or CSF is seeping from a wound or from the nose or ears. Control bleeding from all head wounds with dry, sterile dressings. Examine and treat other serious injuries. Arrange for prompt transport. 5. Determine whether blood CSF is seeping from a wound or from the nose or ears. 6. Control bleeding from all head wounds with dry, sterile dressings. 7. Examine and treat other serious injuries. 8. Arrange for prompt transport.

Injuries of the Face (1 of 4)
Facial injuries commonly result from the following types of injuries: Motor vehicle crashes in which the patient’s face hits the steering wheel or windshield Assaults Falls X. Injuries of the Face A. Facial injuries commonly result from the following types of incidents: 1. Motor vehicle crashes in which the patient’s face hits the steering wheel or windshield 2. Assaults 3. Falls

Airway obstruction is the primary danger in severe facial injuries. If the patient has facial injuries, suspect a spinal injury. Treatment of facial injuries Immobilize the head in a neutral position. Maintain an open airway with the jaw-thrust maneuver. B. Airway obstruction is the primary danger in severe facial injuries. 1. Severe damage to the face and facial bones can cause bleeding and the collapse of the facial bones, leading to airway problems. 2. If the patient has facial injuries, you should also suspect a spinal injury. 3. Facial injuries are rarely life threatening unless the airway is obstructed. C. Treatment of facial injuries 1. Immobilize the head in a neutral position. 2. Maintain an open airway. a. Use the jaw-thrust maneuver. b. Clear any blood or vomitus from the patient’s mouth with your gloved fingers.

Treatment of facial injuries (cont’d) Support breathing. Monitor circulation. Control bleeding by covering any wound with a dry, sterile dressing and applying direct pressure. Look for and stabilize other serious injuries. Arrange for prompt transport. 3. Support breathing. 4. Monitor circulation. 5. Control bleeding by covering any wound with a dry, sterile dressing and applying direct pressure. 6. Look for and stabilize other serious injuries. 7. Arrange for prompt transport.

Treatment of facial injuries (cont’d) If these measures do not keep the airway clear or if you are unable to control severe bleeding, log roll the patient onto the side. 8. If these measures do not keep the airway clear or if you are unable to control severe facial bleeding, log roll the patient onto his or her side, keeping the head and spine stable and rolling the whole body as a unit. Figure: Keep the head and spine in alignment by using the log-roll technique. © Jones & Bartlett Learning.

Injuries to the Spine (1 of 8)
MOIs A displaced vertebra, swelling, or bleeding may put pressure on the spinal cord and damage it. In severe cases, the spinal cord may be severed. XI. Injuries to the Spine A. Spinal injuries can cause irreversible paralysis. B. MOIs 1. A displaced vertebra, swelling, or bleeding may put pressure on the spinal cord and damage it. 2. In severe cases of spinal injury, the spinal cord may be severed. a. If all or part of the spinal cord is cut, nerve impulses cannot travel to and from the brain. b. Without the conduction of these nerve impulses, the patient is paralyzed below the point of injury. Figure: Types of spinal cord injuries. (Left) Pressure on the spinal cord from swelling or fracture. (Center) Bruising of the spinal cord by broken vertebrae. (Right) Injury by displacement and fractured vertebrae. © Jones & Bartlett Learning. © Jones & Bartlett Learning. © Jones & Bartlett Learning.

MOIs (cont’d) Injury to the spinal cord high in the neck paralyzes the diaphragm and results in death. Gunshot wounds to the chest or abdomen may produce spinal cord injury at that level. Falls, motor vehicle crashes, and stabbings are other common MOIs. Suspect a spinal injury if the patient has sustained high-energy trauma. 3. Injury to the spinal cord high in the neck paralyzes the diaphragm and results in death. 4. Gunshot wounds to the chest or abdomen may produce spinal cord injury at that level. 5. Falls, motor vehicle crashes, and stabbings are other common causes of spinal injuries. 6. Suspect a spinal injury if the patient has sustained high-energy trauma. 7. Common causes of spinal cord injuries includ[e] a. Athletic collisions b. Diving injuries c. Gunshot wounds and stabbings to the chest or neck d. Falls of greater than three times the patient’s height e. Hangings f. Motorcycle crashes at speeds exceeding 20 mph g. Motor vehicle crashes with the following conditions: i. Patient is ejected from vehicle ii. Patient is unrestrained iii. Speed is more than 40 mph iv. There is at least 12" of intrusion into the passenger compartment

Signs and symptoms of spinal cord injury Laceration, bruise, or other sign of injury to the head, neck, or spine Tenderness over any point on the spine or neck Pain in the neck or spine or pain radiating to an extremity Extremity weakness, numbness, paralysis, or loss of movement C. Signs and symptoms of spinal cord injury 1. To determine whether a patient has sustained an injury to the spinal cord, talk to the patient and perform a careful examination. a. Ask the patient to describe any points of tenderness or pain. b. Do not move the patient during your examination. c. Be extremely careful and take your time. 2. Signs and symptoms of spinal injuries include a. Laceration, bruise, or other sign of injury to the head, neck, or spine b. Tenderness over any point on the spine or neck c. Pain in the neck or spine or pain radiating to an extremity d. Extremity weakness, numbness, paralysis, or loss of movement

Signs and symptoms (cont’d) Loss of sensation or movement, or tingling/ burning sensation in any part of the body below the neck Loss of bowel or bladder control Treatment of spinal injuries Place the head and neck in a neutral position. Stabilize the head and prevent movement of the neck. e. Loss of sensation or movement, or tingling/burning sensation in any part of the body below the neck f. Loss of bowel or bladder control D. Treatment of spinal injuries 1. Place the head and neck in a neutral position. 2. Stabilize the head and prevent movement of the neck.

Treatment of spinal injuries (cont’d) Maintain an open airway with the jaw-thrust maneuver. Support the patient’s breathing by administering oxygen and by keeping the airway open. Monitor circulation. Assess the pulse, movement, and sensation in all extremities. 3. Maintain an open airway. a. Use the jaw-thrust maneuver. b. Clear any blood or vomitus from the mouth with your gloved fingers. 4. Support the patient’s breathing by administering oxygen (if available) and by keeping the airway open. a. A spinal cord injury may paralyze some or all of the respiratory muscles, resulting in abnormal breathing patterns. b. Breathing using the diaphragm only is called abdominal breathing. 5. Monitor circulation. 6. Assess the pulse, movement, and sensation in all extremities.

Treatment of spinal injuries (cont’d) Examine and treat other serious injuries. Immobilize the patient on a long or short backboard. Arrange for prompt transport. Stabilizing the cervical spine Follow the steps in Skill Drill 15-9. 7. Examine and treat other serious injuries. 8. Do not move the patient unless it is necessary to perform CPR or to remove him or her from a dangerous environment. 9. Assist in immobilizing the patient using a long or short backboard. 10. Arrange for prompt transport. E. Stabilizing the cervical spine 1. Stabilization of the cervical spine is initially accomplished manually, as shown in Skill Drill 15-9.

Injuries of the Spine (7 of 8)
Motorcycle and sports helmets Helmets often do not need to be removed. Remove part or all of a helmet only under the following two circumstances: When the face mask or visor interferes with adequate ventilation or with your ability to restore an adequate airway When the helmet is so loose that securing it to the spinal immobilization device will not provide adequate immobilization of the head F. Motorcycle and sports helmets 1. In most cases, helmets do not need to be removed. a. Helmets are frequently fitted to be snug and cradle the head. b. They can be secured directly to the spinal immobilization device. 2. You should remove part or all of a helmet only under two circumstances: a. When the face mask or visor interferes with adequate ventilation or with your ability to restore an adequate airway i. When part of a motorcycle helmet interferes with ventilation, the visor should be lifted away from the face. ii. In the case of a football helmet, the face guard should be removed. iii. In most instances, exposing the face

Injuries of the Spine (8 of 8)
Motorcycle and football helmets (cont’d) Follow the steps in Skill Drill to remove the mask on a sports helmet. Follow the steps in Skill Drill to remove a helmet. iv. Follow the steps in Skill Drill to remove the mask on a sports helmet. b. When the helmet is so loose that securing it to the spinal immobilization device will not provide adequate immobilization of the head i. A loose helmet can be removed easily while the head and neck are being stabilized manually. ii. The procedure for helmet removal in this circumstance is shown in Skill Drill

Injuries of the Chest (1 of 7)
Fractures of the ribs Even a simple fracture produces pain at the site and difficulty breathing. Rib fractures may be associated with injury to the underlying organs. XII. Injuries of the Chest A. The chest cavity contains the lungs, the heart, and several major blood vessels. B. The cavity is surrounded and protected by the chest wall, which is made up of the ribs, cartilage, and associated chest muscles. C. Fractures of the ribs 1. Even a simple fracture of one rib produces pain at the site and difficulty breathing. 2. Multiple rib fractures result in significant breathing difficulty. 3. The patient may not be able to breathe deeply enough to take in adequate amounts of oxygen. 4. Rib fractures may be associated with injury to the underlying organs. Figure: Broken or fractured ribs. © Jones & Bartlett Learning.

Fractures of the ribs (cont’d) To determine whether a rib is bruised or broken, apply some pressure to another part of the rib. Be alert for signs and symptoms of internal injury, particularly shock. Place a pillow against the injured ribs to splint them. 5. To determine whether a rib is bruised or broken, apply some pressure to another part of the rib. a. Pain in the injured area indicates a bruise, crack, or fracture. 6. If the injury is to the side of the chest, place one hand on the front of the chest and the other on the back and squeeze gently. 7. To check an injury to the front or back of the rib cage, put your hands on either side of the chest and squeeze gently. 8. In patients with rib fractures, be alert for signs and symptoms of internal injury, particularly shock. 9. Treatment of rib fractures a. Place a pillow against the injured ribs to splint them.

Fractures of the ribs (cont’d) Prevent excessive movement of the patient. Administer oxygen if it is available. Flail chest If three or more ribs are broken in at least two places, the injured portion of the chest wall does not move with the rest of the chest. b. Prevent excessive movement of the patient as you prepare for transport. c. Administer oxygen if it is available and you are trained to use it. D. Flail chest 1. If three or more ribs are broken in at least two places, the injured portion of the chest wall does not move with the rest of the chest. 2. The injured part bulges outward when the patient exhales and moves inward when the patient inhales.

Flail chest (cont’d) A flail chest decreases the amount of oxygen and carbon dioxide exchanged in the lungs. 3. A flail chest decreases the amount of oxygen and carbon dioxide exchanged in the lungs, and it causes breathing problems that will progressively become worse. Figure: A flail chest occurs when three or more ribs are broken in at least two places. © Jones & Bartlett Learning.

Flail chest (cont’d) Do not restrict movement of the chest if the patient is having difficulty breathing. It may be helpful to support the patient’s breathing with positive pressure using a bag valve mask and supplemental oxygen. Monitor and support the patient’s ABCs. Arrange for prompt transport. 4. Treatment of flail chest a. If the patient is having difficulty breathing, do not attempt to restrict the movement of the chest while the patient is inhaling. b. It may be helpful to support the patient’s breathing with positive pressure using a bag valve mask and supplemental oxygen. c. Monitor and support the patient’s ABCs. d. Arrange for prompt transport.

Penetrating chest wounds If an object penetrates the chest wall, air and blood escape into the space between the lungs and the chest wall. The air and blood may cause the lung to collapse. E. Penetrating chest wounds 1. If an object (a knife or bullet) penetrates the chest wall, air and blood escape into the space between the lungs and the chest wall. 2. The air and blood may cause the lung to collapse. a. Lung collapse greatly reduces the amount of oxygen and carbon dioxide that is exchanged and can result in shock and death. Figure: A penetrating chest wound may cause the patient’s lung to collapse. © Jones & Bartlett Learning.

Penetrating chest wounds (cont’d) Blood loss into the chest cavity can produce shock. Quickly seal an open chest wound with an occlusive dressing. Administer oxygen if it is available. If a knife or other object is impaled in the chest, do not remove it. Arrange for prompt transport. b. Blood loss into the chest cavity can produce shock. 3. Treatment of penetrating chest wounds a. Quickly seal an open chest wound with a material that will prevent more air from entering the chest cavity. i. If it is more difficult for a patient to breathe after you seal the wound, uncover one corner of the occlusive dressing to see if the breathing improves. b. Administer oxygen if it is available and you are trained to use it. c. If a knife or other object is impaled in the chest, do not remove it. i. Seal the wound around the object with a dressing to prevent air from entering the chest. ii. Stabilize the impaled object with bulky dressings. d. Any chest injury that results in air leakage and bleeding requires prompt transport. e. Patients with severe chest injuries require rapid transport. f. A conscious patient with chest trauma should be placed in a sitting position to ease breathing. i. Unless you must immobilize the spine or treat the patient for shock, help the patient assume whatever position eases his or her breathing. g. If the patient’s heart stops, begin chest compressions, regardless of whether chest injuries are present.

Summary (1 of 4) Musculoskeletal injuries are caused by three types of MOIs: direct force, indirect force, and twisting force. Fractures can be closed (the bone is broken but there is no break in the skin) or open (the bone is broken and the overlying skin is lacerated). A. Musculoskeletal injuries are caused by three types of MOIs: direct force, indirect force, and twisting force. B. A fracture is a broken bone. Fractures can be closed (the bone is broken but there is no break in the skin) or open (the bone is broken and the overlying skin is lacerated).

Summary (2 of 4) A dislocation is a disruption that tears the supporting ligaments of the joint. A sprain is a joint injury caused by excessive stretching of the supporting ligaments. The three basic types of splints are rigid, soft, and traction. C. A dislocation is a disruption that tears the supporting ligaments of the joint. D. A sprain is a joint injury caused by excessive stretching of the supporting ligaments. E. Follow three steps in examining a patient with a limb injury: 1. Perform a general assessment of the patient. 2. Examine the injured part. 3. Evaluate the circulation, sensation, and movement in the injured limb. F. Regardless of the extent or severity, all limb injuries are treated the same way in the field. For all open extremity wounds, first cover the entire wound with a dry, sterile dressing and then apply firm but gentle pressure to control bleeding, if necessary. The injured limb should then be splinted. The three basic types of splints are rigid, soft, and traction. It takes two people to splint most limb injuries adequately: one to stabilize and support the extremity and one to apply the splint.

Summary (3 of 4) In a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to irreversible brain damage. An open injury of the head usually bleeds profusely. Airway obstruction is the primary danger in severe facial injuries. I. Severe head and spinal cord injuries can result from many different kinds of trauma. These injuries are common causes of death; if not fatal, they may lead to irreversible paralysis and permanent brain damage. J. Injuries of the head are classified as open or closed. In a closed head injury, bleeding and swelling within the skull may increase pressure on the brain, leading to irreversible brain damage. An open injury of the head usually bleeds profusely. K. When a sign or symptom of a head injury is present, immobilize the head and stabilize the patient’s neck; maintain an open airway; support breathing; monitor circulation; determine whether cerebrospinal fluid or blood is seeping; control bleeding with dry, sterile dressings; treat other serious injuries; and arrange for prompt transport. L. Airway obstruction is the primary danger in severe facial injuries.

Summary (4 of 4) When you suspect a spinal injury, do not move the patient during the examination. The most common chest injuries are rib fractures, flail chest, and penetrating wounds. M. When facial injuries are present, immobilize the head and stabilize the patient’s neck; maintain an open airway; support breathing; monitor circulation; control bleeding with a dry, sterile dressing and apply direct pressure; treat other serious injuries; and arrange for prompt transport. N. When you suspect a spinal injury, do not move the patient during the examination, and do not allow the patient to move. O. When a sign or symptom of spinal injury is present, place the patient’s head and neck in a neutral position; stabilize the head and prevent movement of the neck; maintain an open airway; support breathing; monitor circulation; assess pulse, movement, and sensation; examine and treat other serious injuries; assist in immobilizing the patient using a long or short backboard; and arrange for prompt transport. P. The most common chest injuries are rib fractures, flail chest, and penetrating wounds.

Review The musculoskeletal system refers to the
involuntary muscles of the nervous system. connective tissue that supports the skeleton. bones and voluntary muscles of the body. nervous system’s control over the muscles. 91

Review Answer: C. bones and voluntary muscles of the body.

Review When examining an injured extremity, you should be sure to
manipulate it in different directions to determine where fractures might exist. keep it elevated at all times. splint it to reduce movement before conducting any assessments. squeeze the entire limb starting from the top in a systematic, firm manner. I capitalized the answers. 93

Review Answer: D. squeeze the entire limb starting from the top in a systematic, firm manner.

Review Facial injuries should be identified and treated as soon as possible because bleeding is more obvious on the face. patients are always concerned about their faces. swelling may mask hidden injuries. of the risk for airway problems. 95

Review Answer: D. of the risk for airway problems.

Chapter 15: Injuries to Muscles and Bones

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Chapter 15: Injuries to Muscles and Bones

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