1. Musculoskeletal System
& Emergencies

2. Functions of the Musculoskeletal System
Gives the body shape
Protects internal organs
Provides for movement
Consists of more than 600 muscles

3. Anatomy Muscles - provide movement & generate heat.
Ligaments - connect bone to bone
injury = sprain
Tendons - connect bone to muscle
injury = strain
Bones - protection & shape

4. The Skeletal System Gives form to the body Protects vital organs
Consists of 206 bones
Acts as a framework for attachment of muscles
Designed to permit motion of the body

5. The Skull
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6. The Neck

7. The Spinal Column
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8. The Thorax
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9. The Pelvis
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10. The Lower Extremity Hip Thigh Knee Leg Ankle Foot
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11. The Upper Extremity Shoulder girdle Arm Elbow Forearm Wrist Hand
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12. Joints
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13. Types of Muscle (1 of 2) Skeletal (voluntary) muscle
Attached to the bones of the body
Smooth (involuntary) muscle
Carry out the automatic muscular functions of the body

14. Types of Muscle (2 of 2) Cardiac muscle Involuntary muscle
Has own blood supply and electrical system
Can tolerate interruptions of blood supply for only very short periods

15. Injuries
Sprain
Strain
Dislocation
Closed fracture
Open fracture

16. Sprains & Strains Sprain Strain Joint injury with tearing of ligaments
Stretching or tearing of a muscle

17. S/S Pain Edema and Ecchymosis Joint instability
Treatment: - immobilize, ice, & elevate if possible

18. Dislocation
A disruption of a joint, in which the bone ends are no longer in contact and the supporting ligaments are torn

19. S/S of a Dislocation Marked deformity Edema Pain
Tenderness on palpation
Complete loss of joint function
Distal numbness
Treatment - immobilize, ice, elevate if possible.

20. Fractures Closed fracture Nondisplaced fracture Open fracture
does not break the skin
Open fracture
External wound
Nondisplaced fracture
Simple crack
Displaced fracture
deformity

21. Closed fracture Signs & symptoms
Pain
Edema
Possible deformity
Contusion
Loss of motion
false motion
Crepitus
Guarding
Treatment - immobilize, ice, elevate if possible.

22. Open fracture Signs & symptoms Pain Deformity
Break in skin and/or exposed bone
Treatment - dressing, immobilize, ice, & elevate if possible

23. Old terminology
Simple & compound

24. Types of Fractures Green stick Spiral Transverse Comminuted Pathologic
Epiphyseal

25. complications of fx blood vessel & nerve damage Fat embolus
disability or deformity

26. Bleeding (internal) Bones have a blood supply!
Fractures bleed internally -
Femur - 1 liter
Pelvis - 1 liter
Tibia cc

27. Other considerations What is beneath fracture site? open fracture
Joint involved?

28. Tips & other stuff Angulation or angulated extremity
Depressed skull fracture
Basilar skull fracture
Flail Chest

29. Hip Injury Hip Fracture – classic presentation Hip Dislocation
Shortened, externally rotated
Hip Dislocation
Usually flexed and internally rotated
Requires significant force

30. TX draw-sheet method Make NO attempt to straighten leg
Support with rolled blankets
Prevent hip movement

31. Assessment of injured extremities
PMSC
Pulse
Movement
Sensation
Capillary refill
Cold, blue, pulseless extremity has circulation problem

32. ALWAYS CHECK DISTAL FUNCTION BEFORE & AFTER SPLINTING !!!!!
AND DOCUMENT WHAT YOU FOUND !!

33. Splinting Why we splint... relieve pain
reduce tissue/vessel damage during movement

34. Types of splints Self splinting Pillows, blankets, & items of clothing
Sling & swath
Rigid
Cardboard
plastic
ladder
Air or vacuum
Traction

35. Traction splints
Closed, mid-shaft femur fracture without hip, knee, or ankle injury.

36. General Principles of Splinting (1 of 2)
Remove clothing area
PMSC
Dress all wounds
Do not move the patient before splinting

37. General Principles of Splinting (2 of 2)
Immobilize the joints
Pad rigid splints
Maintain manual immobilization.
Realign angulations PRN
When in doubt, splint
Reassess PMSC
Immobilize all suspected spinal injuries in a neutral in-line position*
*pain, resistance, crepitus

38. Realignment issues NEVER REALIGN A JOINT
NEVER REALIGN A INJURY WITH GOOD DISTAL FUNCTION
Only pulseless, longbone fractures

39. Basic Realignment Steps
Have all equipment ready & in place
Explain procedure to patient
In 1 move, with gentle traction, align extremity (goal is anatomical position)
Use the least amount of force necessary.
If resistance is met or pain increases, splint in deformed position.
Reassess distal function

40. Remember
No matter how bad the fracture our priorities are the ABC’s

41. Hazards of Improper Splinting
Further damage
Delay in transport
Reduction of distal circulation
Aggravation of the injury
Injury to tissue, nerves, blood vessels, or muscle

42. end
Questions???