musculoskeletal system - angelfire · chapter 28 musculoskeletal injuries limmer et al., ... system...
TRANSCRIPT
1
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
CHAPTER 28
Musculoskeletal Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
MusculoskeletalMusculoskeletalSystemSystem
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy & PhysiologyBones provide framework.
Joints allow for bending.
Muscles allow for movement.
Cartilage provides flexibility.
Tendons connect muscle to bone.
Ligaments connect bone to bone.
2
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
TorsoTorso
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Pelvis andPelvis andLower Lower ExtremitiesExtremities
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Upper Upper ExtremitiesExtremities
3
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
BallBall--andand--Socket JointSocket Joint Hinge JointHinge Joint
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Types of MuscleSmooth (involuntary)
Found in organ walls & digestive system
Cardiac (myocardium)Found in walls of the heart
Skeletal (voluntary)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Voluntary (Skeletal) Muscle
Attaches to the bones
Forms the major muscle mass of the body
Responsible for movement
Under conscious control
Gives the body shape
4
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Injuries toInjuries toBonesBones
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
MechanismsMechanismsof Injuryof Injury
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Types of Musculoskeletal Injuries
FractureBones break
DislocationJoints “come apart”
SprainStretching & tearing of ligaments
StrainOverexertion of muscle
5
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
All musculoskeletal injuries may present with the same symptoms & signs; care is directed at minimizing injury, not determining which type!
Types of MusculoskeletalInjuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Types of FracturesTypes of Fractures
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Signs & Symptoms of Musculoskeletal Injuries
Pain and tenderness
Deformity or angulation
Grating (crepitus)
Swelling
Continued…
6
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Bruising (discoloration)
Exposed bone ends
Joint locked in position
Nerve/blood vessel compromise
Signs & Symptoms of Musculoskeletal Injuries
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Care of Musculoskeletal Injuries
BSI.
Oxygen, if indicated.
Apply cervical collar as needed.
After control of life threats, splint injuries.
Cold pack/elevate.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
SplintingSplinting
7
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Bone fragments
Bone ends
Angulated joints
Splinting prevents motion of:
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splinting minimizes:
Damage to muscles, nerves, blood vessels
Conversion of closed injury to open injury
Restriction of blood flow
Excessive bleeding
Pain/paralysis
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splinting – General Rules
Assess distal pulse, motor function, and sensation (PMS) before & after application.
Immobilize joints above & below injury.
8
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splinting – General Rules
Remove or cut away clothing.
Cover open wounds with sterile dressings.
Do not replace protruding bone ends.
Pad splint.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splinting – General Rules
If the following:
Severe deformity
Cyanotic distal extremity
Pulseless distal extremity
Then align with gentle traction unless resistance is felt.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Align joints with gentle traction.
9
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splinting – General Rules
Splint patient before moving.
When in doubt, splint.
Care for ABCs and life threats first.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Types of SplintsTypes of Splints
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Hazards of Improper Splinting
Compression of nerves, tissues, and blood vessels
Delays transport of critical patients
Continued…
10
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Hazards of Improper Splinting
Reduced distal circulation from tight splints
May aggravate or worsen initial injury (splint loose or excessive motion)
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
LongLong--Bone SplintingBone SplintingStabilize extremity manually.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess distal PMS.Assess distal PMS.
11
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Make sure splint extends several inchesMake sure splint extends several inchesbeyond joints above/below injury.beyond joints above/below injury.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Apply splint. Immobilize joints Apply splint. Immobilize joints above/below injury.above/below injury.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure extremity to splint.Secure extremity to splint.
12
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure foot or hand in the positionSecure foot or hand in the positionof function.of function.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Reassess distal PMS.Reassess distal PMS.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Immobilization:Joint Immobilization:Stabilize injured area manually.
13
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess distal PMS.Assess distal PMS.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Immobilize injury site and bonesImmobilize injury site and bonesabove and below.above and below.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Reassess distal PMS.Reassess distal PMS.
14
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Pelvic InjuryPelvic fracture
Hip dislocation
Maintain strong suspicion of spinal injury.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Treatment of Pelvic Injury
Minimize motion of injured area.
Assess distal PMS.
Attempt to straighten lower extremities into anatomical position.
Pad between extremities with blanket.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Treatment of Pelvic Injury
Apply PASG if patient is hypotensive.
Place patient on spine board. (Use caution with log-roll!)
Reassess distal PMS.
Care for shock.
Transport.Continued…
15
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Treatment of Pelvic Injury
Pelvic wrap is an option.
Perform patient assessment.
Treat for shock.
When correctly placed, sheet will appear lower than iliac “wings.”
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Pelvic WrapPelvic WrapPrepare backboard.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Pelvic WrapPelvic WrapLogroll patient & bring sheets around patient.
16
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Pelvic WrapPelvic WrapSecure sheets without over-compressing.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Traction Splinting
Use a traction splint to immobilize a painful, swollen, or deformed thigh with no joint or lower leg pain.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Traction Splinting
Contraindications
Injury to:Knee or nearby areaHip (proximal femur)PelvisLower leg; or
Avulsion or partial amputation of lower leg
17
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Traction Splinting: Traction Splinting: Stabilize leg manually. Assess distal PMS.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Direct application of manual traction.Direct application of manual traction.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Adjust splint length and position.Adjust splint length and position.
18
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Apply proximal securing device.Apply proximal securing device.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Apply distal securing device.Apply distal securing device.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Apply mechanical traction.Apply mechanical traction.
19
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Position/fasten support straps. Position/fasten support straps. Reevaluate proximal/distal securing Reevaluate proximal/distal securing devices.devices.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Reassess distal PMS.Reassess distal PMS.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure patient and splint to long board.Secure patient and splint to long board.
20
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Sling and Swathe:Sling and Swathe:Sling should be triangular.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Assess PMS; position sling.Assess PMS; position sling.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Form sling.Form sling.
21
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Fasten sling.Fasten sling.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Leave fingertips exposed. Check distal Leave fingertips exposed. Check distal PMS.PMS.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Secure corner of sling.Secure corner of sling.
22
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Tie swathe around sling.Tie swathe around sling.
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splint for Injured ForearmSplint for Injured Forearm
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Splint for Injured FingerSplint for Injured Finger
23
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
1. List signs and symptoms of musculoskeletal injuries.
2. What complications will you prevent by splinting properly?
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
3. What must you assess before and after applying a splint?
4. When should you use traction while splinting an extremity?
5. When should you use a traction splint?
Review Questions
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
What priority would you assign to this patient? Why?
How would you continue your assessment?
STREET SCENESSTREET SCENES
24
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
What signs might you expect to find with a broken long bone?
What are you major concerns with possible broken bones in the extremities?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
What interventions are appropriate for this patient?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ
Sample Documentation