Transcript Bleeding and Shock - Monterey County Fire Training

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Musculoskeletal System
Temple College
EMS Professions
Musculoskeletal System
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Bones
Muscles
Cartilages
Tendons
Ligaments
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Skeleton
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Support against gravity
Movement
Protection
Production of blood cells
Storage of calcium, phosphorus
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Skull
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Cranium
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Frontal
Parietal
Temporal
Occipital
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Face
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Mandible
Maxilla
Zygoma
Nasal bones
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Spinal Column
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Cervical: 7 vertebrae
Thoracic: 12 vertebrae
Lumbar: 5 vertebrae
Sacrum: 5 vertebrae (fused)
Coccyx: 4 vertebrae (fused)
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Thorax
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12 pairs of ribs
Sternum
Protects heart, lungs
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Pelvis
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Bony ring
Two innominate bones, each made of 3
fused bones
• Ilium
• Ischium
• Pubis
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Lower Extremity
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Femur (largest bone in body)
Patella (knee cap)
Tibia (shin bone)
Fibula
Tarsals
Metatarsals
Phalanges
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Upper Extremity
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Shoulder girdle
• Scapula
• Clavicle
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Humerus
Radius
Ulna
Carpals
Metacarpals
Phalanges
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Muscles
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Maintain posture, allow movement
3 types:
• Skeletal (Striated)
• Smooth (Involuntary)
• Cardiac
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Skeletal Muscles
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Voluntary muscles
Attach to bones by tendons that cross joints
Shortening of muscle moves joint
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Smooth Muscles
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Carry out involuntary movements
Located in walls of:
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GI tract
GU tract
Respiratory tract
Blood vessels
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Cardiac Muscle
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Found only in heart
Automaticity
Can initiate own contractions without
external stimulation
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Joints
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Joining points of bones
Bone-ends covered with cartilage
Ligaments connect bone-to-bone
Inner surface of joint capsule lined with
synovial membrane
• Produces synovial fluid
• Lubricates joint
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Extremity Trauma
Temple College
EMS Professions
Fracture
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Break in bone’s continuity
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Fracture Causes
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Direct force
Indirect force
Twisting forces (torsion)
Diseases of bones (pathological fractures)
• Osteoporosis
• Tumors
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Open vs. Closed Fractures
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Closed = skin over fracture site intact
Open = break in skin over fracture site
• Bone ends do not have to be exposed
• Small opening in skin communicating with
fracture site = open fx
• Open fractures more serious due to external
blood loss, possible infection
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Fractures
One of the most important things we
do in EMS is prevent closed
fractures from becoming open ones
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Fracture Types
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Transverse: fracture is at 90o angle to shaft
Oblique: fracture is at an angle other than
90o to shaft
Spiral: fracture coils through shaft of bone
like a spring
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Fracture Types
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Impacted: bone ends driven into each other
Comminuted: bone broken into > 3 pieces
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Fracture Types
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Greenstick
• Shaft of bone not completely broken
• Compressed on one side, splintered outward on
other
• What group of patients does this type of
fracture occur in?
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Fracture Signs
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Deformity
Tenderness
• Usually point tenderness
• Overlies fracture site
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Inability to use limb
• Reliable sign of significant injury if present
• Reverse is not true
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Fracture Signs
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Swelling, ecchymosis
Exposed fragments
Crepitus
• Grating of bone ends
• May be heard or felt
• Do NOT actively seek
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Dislocation
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Displacement of bones from normal
positions at joint
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Dislocation Signs
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Deformity
Swelling, ecchymosis about joint
Pain/tenderness in joint
Loss of motion usually perceived as
“locked” joint
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Sprains
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Partial, temporary dislocations
Result in tearing of ligaments
Bone ends NOT displaced from normal
positions
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Sprain Signs
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Tenderness
Swelling, ecchymosis
Inability to use extremity
No deformity
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Sprains
Degree of joint dislocation at time
of injury cannot be determined
during exam
Extensive damage to neural or
vascular structures may have
occurred
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Strains
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“Muscle pull”
Injury to musculotendenous unit
Pain on active motion
Pain not present on passive motion
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Assessment
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Perform initial (primary) assessment
Locate, treat life-threats
Assess for injuries of head, chest, abdomen,
pelvis
Assess distal neurovascular function
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Assessment
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With exception of pelvic, possibly femur
fractures, orthopedic injuries are NOT lifethreatening.
Do NOT let spectacular orthopedic injury
distract you from ABCs
It’s the unobvious things that kill patients!
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Assessment
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Evaluation must ALWAYS be done of
distal neurovascular function.
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Pulse
Skin color
Capillary refill
Sensation
Movement
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Management
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Splinting
• Prevents further movement at injury site
• Limits tissue damage, bleeding
• Eases pain
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Management
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When in doubt
SPLINT
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It is difficult to differentiate fractures,
dislocations and sprains
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Principles of Splinting
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Do NOT move patients before splinting
unless patient is in danger
Remove clothes to allow inspection of limb
Note, record distal neurovascular function
before, after splinting
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Principles of Splinting
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Cover wounds with dry, sterile compression
dressings
Fractures: splint joint above, below fracture
Dislocations: splint bone above, below joint
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Principles of Splinting
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Minimize movement
Support injury until splinting completed
Pad splint to avoid local pressure
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Principles of Splinting
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Angulated fractures
• Realign before splinting
• If resistance, pain encountered stop,
immobilize as is
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Dislocations
• Splint as is unless circulation compromised
• Attempt to reposition once to restore pulse
• If resistance, pain encountered stop,
immobilize as is
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