Transcript bledsoe_pcpp4_ch13_lecture - McLaren

Paramedic Care: Principles & Practice
Fourth Edition
Volume 4: Medicine
CHAPTER
13
Nontraumatic
Musculosketetal
Disorders
Standard
• Medicine (Nontraumatic Musculoskeletal
Disorders)
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Competency
• Integrates assessment findings with
principles of epidemiology and
pathophysiology to formulate a field
impression and implement a
comprehensive treatment/disposition
plan for a patient with a medical
complaint.
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Introduction
• Most musculoskeletal complaints
related to recent trauma.
• Many nontraumatic (medical)
musculoskeletal disorders inflammatory
or autoimmune in nature.
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Introduction
• Rheumatologists: physicians who
specialize in treatment of nontraumatic
conditions that affect muscles, joints,
bones.
• Physiatrists: physicians who specialize
in physical medicine and rehabilitation,
manage medical conditions of
musculoskeletal system.
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Anatomy and Physiology Review
• Musculoskeletal system: muscular
system and skeletal system.
• Provides body with form, support,
stability, ability to move about.
• Skeletal system: bones, joints,
ligaments, connective tissues.
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Anatomy and Physiology Review
• Muscular system: muscles, tendons,
connective tissues.
• Nervous system: major role in
nontraumatic medical conditions.
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Anatomy and Physiology Review
• Skeletal System
– 206 bones classified based on shape:
 Long
 Short
 Flat
 Irregular
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Anatomy and Physiology Review
• Skeletal System
– Long bones found in extremities.
– Short bones found in wrists and ankles.
– Flat bones form skull, ribs, sternum.
– Irregular bones found in joints and
spine.
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Bone shapes.
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Basic bone anatomy.
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Anatomy and Physiology Review
• Skeletal System
– Bones joined together by ligaments to
form joints; allow us to move.
 Gliding joints (wrists and ankles)
 Hinge joints (elbows and knees)
 Saddle joints (base of thumb)
 Pivot joints (forearm)
 Ellipsoidal joints (wrist and foot)
 Ball-and-socket joints (shoulder and hip)
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Types of joints.
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Anatomy and Physiology Review
• Skeletal System
– Joints contain cartilage.
 Flexible connective tissue; provides
support and structure for joint and
cushioning effect.
 Avascular tissue: not supplied by blood
vessels.
 Found outside of joints in ears, nose,
larynx, trachea, rib cage.
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Anatomy and Physiology Review
• Skeletal System
– Hyaline cartilage: lines bones in joints.
– Elastic cartilage: more flexible; found in
outer ear and larynx.
– Fibrocartilage cartilage: strongest and
most rigid type; intervertebral discs of
spine; connects tendons and ligaments
to bones.
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Anatomy and Physiology Review
• Skeletal System
– Joints contain lubricant: synovial fluid.
 Oily, straw-colored fluid; fills joint space;
serves to reduce friction in joint.
– Bursae: fluid-filled sacs and synovial
pockets; cushion tendons and bones
and reduce friction, allowing free
movement.
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Articular cartilage and synovial joint.
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Anatomy and Physiology Review
• Muscular System
– 700 skeletal muscles in humans.
 Allowing movement of skeleton.
 Supporting soft tissues.
 Maintaining posture and body position.
 Protecting entrances and exits of
digestive and urinary tracts.
 Maintaining body temperature.
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Anatomy and Physiology Review
• Muscular System
– Muscles contractile units.
– Tendons located at end of muscle; form
fibrous bundle that connects muscle to
bone.
– Skeletal muscles controlled by
voluntary nervous system.
– Significant user of energy; subject to
fatigue and injury.
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The muscular system.
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Assessment and Findings
• Nontraumatic musculoskeletal disorders
present with pain, tenderness,
associated swelling or abnormality.
• Loss of movement of affected joints.
• Deformity (temporary or permanent)
can occur.
• Primary assessment; ensure adequacy
of airway, breathing, circulation.
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Assessment and Findings
• Secondary assessment; focused and
detailed history of illness.
• Review patient's medications.
• Joint pain: examine joint for
tenderness, swelling, erythema,
restriction in range of motion.
• Muscle disorders: restrictions in range
of motion; tender points and muscle
spasm.
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Assessment and Findings
• Back Pain
– Detailed exam to exclude conditions
that require emergency treatment, such
as cauda equina syndrome.
– Neurologic exam including deep tendon
reflexes; sensory or motor deficits.
– Signs of urinary or fecal incontinence,
saddle anesthesia.
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Assessment and Findings
• Treatment
– Supportive and symptomatic.
– Pain management provided with opiate
analgesics and nonsteroidal antiinflammatory drugs.
– Splinting; application of cold or heat
packs.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Form of trauma; tend to be chronic;
often considered medical conditions.
– Occur from repetitive events; lead to
signs and symptoms similar to those
associated with acute trauma.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Repetitive-motion injuries
 Common; microscopic tears of affected
tendons or muscles.
 Body unable to repair affected tissues
because of continued use.
 Related to vocation or avocation.
 Causes: trauma, crystal deposits within
joint, friction, systemic diseases.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Repetitive-motion injuries
 Pain or tenderness; range of motion
restricted due to swelling and/or pain.
 Tendinitis, bursitis, myalgias, carpal
tunnel syndrome.
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Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Repetitive-motion injuries
 Tendinitis (tendonitis): inflammation of
tendon; elbow, biceps muscle, shoulder.
 Tennis elbow (epicondylitis):
inflammation of extensor tendon on
lateral aspect of elbow.
 Golfer's elbow (epicondylitis): involves
tendinous sheath that inserts into medial
epicondyle.
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Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Repetitive-motion injuries
 Tenosynovitis: inflammation of lining of
sheath that surrounds tendon.
 Bursitis: inflammation of bursae; elbow,
knee hip.
 Bursae: small synovial sacs located along
tendons at points where friction can
develop.
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Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Repetitive-motion injuries
 Chronic myalgia: painful condition of
various causes; lifting, moving, turning.
 Any muscle that is overused or
repetitively used at risk for developing
myalgia.
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Nontraumatic Musculoskeletal
Conditions
• Overuse/Repetitive-Motion Disorders
– Repetitive-motion injuries
 Carpal tunnel syndrome (CTS): caused
by pressure on median nerve in wrist.
 Tingling, numbness, weakness, pain felt
in fingers and hand.
 Repetitive motion that led to condition
exacerbates pain.
 Common work-related disability.
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Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Disturbance in normal functioning of
affected tissues or organs system.
– Due to age and wear and tear.
– Can affect virtually any body system.
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Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Osteoarthritis (OA)
 Degenerative joint disease; wear and
tear on joints.
 Associated with aging; runs in families.
 Exacerbated by obesity.
 Can result from medical disorders
(hemophilia, avascular necrosis, arthritic
disorders).
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Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Osteoarthritis (OA)
 Pain and stiffness on arising in morning;
improves with movement.
 Becomes worse over time; may be
swelling or crackling in joint.
 Routine movement and activities painful.
 Chronic condition; improves with
medications and physical therapy.
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Osteoarthritis. (Fotolia.com)
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Osteoporosis
 Common form of bone disease.
 Thinning of bone tissue; loss of bone
density occurs over time.
 Body fails to produce enough new bone
to replace bone being resorbed or used.
 Calcium and phosphate substances
essential for normal bone formation.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Osteoporosis
 Primary causes: loss of estrogen in
women during menopause; drop in
testosterone levels in men.
 Increased risk: women over 50; men
over 70.
 Chronic arthritis, patients taking
corticosteroids, hyperparathyroidism,
vitamin D deficiency, bedridden patients.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Osteoporosis
 As condition progresses: bone pain,
tenderness, fracture with little or no
trauma.
 Patient may lose body height.
 Prone to low back and neck pain.
 Women tend to develop increased
kyphosis of spine ("dowager's hump").
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Osteoporosis
 Treatment: pain control, medications and
therapies to reduce bone loss and
promote bone development, preventive
strategies to minimize falls and injuries.
 Calcium replacement, hormonal therapy,
exercise often used.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Degenerative disc disease
 Common cause of low back pain; agerelated changes in spinal discs.
 Discs dehydrate and become stiff;
function less effectively as shock
absorbers.
 Outer layer cracks; jellylike material
forced out through cracks, causing disc
to bulge or rupture.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Degenerative Conditions
– Degenerative disc disease
 Herniated portion of disc places pressure
on spinal nerves, causing pain and
weakness.
 Does not have blood supply; inefficient in
repairing itself.
 Pain often worsened with movement.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Inflammatory joint diseases: group of
rheumatologic conditions; inflammation
within joint.
 Pain, stiffness, erythema, warmth,
swelling of joint.
 Inflammation so severe that range of
motion of joint lost.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Rheumatoid arthritis (RA)
 Chronic disease that leads to
inflammation and injury to joints and
surrounding tissues.
 Autoimmune disease.
 Women more often affected; joints of
wrists, fingers, knees, ankles, feet.
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Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Rheumatoid arthritis (RA)
 Fatigue, low-grade fever, malaise,
weakness.
 Joint painful and swollen; prolonged
morning stiffness.
 Significant damage to joints, with
deformity.
 Chronic condition that cannot be cured;
can be treated with medications.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Rheumatoid arthritis (RA)
 Surgery can restore damaged joints to
fairly normal level of function.
 Many medications used are quite toxic.
 Physical therapy modalities.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Ankylosing spondylitis (AS)
 Inflammatory arthritis; affects spine.
 Inflammation of joints between vertebrae
of spine and sacroiliac joints in pelvis.
 New bone forms as a part of healing
process resulting in bony bridge.
 Spine becomes stiff and inflexible.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Ankylosing spondylitis (AS)
 Fusion can affect rib cage, restricting
lung capacity and function.
 Spine becomes fused into single unit
incapable of flexion, extension, lateral
movement.
 Patient's spine inflexible; cannot be
moved.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Ankylosing spondylitis (AS)
 Fused spine extremely fragile; subject to
fracture with spinal cord injury.
 Important to pad underneath head, neck,
upper back with sheets or pillows.
 Airway management techniques applied
without extending neck.
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Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Systemic lupus erythematosus (SLE)
 Chronic autoimmune disease; affects
skin, joints, kidneys, other organs.
 Runs in families; common in women.
 Joint pain and swelling; some will
develop full-blown arthritis.
 Fingers, wrists, knees affected.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Systemic lupus erythematosus (SLE)
 Chest pain, fatigue, fever, malaise, skin
rash, swollen lymph nodes.
 Diagnosed: laboratory testing and
physical exam.
 Treatment: symptomatic.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Gout
 Inflammatory arthritis; uric acid
accumulates in joints.
 Accumulation of uric acid crystals in
joints (gouty arthritis).
 Not every patient with elevated uric acid
will develop gout.
 Tends to occur in families; affects men
more often than women.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Inflammatory Conditions
– Gout
 Severe pain, swelling, erythema.
 Pain so severe that sheet resting on joint
is unbearable.
 Treatment: medications for pain and
inflammation.
 Dietary restrictions: help in keeping uric
acid levels at minimum.
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Gout. (American Society for Surgery of the Hand)
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Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections: skin, underlying
tissues, fascia, tendons, muscle.
 Cellulitis
– Infection of skin-associated soft tissues.
– Swelling, tenderness, erythema, exudate.
– Treatment: antibiotics; pain medication.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Fasciitis
– Inflammation and infection of fascia.
– Fascia surrounds muscles, muscle groups,
blood vessels, nerves.
– Can become life threatening.
– Necrotizing fasciitis (NF): flesh-eating
disease.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Fasciitis
– NF: bacterial infection; rapidly destroys
skin, muscles, surrounding tissues; often
due to multiple bacteria.
– Causes widespread tissue damage.
– Bacteria resistant to potent antibiotics.
– Critically ill; mortality rate very high.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Tenosynovitis
– Inflammation of fibrous sheath that
surrounds tendon.
– Inflammation can result from infection;
spread to adjoining tissues.
– Treated with parenteral antibiotics;
surgical drainage.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Gangrene
– Death of tissue in part of body affected.
– Blood supply in affected tissue
interrupted.
– Peripheral vascular disease, diabetes,
immunosuppressed, following surgical
procedures.
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Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Gangrene
– Pain; discoloration of skin (blue or black).
– Foul-smelling discharge; loss of sensation
in affected area.
– Surgery to remove dead tissue and/or to
restore blood supply.
– In many instances, amputation only
alternative.
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Gangrene. (Centers for Disease Control)
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Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Diabetic foot
– Feet (lesser degree hands) affected by
complications of poorly controlled diabetes
mellitus.
– Adversely affects peripheral blood vessels
and nerves.
– Decreased blood supply and sensation.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Diabetic foot
– Laceration or skin ulcer; leads to
development of serious foot infection.
– Spreads to bone, causing osteomyelitis.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Soft tissue infections
 Neuropathic arthropathy/Charcot joint
disease
– Complication of diabetes.
– Progressive degeneration of weightbearing joints, particularly in foot.
– Bone destruction and deformity.
– Possibility of ulceration; can lead to
amputation of affected extremity or death.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Bone and joint infections
 Osteomyelitis
– Infection of bone; acute or chronic, based
on duration of infection.
– Causes: bacterial or fungal infection.
– Spread of infection from skin, muscles,
and/or tendons to affected bone.
– Chronic wounds or chronic skin ulcer.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Bone and joint infections
 Osteomyelitis
– Infection in another part of body that has
spread to bone via bloodstream.
– At risk: diabetics, chronic hemodialysis,
intravenous drug users, peripheral
vascular disease, recent trauma,
splenectomy.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Bone and joint infections
 Osteomyelitis
– Signs and symptoms: vary based on
underlying condition.
– Diagnosis: diagnostic imaging and
laboratory analysis.
– Treatment: antibiotics, surgical drainage,
resection of affected bone.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Bone and joint infections
 Septic joint (septic arthritis)
– Infection of joint: bacteria, viruses, fungi.
– At risk: surgical procedures, prosthetic
joint, those on immunosuppressant drugs.
– Infection spreads to joint through direct
contact with skin; spread via bloodstream.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Infectious Conditions
– Bone and joint infections
 Septic joint (septic arthritis)
– Joint pain, swelling, redness, low-grade
fever.
– Diagnosis: imaging, withdrawing fluid
from joint, laboratory analyses.
– Treatment: antibiotics, surgical drainage
and irrigation.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Neoplastic Processes
– Neoplasm: abnormal growth of body
tissue; tumor.
– Tumors: bone and muscle tissue.
– Primary musculoskeletal tumor arises
from muscle, bone, associated tissues.
– Secondary musculoskeletal tumor
spreads to muscle or bone from another
site or tissue type.
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Nontraumatic Musculoskeletal
Conditions
• Neoplastic Processes
– Bone tumors benign or malignant
(cancerous).
– Most benign bone tumors:
osteochondromas.
– Most malignant bone tumors: sarcomas.
– Sarcomas arise from bone, cartilage,
muscle, fat, similar tissues.
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Nontraumatic Musculoskeletal
Conditions
• Neoplastic Processes
– Malignant bone tumors
 Chondrosarcoma (arises from cartilage)
 Ewing's sarcoma (round cell tumor)
 Osteosarcoma (arises from bone)
 Fibrosarcoma (arises from fibrous tissue)
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Nontraumatic Musculoskeletal
Conditions
• Neoplastic Processes
– Malignant tumors arise from muscle and
connective tissues.
 Rhabdomyosarcoma (arises from skeletal
muscle)
 Synovial sarcoma (arises from synovium)
 Liposarcoma (arises from fatty tissue)
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Nontraumatic Musculoskeletal
Conditions
• Neoplastic Processes
– Pain, swelling, deformity common
complaints with these conditions.
– Fractures secondary to tumor.
– Acute onset of pain or inability to use
affected part, may be related to
pathological fracture.
– Treatment: symptomatic.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Chronic Pain Syndrome
– Pain persists longer than for others who
have same condition; six D's:
 Dramatization of complaints
 Drug misuse
 Dysfunction/disuse
 Dependency
 Depression
 Disability
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Chronic Pain Syndrome
– Pain lasts in excess of 3 to 6 months.
– Associated psychological syndromes:
depression, anxiety, hypochondriasis.
– Use pain scoring system.
– Long-term treatment: medications,
including antidepressants.
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Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Chronic Pain Syndrome
– Fibromyalgia (central sensitivity
syndrome)
 Widespread pain in muscles and soft
tissues.
 More common in young or middle-aged
women.
 Cause: unknown.
 Presence of tender spots (trigger points).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Chronic Pain Syndrome
– Fibromyalgia (central sensitivity
syndrome)
 Chronic fatigue, difficulty sleeping,
headaches, difficulty concentrating,
morning stiffness, irritable bowel
syndrome, depression.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Chronic Pain Syndrome
– Reflex sympathetic dystrophy (RSD)
 Chronic pain condition; diffuse pain,
swelling, limitation of movement that
follows injury to arm or leg.
 Pain, swelling, vasomotor dysfunction.
 Type of complex regional pain syndrome
(CRPS).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Chronic Pain Syndrome
– Reflex sympathetic dystrophy (RSD)
 Treatment: corticosteroids and
medications that block sympathetic
nervous system.
 Severe cases, surgical removal of parts
of sympathetic nervous system.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Pediatric Conditions
– Juvenile rheumatoid arthritis:
debilitating condition of children.
– Osgood-Schlatter disease: painful
swelling of anterior tibial tubercle.
 Bump on upper tibia below knee;
repetitive injuries before growth
complete.
 Treatment: rest, ice, nonsteroidal antiinflammatory medications.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Pediatric Conditions
– Slipped capital femoral epiphysis
 Separation of ball of hip joint from
femur; at growth plate (epiphysis) in
proximal femur.
 More common in boys ages 11 to 15;
somewhat obese or growing rapidly.
 Limp, difficulty walking, hip or knee pain,
hip stiffness, restricted range of motion.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Nontraumatic Musculoskeletal
Conditions
• Pediatric Conditions
– Slipped capital femoral epiphysis
 Diagnosis: X-ray and physical exam.
 Treatment: surgery to stabilize bone
using pins.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Most musculoskeletal problems you will
encounter as paramedic are traumatic
in origin.
• Some nontraumatic conditions can
become emergent; characterized by
acute exacerbations that may warrant
prehospital care.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Most emergency care is symptomatic.
• Patient's primary complaint will be
pain; treated appropriately using
medications recommended for condition
and by local EMS protocols.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Measures such as rest, ice,
compression, heat, elevation beneficial.
• In chronic pain conditions, there is
often significant overlay of anxiety and
depression that contributes to pain.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Chronic pain patients can be difficult to
deal with and require greater-thanexpected doses of medications to
alleviate pain.
• Role of paramedic: address immediate
problem; provide needed treatment—
even if only symptomatic and
supportive care.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.