Transcript Chapter8_Musculoskeletal_Trauma

Chapter 8
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Establish the principles for assessing the
patient with MSK injuries
Establish treatment priorities
Identify the importance of MSK injuries in the
multiply injured patient
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How do musculoskeletal injuries impact on
the primary survey?
What are my prioriries?
What are my management principles?
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C - Circulation
External bleeding
Occult blood loss:
◦ Long bone fractures
◦ Pelvic fractures
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The 3 S’s
◦ Stop the bleeding
◦ Splint the extremity
◦ Stabilize the pelvis
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Prevents further blood loss and injury
May restore or maintain perfusion
Relieves pain
◦ Important during evaluation
◦ Do not delay
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Vascular compromise
Open fractures
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Reduce fracture
Splint fracture
Assess by Doppler if available
Obtain consult
Consider angiography if available
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Mechanism of injury
◦ Blunt or penetrating
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Energy forces involved
◦ Crush or deceleration
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Associated factors
◦ Injury patterns such as pelvic or diaphragmatic
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Time of injury
◦ Time from injury to definitive treatment
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Location of injury
◦ Where injury occurred
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Apply appropriate splint
Cleanse/debride
Consider time factor
Obtain orthopedic consult
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Look
Feel
Listen
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FOR WHAT?
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Look
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Deformity
Pain
Tenderness
Wound
Feel
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Crepitus
Skin flaps
Neuro deficit
Pulses
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Listen
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Doppler
Bruit
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What X-rays do I need
◦ Any suspected areas
◦ One joint above and below
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When do I obtain them
◦ When patient is stable
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Tibia and forearm fractures
Vascular and bony injuries
Injuries immobilized in tight dressings or
casts
Severe crush injuries to muscle
Burn injuries
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Pain: out of keeping with injury
Paresthesia
Pallor
Paralysis
Pulse loss (late)
Tissue pressures > 35 to 45 mmHg
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Occult fractures
Vascular injury
Compartment syndrome
Minor injuries
Antocoagulation
Altered sensorium