Transcript Injuries
Pathophysiology of the Musculoskeletal System Joint Injury Sprain Subluxation Dislocation Bone Injury Open Fracture Closed Fracture Hairline Fracture Impacted Fracture Pathophysiology — Mechanism of Injury Five forces cause bone and joint injury Direct force Indirect force Twisting force Pathological Fatigue Classifications of Musculoskeletal Injuries Injuries include: Fractures Sprains Strains Joint dislocations Musculoskeletal Injuries Direct trauma Blunt force applied to an extremity Indirect trauma Vertical fall that produces spinal fracture distant from site of impact Pathological conditions Some forms of arthritis Malignancy Pathophysiology — Fractures Unstable — Proximal and distal ends move freely in relationship to each other Impacted — Jammed together so there is no movement between proximal and distal bones Open — Skin is open, allowing introduction of bacteria, dirt, and other foreign bodies Closed — Skin is intact Fracture with dislocation — Fracture at joint with injury to supporting structures Fractures Break in continuity of bone or cartilage Complete or incomplete Line of fracture through bone Open or closed Integrity of skin near fracture site Classification of Fractures Open Closed Comminuted Greenstick Spiral Classification of Fractures Oblique Transverse Stress Pathological Epiphyseal Classification of Fractures Pathophysiology — Fractures Impacted Pathophysiology — Fractures Joint Dislocations Normal articulating ends of two or more bones are displaced Luxation: Complete dislocation Subluxation: Incomplete dislocation Frequently dislocated joints Suspect joint dislocation when joint is deformed or does not have normal range of motion Dislocations can result in great damage and instability Pathophysiology — Fractures Dislocation - Angulated Pathophysiology — Fractures Sprains Partial tearing of ligament Caused by sudden twisting or stretching of joint beyond normal range of motion Common in ankle and knee Graded by severity First-degree sprain Second-degree sprain Third-degree sprain Strains Injury to muscle or its tendon Overexertion or overextension Common in back and arms May have significant loss of function Severe strains may cause avulsion of bone from attachment site Pathophysiology of the Musculoskeletal System Inflammatory & Degenerative Conditions Bursitis Tendinitis Arthritis Osteoarthritis Degenerative Rheumatoid Arthritis Chronic, systemic, progressive, debilitating Gout Inflammation of joints produced by accumulation of uric acid crystals Bursitis Inflammation of bursa Small, fluid-filled sac acts as cushion at a pressure point near joints Most important bursae are around knee, elbow, and shoulder Bursitis Bursitis is usually from: Pressure Friction Injury to membranes surrounding the joint Treatment Rest, ice, and analgesics Tendonitis Inflammation of tendon Often caused by injury Symptoms include: Pain Tenderness Restricted movement of muscle attached to affected tendon Treatment Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroid medications Arthritis Joint inflammation Pain, swelling, stiffness, and redness Joint disease Involving one or many joints Many causes Varies in severity Mild ache and stiffness Severe pain and later joint deformity Arthritis Osteoarthritis (degenerative arthritis) most common Pain usually managed with antiinflammatory agents Extremity Trauma Signs and symptoms Pain on palpation or movement Swelling, deformity Crepitus Decreased range of motion False movement (unnatural movement of extremity) Decreased or absent sensory perception or circulation distal to injury Six "P"s of Compartment Syndrome Pain On palpation (tenderness) On movement Pallor—pale skin or poor capillary refill Paresthesia—pins and needles sensation Pulses—diminished or absent Paralysis—inability to move Pressure Associated Complications Hemorrhage Instability Loss of tissue Simple laceration and contamination Interruption of blood supply Nerve damage Long-term disability Assessment Determine if life-threatening conditions are present Care for those first Never overlook musculoskeletal trauma Don’t allow noncritical musculoskeletal injury to distract from priorities of care Musculoskeletal Assessment Four classes of patients Life-/limb-threatening injuries or conditions Includes life-/limb-threatening musculoskeletal trauma Other life-/limb-threatening injuries and simple musculoskeletal trauma Life-/limb-threatening musculoskeletal trauma No other life-/limb-threatening injuries Isolated, non-life-/limb-threatening injuries Musculoskeletal Injury Assessment Scene Size-up Initial Assessment Categories of urgency Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal injuries Rapid Trauma Assessment Focused H&P 6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses Detailed Physical Exam Ongoing Assessment Sports Injury Consideration Age-Associated Changes in Bones Water content of intervertebral disks decreases Increased risk of disk herniation Loss of stature is common – ½ - 3/4 inch Bone tissue disorders shorten trunk Age-Associated Changes in Bones Vertebral column assumes arch shape Costal cartilages ossify, making thorax more rigid Shallow breathing due to rigid thoracic cage Facial contours change Fractures Limb-Threatening Injuries Knee dislocation Fracture or dislocation of ankle Subcondylar fractures of elbow Require rapid transport Musculoskeletal Injury Management Other Injury Consideration Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support Musculoskeletal Injury Management General Principles Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function Musculoskeletal Injury Management Splinting Devices Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids Vacuum Splints Air Sprints Cravats or Velcro Splints Fracture Care Joint Care Muscular & Connective Tissue Care Musculoskeletal Injury Management Care for Specific Fractures Pelvis Scoop Stretcher PASG Fluid Resuscitation Femur Traction Splints PASG Fracture versus hip doslocation Musculoskeletal Injury Management Care Specific Fractures Tibia/Fibula Clavicle Most frequently fractured bond in the body Transmitted to 1st and 2nd rib Alert for lung injury Humerus Radius/Ulna Musculoskeletal Injury Management Care for Specific Joint Injuries Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger Joint Injuries Alert for PMS Compromise Musculoskeletal Injury Management Soft & Connective Tissue Injuries Tendon Ligament Muscle Musculoskeletal Injury Management Medications Nitrous Oxide 50% O2:50% N Non-explosive Effects dissipate in 2-5 minutes Easily diffused into air filled spaces in body. Dose Inhaled & self administered Onset 1-2 minutes Not A Biotel Option Diazepam Benzodiazepine Antianxiety Analgesic Dose 5-15 mg titrated Onset 10-15 minutes Duration 15-60 minutes Counter Agent Flumazenil Dislocation of Acromioclavicular Joint Humerus Injury Older adults and children Difficult to stabilize Complications Radial nerve damage if fracture in middle or distal portion of humeral shaft Humeral neck fracture may cause axillary nerve damage Internal hemorrhage into joint Musculoskeletal Injury Management Medications Oxygen n Nitrous Oxide n Morphine Sulfate Fluids Nitrous Oxide Class: Gaseous Analgesic/Anesthetic Route: Inhalation Adult Dose: Instruct patient to inhale deeply through patient-held mask or mouthpiece Pediatric Dose: Instruct patient to inhale deeply through patientheld mask or mouthpiece Drug Action: Depresses the central nervous system Increases oxygen tension in the blood thereby reducing hypoxia Onset:2 minutes - 5 minutes Duration:2 minutes - 5 minutes Nitrous Oxide Indications: Adjunct analgesic for ischemic chest pain Severe pain or discomfort in all patients without contraindications. Precautions: Must be self administered Check machine gauges daily for proper concentrations Monitor blood pressure and pulse oximetry values during administration Side Effects: Hypotension Dizziness Nausea and vomiting Contraindications: Any altered level of consciousness or head injury Chronic obstructive pulmonary disease Chest trauma or actual/suspected pneumothorax Abdominal trauma Major facial trauma Acutely psychotic patients Pregnancy, other than active labor Any patient (adult or pediatric) unable to self-administer Decompression sickness Morphine Sulfate Indications Pain and anxiety secondary to AMI Chest pain unrelieved by Nitroglycerin Pulmonary edema Pain secondary to amputations or fractures Precautions: Monitor respiratory status and blood pressure closely. Notify Biotel prior to administration if patient is >65yrs of age, debilitated, has altered mental status, or systolic BP<110mmHg CHF: be prepared to intubate Antidote: Naloxone (Narcan®) Morphine Sulfate Class: Narcotic Analgesic Route: Slow IV push Dose: Adult: Administer in titrated doses of 2 - 4mg, up to a maximum of 10mg Pediatric: 0.1mg/kg Drug Action: Alleviates pain Decreases peripheral vascular resistance - vasodilator Decreases cardiac workload and oxygen demand on the heart