Transcript Musculoskeletal System

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Musculoskeletal System
Temple College
EMS Professions
Musculoskeletal System
Bones
w Muscles
w Cartilages
w Tendons
w Ligaments
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Skeleton
Support against gravity
w Movement
w Protection
w Production of blood cells
w 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
Cervical: 7 vertebrae
w Thoracic: 12 vertebrae
w Lumbar: 5 vertebrae
w Sacrum: 5 vertebrae (fused)
w Coccyx: 4 vertebrae (fused)
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Thorax
12 pairs of ribs
w Sternum
w Protects heart, lungs
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Pelvis
Bony ring
w Two innominate bones, each made of 3
fused bones
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• Ilium
• Ischium
• Pubis
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Lower Extremity
Femur (largest bone in body)
w Patella (knee cap)
w Tibia (shin bone)
w Fibula
w Tarsals
w Metatarsals
w Phalanges
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Upper Extremity
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Shoulder girdle
• Scapula
• Clavicle
Humerus
w Radius
w Ulna
w Carpals
w Metacarpals
w Phalanges
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Muscles
Maintain posture, allow movement
w 3 types:
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• Skeletal (Striated)
• Smooth (Involuntary)
• Cardiac
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Skeletal Muscles
Voluntary muscles
w Attach to bones by tendons that cross joints
w Shortening of muscle moves joint
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Smooth Muscles
Carry out involuntary movements
w Located in walls of:
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GI tract
GU tract
Respiratory tract
Blood vessels
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Cardiac Muscle
Found only in heart
w Automaticity
w Can initiate own contractions without
external stimulation
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Joints
Joining points of bones
w Bone-ends covered with cartilage
w Ligaments connect bone-to-bone
w Inner surface of joint capsule lined with
synovial membrane
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• 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
Direct force
w Indirect force
w Twisting forces (torsion)
w Diseases of bones (pathological fractures)
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• Osteoporosis
• Tumors
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Open vs. Closed Fractures
Closed = skin over fracture site intact
w Open = break in skin over fracture site
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• 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
Transverse: fracture is at 90o angle to shaft
w Oblique: fracture is at an angle other than
90o to shaft
w Spiral: fracture coils through shaft of bone
like a spring
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Fracture Types
Impacted: bone ends driven into each other
w 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
Deformity
w Tenderness
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• 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
Swelling, ecchymosis
w Exposed fragments
w Crepitus
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• 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
Deformity
w Swelling, ecchymosis about joint
w Pain/tenderness in joint
w Loss of motion usually perceived as
“locked” joint
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Sprains
Partial, temporary dislocations
w Result in tearing of ligaments
w Bone ends NOT displaced from normal
positions
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Sprain Signs
Tenderness
w Swelling, ecchymosis
w Inability to use extremity
w 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
“Muscle pull”
w Injury to musculotendenous unit
w Pain on active motion
w Pain not present on passive motion
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Assessment
Perform initial (primary) assessment
w Locate, treat life-threats
w Assess for injuries of head, chest, abdomen,
pelvis
w Assess distal neurovascular function
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Assessment
With exception of pelvic, possibly femur
fractures, orthopedic injuries are NOT lifethreatening.
w Do NOT let spectacular orthopedic injury
distract you from ABCs
w 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
w 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
Do NOT move patients before splinting
unless patient is in danger
w Remove clothes to allow inspection of limb
w Note, record distal neurovascular function
before, after splinting
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Principles of Splinting
Cover wounds with dry, sterile compression
dressings
w Fractures: splint joint above, below fracture
w Dislocations: splint bone above, below joint
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Principles of Splinting
Minimize movement
w Support injury until splinting completed
w 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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PowerPoint Source
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Slides for this presentation from Temple
College EMS:
http://www.templejc.edu/dept/ems/pages/
powerpoint.html
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