Transcript Musculoskeletal Emergencies

Musculoskeletal System
& Emergencies
Musculoskeletal system & Emergencies
Functions of the
Musculoskeletal System
– Gives the body shape
– Protects internal organs
– Provides for movement
– Consists of more than 600 muscles
Musculoskeletal system & Emergencies
Anatomy

Muscles

Ligaments

Tendons

Bones
Musculoskeletal system & Emergencies
- provide movement &
generate heat.
- connect bone to bone
injury = sprain
- connect bone to muscle
injury = strain
- protection & shape
The Skeletal System

Gives form to the body

Protects vital organs

Consists of 206 bones

Acts as a framework for attachment of
muscles

Designed to permit motion of the body
Musculoskeletal system & Emergencies
The Skull
Musculoskeletal system & Emergencies
The Neck
Musculoskeletal system & Emergencies
The Spinal Column
Musculoskeletal system & Emergencies
The Thorax
Musculoskeletal system & Emergencies
The Pelvis
Musculoskeletal system & Emergencies
The Lower Extremity

Hip

Thigh
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Knee

Leg
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Ankle

Foot
Musculoskeletal system & Emergencies
The Upper Extremity

Shoulder girdle

Arm

Elbow

Forearm

Wrist

Hand
Musculoskeletal system & Emergencies
Joints
Musculoskeletal system & Emergencies
Types of Muscle (1 of 2)

Skeletal (voluntary) muscle
– Attached to the bones of the body

Smooth (involuntary) muscle
– Carry out the automatic muscular
functions of the body
Musculoskeletal system & Emergencies
Types of Muscle (2 of 2)

Cardiac muscle
– Involuntary muscle
– Has own blood supply and electrical
system
– Can tolerate interruptions of blood
supply for only very short periods
Musculoskeletal system & Emergencies
Injuries
Sprain
 Strain
 Dislocation
 Closed fracture
 Open fracture

Musculoskeletal system & Emergencies
Sprains & Strains

Sprain
– Joint injury with tearing of ligaments

Strain
– Stretching or tearing of a muscle
Musculoskeletal system & Emergencies
S/S
 Pain
 Edema
and Ecchymosis
 Joint instability
 Treatment: - immobilize, ice, &
elevate if possible
Musculoskeletal system & Emergencies
Dislocation

A disruption of a joint, in which the
bone ends are no longer in contact and
the supporting ligaments are torn
Musculoskeletal system & Emergencies
S/S of a Dislocation
Marked deformity
 Edema
 Pain
 Tenderness on palpation
 Complete loss of joint function
 Distal numbness
 Treatment - immobilize, ice, elevate if
possible.

Musculoskeletal system & Emergencies
Fractures

Closed fracture

– does not break the
skin

Open fracture
– External wound
Musculoskeletal system & Emergencies
Nondisplaced
fracture
– Simple crack

Displaced fracture
– deformity
Closed fracture

Signs & symptoms
–
–
–
–
–
–
–
–

Pain
Edema
Possible deformity
Contusion
Loss of motion
false motion
Crepitus
Guarding
Treatment - immobilize, ice, elevate if possible.
Musculoskeletal system & Emergencies
Open fracture
 Signs
& symptoms
– Pain
– Deformity
– Break in skin and/or exposed bone

Treatment - dressing, immobilize, ice, &
elevate if possible
Musculoskeletal system & Emergencies
Old terminology

Simple & compound
Musculoskeletal system & Emergencies
Types of Fractures
Green stick
 Spiral
 Transverse
 Comminuted
 Pathologic
 Epiphyseal

Musculoskeletal system & Emergencies
complications of fx
 blood
 Fat
vessel & nerve damage
embolus
 disability
or deformity
Musculoskeletal system & Emergencies
Bleeding (internal)
 Bones
have a blood supply!
 Fractures
bleed internally -
– Femur - 1 liter
– Pelvis - 1 liter
– Tibia - 500 cc
Musculoskeletal system & Emergencies
Other considerations

What is beneath fracture site?

open fracture

Joint involved?
Musculoskeletal system & Emergencies
Tips & other stuff
Angulation or angulated extremity
 Depressed skull fracture
 Basilar skull fracture
 Flail Chest

Musculoskeletal system & Emergencies
Hip Injury
 Hip
Fracture – classic presentation
– Shortened, externally rotated
 Hip
Dislocation
– Usually flexed and internally rotated
 Requires
significant force
Musculoskeletal system & Emergencies
TX
draw-sheet method
 Make NO attempt to straighten leg
 Support with rolled blankets
 Prevent hip movement

Musculoskeletal system & Emergencies
Assessment of injured
extremities

PMSC
–
–
–
–
Pulse
Movement
Sensation
Capillary refill
Cold, blue, pulseless extremity has
circulation problem
Musculoskeletal system & Emergencies
ALWAYS CHECK DISTAL
FUNCTION BEFORE &
AFTER SPLINTING !!!!!
AND DOCUMENT WHAT YOU
FOUND !!
Musculoskeletal system & Emergencies
Splinting
 Why
we splint...
– relieve pain
– reduce tissue/vessel damage
during movement
Musculoskeletal system & Emergencies
Types of splints

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Self splinting
Pillows, blankets, & items of clothing
Sling & swath
Rigid
– Cardboard
– plastic
– ladder


Air or vacuum
Traction
Musculoskeletal system & Emergencies
Traction splints

Closed, mid-shaft femur fracture
without hip, knee, or ankle injury.
Musculoskeletal system & Emergencies
General Principles of
Splinting (1 of 2)
Remove clothing area
 PMSC
 Dress all wounds
 Do not move the patient
before splinting

Musculoskeletal system & Emergencies
General Principles of
Splinting (2 of 2)



Immobilize the joints
Pad rigid splints
Maintain manual immobilization.
Realign angulations PRN
 When in doubt, splint
 Reassess PMSC
 Immobilize all suspected spinal
injuries in a neutral in-line position*

*pain, resistance, crepitus
Musculoskeletal system & Emergencies
Realignment issues

NEVER REALIGN A JOINT

NEVER REALIGN A INJURY WITH
GOOD DISTAL FUNCTION

Only pulseless, longbone fractures
Musculoskeletal system & Emergencies
Basic Realignment Steps
Have all equipment ready & in place
 Explain procedure to patient
 In 1 move, with gentle traction, align
extremity (goal is anatomical position)


Use the least amount of force necessary.
If resistance is met or pain increases, splint
in deformed position.

Reassess distal function

Musculoskeletal system & Emergencies
Remember

No matter how bad the fracture our
priorities are the ABC’s
Musculoskeletal system & Emergencies
Hazards of Improper
Splinting

Further damage

Delay in transport

Reduction of distal circulation

Aggravation of the injury

Injury to tissue, nerves, blood
vessels, or muscle
Musculoskeletal system & Emergencies
end
Questions???
Musculoskeletal system & Emergencies