Transcript Document
Musculoskeletal Trauma Sections Introduction to Musculoskeletal Trauma Anatomy and Physiology of the Musculoskeletal System Pathophysiology of the Musculoskeletal System Musculoskeletal Injury Assessment Musculoskeletal Injury Management Introduction to Musculoskeletal Injuries Millions of Americans experience annually. Multiple MOI Falls, Crashes, Violence, etc Multi-system trauma Anatomy & Physiology of the Musculoskeletal System Skeletal Tissue & Structure Protects organs Allows for efficient movement Stores salts and other materials needed for metabolism Produces RBC’s Musculoskeletal System Bone Structure Diaphysis Epiphysis End of a long bone Metaphysis Between epiphysis and diaphysis Growth plate Medullary Canal Contains bone marrow Periosteum Fibrous covering of diaphysis Cartilage Connective tissue that provides a smooth articulation surface for other bones. Figure 7-1 Anatomy & Physiology of the Musculoskeletal System Joint Structure Joint Where bones interact Synarthrosis A joint that does not permit movement Diarthroses (Synovial Joints) Monaxial: hinge or pivot joints Biaxial: gliding, sliding, or saddle joints Triaxial: Ball & socket joints Ligaments Joint Capsule Synovial fluid Anatomy & Physiology of the Musculoskeletal System Skeletal Organization 206 Bones Axial Skeleton Head, Thorax & Spine Appendicular Skeleton Upper Extremities Lower Extremities Anatomy & Physiology of the Musculoskeletal System Bone Aging Birth to Adult (18-20) Transition from flexible to firm bone Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature Anatomy & Physiology of the Musculoskeletal System Muscular Tissue & Structure 600 muscle groups (continued) Anatomy & Physiology of the Musculoskeletal System Types of muscles Smooth Striated Cardiac Pathophysiology of the Musculoskeletal System Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain Pathophysiology of the Musculoskeletal System Joint Injury Sprain Subluxation Dislocation Bone Injury Open Fracture Closed Fracture Hairline Fracture Impacted Fracture Pathophysiology of the Musculoskeletal System Pediatric Considerations Flexible nature Geriatric Considerations Osteoporosis Pathological Fractures Pathological diseases Pathophysiology of the Musculoskeletal System General Considerations with musculoskeletal injuries Neurological compromise Decreased stability Muscle spasm Bone Repair Cycle Osteocytes produce osteoblasts Deposition of salts Increasing strength of matrix 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 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 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 dislocation Musculoskeletal Injury Management Care Specific Fractures Tibia/Fibula Clavicle Most frequently fractured bone 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 neurological Compromise Musculoskeletal Injury Management Soft & Connective Tissue Injuries Tendon Ligament Muscle Musculoskeletal Injury Management Medications Nitrous Oxide 50% O2:50% N2O Non-explosive Effects dissipate in 2-5 minutes Easily diffused into air filled spaces in body. Dose Inhaled & self administered Onset 1-2 minutes Diazepam Benzodiazepine Antianxiety Analgesic Dose 5-15 mg titrated Onset 10-15 minutes Duration 15-60 minutes Counter Agent Flumazenil Musculoskeletal Injury Management Medications Morphine Sulfate Opiate alkaloid Reduces vascular volume and cardiac preload Do not administer to hypovolemic patients Dose 2mg IVP slow Counter Agent Narcan (continued) Musculoskeletal Injury Management Medications Meperidine Demerol Narcotic Analgesic Dose 50-100 mg Counter Agent Narcan Musculoskeletal Injury Management Medications Nalbuphine Nubain Narcotic Analgesic Equivalent to Morphine Dose 2-5 mg Onset 2-3 minutes Duration 3-6 hours Musculoskeletal Injury Management Other Injury Consideration Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support