Transcript Paramedic Care: Principles & Practice Volume 4

Paramedic Care:
Principles & Practice
Volume 4
Trauma Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 7
Musculoskeletal Trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Introduction to Musculoskeletal Trauma
Anatomy and Physiology of the
Musculoskeletal System
Pathophysiology of the Musculoskeletal
System
Musculoskeletal Injury Assessment
Musculoskeletal Injury Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to
Musculoskeletal Injuries
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to
Musculoskeletal Injuries
In trauma, incidences of musculoskeletal
injury are second in frequency only to softtissue injuries.
– Millions of Americans sustain musculoskeletal
injuries each year.
– Multiple MOI
Falls, crashes, violence, etc.
Multi-system trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Prevention Strategies
Application of modern vehicle and highway
designs and safe driving practices
– Use of restraints
Workplace safety standards
Sports activities remain a significant cause of
injury
– Protective gear, improved equipment design, and
better conditioning of athletes has reduced
injuries
Household accidents and falls
– Use of good safety practices
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the
Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Skeletal Tissue and Structure
– Gives the body its structural form
– Protects vital organs
– Promotes efficient movement despite the forces of
gravity
– Stores salts and other materials needed for
metabolism
– Produces red blood cells
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Bone Structure
– Diaphysis
– Epiphysis
– Metaphysis
Growth plate
– Medullary canal
– Periosteum
– Cartilage
Provides a smooth
articulation surface for
other bones
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Bone Classification
– Bones are classified according to their general
shape
Long
Humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals, and
phalanges
Short
Carpals and tarsals
Irregular
Vertebrae, facial
Flat
Cranium, sternum, ribs, shoulder, and pelvis
Sesamoid
Patella
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Joint Structure
– Three basic types of joints
Synarthroses
Immovable joints
Amphiarthoses
Very limited movement
Diarthroses
Synovial joints
Permit free movement
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Diarthroses
– Monaxial
joints
Hinge joints
Pivot joints
– Biaxial joints
Condyloid
Ellipsoidal
Saddle joints
– Triaxial joints
Ball-andsocket
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Ligaments
– Bands of connective
tissue that hold
bones together at
joints
Joint Capsule
– Synovial capsule
– Synovial fluid
– Bursae
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Skeletal
Organization
– 206 bones
– Axial skeleton
Head, thorax, and
spine
– Appendicular
skeleton
Upper extremities
Lower extremities
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and 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
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Types of Muscles
– Smooth
– Striated
– Cardiac
Muscular Tissue
and Structure
– 600 muscle groups
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscles
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology
of the Musculoskeletal System
Skeletal muscles attach
to the bones at a
minimum of two
locations
– Origin
– Insertion
Opposition
– Allows straightening of
muscles
Tendons
Muscle tone
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
The complex arrangement of connective,
skeletal, vascular, nervous, and muscular
tissue is endangered whenever significant
kinetic forces are applied to the extremities.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
Muscular Injury
– Results from direct blunt or penetrating trauma,
overexertion, or problems with oxygen supply
during exertion
– Injuries include:
Contusions
Compartment syndrome
Penetrating injuries
Fatigue
Cramps
Spasms
Strains
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Contusion
– Small blood vessels rupture with crushing forces
– Blood will pool beneath or within tissue layers
Compartment Syndrome
– Occurs in extremities
– Contained by the fascia, this swelling increases
the pressure within the compartment
– Deep and burning pain that appears out of
proportion to the apparent injury
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Penetrating injury
– Deep lacerations may penetrate skin and
subcutaneous tissues
Affects muscles below
Contraction of the opposing muscle
Fatigue
– Muscles reach their limit of performance
– Cells become hypoxic
– Strength diminishes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Muscle Cramping
– A painful spasm of the muscle tissue
– Due to accumulation of wastes
Electrolyte imbalances
Lactic acid
Muscle Spasms
– An intermittent (clonic) or continuous (tonic)
contraction
– Spasm usually subsides with rest
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Muscular Injury
Strain
– Occurs when muscle fibers are overstretched by
forces that exceed the strength of the fibers
Tearing of muscle occurs
– Fibers are damaged without internal bleeding,
edema, or discoloration
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
Joint Injury
– Sprain
– Subluxation
– Dislocation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Injury
Sprain
– Tearing of a joint capsule’s connective tissues
Ligaments
– Classified according to degree of tear
Subluxation
– A partial displacement of a bone end from its
position within a joint capsule
– Differs from the sprain in that it more significantly
reduces the joint’s integrity
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Joint Injury
Dislocation
– A complete
displacement of
bone ends from
their normal joint
position
– Danger of
entrapping,
compressing, or
tearing blood
vessels and nerves
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
Bone Injury
– Caused by extreme
compressional
forces or significant
lateral forces
Exceeds the tensile
strength of a bone
May be open or
closed
© Mark C. Ide
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Fractures
Types of Fractures
–
–
–
–
–
–
–
Hairline fracture
Impacted fracture
Transverse
Oblique
Comminuted
Spiral
Fatigue
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
Pediatric Considerations
– Flexible nature
Greenstick fracture
– Epiphyseal fracture
Geriatric Considerations
– Osteoporosis
Pathological Fractures
– Pathological diseases
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pathophysiology of the
Musculoskeletal System
Inflammatory and Degenerative Conditions
– Bursitis
– Tendinitis
– Arthritis
Osteoarthritis
Degenerative
Rheumatoid arthritis
Chronic, systemic, progressive, debilitating
Gout
Inflammation of joints produced by accumulation of uric acid
crystals
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Assessment
A patient with an isolated musculoskeletal
injury will receive complete assessment and
management at the scene.
Look for indications of the severity of the
trauma forces and the possibility that the
forces also caused internal injuries.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Scene Size-up
– Don the appropriate personal protective
equipment
– Clues to specific injuries
MOI
– History may suggest other injuries
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Initial Assessment
– Categories of urgency
Life- and 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
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Rapid Trauma Assessment
– Performed on any patient with any sign, symptom,
or mechanism of injury that suggests serious
injury
– Perform in a carefully ordered way
Pay attention to pelvis and femur areas
May be significant blood loss
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Focused History and Physical Exam
– Observe and inquire carefully for signs and
symptoms of fracture, dislocation, or other
musculoskeletal injury in each limb with
suspected injury
– 6 Ps:
Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
– Carefully evaluate the distal circulation, sensation,
and motor function
– Identify all injuries, prioritize them, and establish
the order of care for them
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Detailed Physical Exam
– A search for the signs and symptoms of further
injury
Head-to-toe
– Look specifically where you have not looked
before and with enough care to identify any subtle
indications of injury
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Ongoing Assessment
– Focus
Serial measurement of
the patient’s vital signs,
level of consciousness,
and the signs and
symptoms of the major
trauma affecting the
patient
– Monitor distal
sensation and pulses
frequently
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment
Sports Injury Consideration
– Assess the mechanism of injury
– Determine whether there was a major kinetic force
involved
– Downplaying of injuries
– Specific and serious musculoskeletal injury
associated with sports is the sprain
Commonly the knee
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management
General Principles
– Protecting open wounds
– Positioning the limb
You should not attempt alignment of dislocations and
serious injuries within 3 inches of a joint.
– Immobilizing the injury
– Checking neurovascular function
Pulse, motor, sensation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Splinting Devices
– Rigid splints
– Formable splints
Vacuum splints
Air splints
– Soft splints
– Traction splints
– Other splinting aids
Cravats or Velcro
splints
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Fracture Care
– Carefully immobilize the limb in the position found
unless there is a significant circulatory or nervous
deficit.
– Ensure distal pulses, sensation, and motor
function.
– If you identify any neurovascular deficit, attempt to
correct the problem by gentle repositioning.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Joint Care
– Assess for distal neurovascular function
If present, immobilize the joint in the position found
If absent, consider moving the limb to reestablish it
Reduction
– Splint the limb in the position of function and
transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Management
Muscular and Connective Tissue Care
– To manage muscle, tendon, and ligament injuries,
immobilize the region surrounding them
– Provide gentle circumferential bandaging
Monitor distal circulation
– Application of local cooling
– Elevation and position of function
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Pelvis
– Involves either the
iliac crest or the
pelvic ring
Pelvic ring fractures
are often serious,
life-threatening
events due to
hemorrhage
– Pelvic sling device
PASG as a reserve
device only
– Fluid resuscitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Femur Fractures
– High-force injury
– High potential for
shock
– Assessment
considerations
– Traction splints
Do not use if
suspected pelvic,
knee, tibia, or foot
injuries
– PASG
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Tibia-Fibula Fractures
– Frequently open fractures
– Cover bone ends with moist dressing
– Depending on level of fracture, use:
Rigid splint
Air splint
Pillow
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Clavicle
Most frequently fractured bone in the body
Has the potential to cause serious internal injury
Transmitted to 1st and 2nd rib
Be alert for lung injury
Immobilize the affected limb in a sling and swathe
against the chest
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Fractures
Humerus
– Difficult to immobilize at its proximal end
Most effective technique for splinting this fracture is to
apply a sling and swathe
Radius/Ulna
– Most commonly, fracture occurs at the distal end
of ulna
Displaces in volar direction (toward palm)
Colles’ fracture
– Splint forearm fractures with a short, padded rigid
splint
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Hip
– The hip may dislocate in two directions
Anterior
With the foot turned outward and the head of the femur palpable in
the inguinal area
Posterior
Most common
Knee flexed and the foot rotated internally
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Hip Dislocation Management
–
–
–
–
Splint in most comfortable position
Document sensation and pulse
Prompt transport
Be alert for associated knee injuries or fractures
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Knee Fracture or
Dislocation
– Orthopedic
emergency
– Frequently causes
vascular injury
– Dislocation
associated with 50%
rate of amputation of
leg
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Knee Fracture or Dislocation
– Obvious dislocation without distal pulse
Apply gentle traction along the long axis of the joint
– If gentle traction does not restore the pulse
Splint in place
– Prompt transport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Foot or Hand Injury
– Common industrial
injuries
– Often disabling
– Rarely life
threatening
– Splint foot with
pillow
– Splint hand in
position of function
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Shoulder Injuries
– Most commonly involves the proximal humerus,
lateral scapula, and distal clavicle
– Shoulder Dislocation
Anterior dislocations displace the humoral head forward
Posterior dislocations rotate the arm internally
The elbow and forearm held away from the chest
Use pillow with sling and swathe
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Elbow Injury
– Fracture or
dislocation may
cause
neurovascular injury
– Splint in position
found
– Transport promptly
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Wrist/Hand Injury
– Noticeable deformity and significant pain reported
by the patient
– Rigid Splint
Keep hand in “position of function”
– Air Splint
May be hard to reassess circulation
– Pillow
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Care for Specific Joint Injuries
Finger
– Forces may displace the phalanges from their
joints
May occur between the phalanges
May occur between the proximal phalanx and the
metacarpal
– Use tongue depressor to splint
– Malleable splints
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Soft and Connective
Tissue Injuries
Massive muscular contusions and
hematomas may contribute to hypovolemia.
Ligament and tendon injuries can endanger
the future function of a limb.
Treat these injuries as you would dislocations
and immobilize the adjacent joints.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medications
Diazepam
Nitrous Oxide
– 50% O2:50% N2O
– Non-explosive
– Effects dissipate in 2–5
minutes
– Easily diffused into airfilled spaces in body
– Dose
Inhaled and self
administered
– Onset
–
–
–
–
Benzodiazepine
Antianxiety
Analgesic
Dose
5–15 mg titrated
– Onset
10–15 minutes
– Duration
15–60 minutes
– Counteragent
Flumazenil
1–2 minutes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medications
Morphine Sulfate
–
–
–
–
Opiate alkaloid
Reduces vascular volume and cardiac preload
Do not administer to hypovolemic patients
Dose:
2mg IVP slow
– Counteragent:
Narcan
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medications
Meperidine
– Demerol
– Narcotic analgesic
– Dose
50–100 mg
– Counteragent
Narcan
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medications
Sublimaze
–
–
–
–
Fentanyl
Synthetic opioid
Equivalent to morphine
Dose
25–50 mg SIVP followed by an additional 25 mg as
needed
– Onset
Less than a minute
– Duration
3–6 hours
– Considerations
If given too rapidly, chest wall rigidity may ensue, leading
to respiratory compromise
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Musculoskeletal Injury
Management
Other Injury Considerations
– Pediatric musculoskeletal injury
Greenstick fractures and epiphyseal fractures
– Athletic musculoskeletal injury
Injuries to the joints are common
– Patient refusals and referral
– Psychological support
Concerned attitude and a professional demeanor
Communicating frequently and compassionately
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Introduction to Musculoskeletal Trauma
Anatomy and Physiology of the
Musculoskeletal System
Pathophysiology of the Musculoskeletal
System
Musculoskeletal Injury Assessment
Musculoskeletal Injury Management
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ