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Chpt 19 EMR - Caring for Muscle and Bone Injuries

Chapter 22 Emergency Medical Responder: First on Scene 9th edition
by

Boyd Darling

on 25 November 2013

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Transcript of Chpt 19 EMR - Caring for Muscle and Bone Injuries

Chapter 19
Caring for Muscle and Bone Injuries

Topics
Musculoskeletal System
Appendicular Skeleton
Splinting
Management of Secific Extremity Injuries
Musculoskeletal System
Musculoskeletal System
Made up of muscles, bones, joints, connective tissues, blood vessels & nerves
EMR's job is to carefully assess patient, looking for signs and symptoms of injury
Pain, swelling, deformity, discoloration
Musculoskeletal System
Four Major Functions
Support
Movement
Protection
Cell Reproductions
Skeltal System Major Divisions
Axial sekelton
Appendicular Skeleton
Think About It
What does it mean to use an assessment-based approach?
What is the EMR's primary job in dealing with musculotskeletal injuries?
What can happen when blood vessels and nerves are injured?

Appendicular Skeleton
Made up of bones that form the upper and lower extremities
Upper extremities made up of shoulder girdle and both arms, down to and including fingers
Lower extremities made up of pelvis and both legs, down to and including toes.
Appendicular Skeleton
Causes of Extremity Injuries
Direct Force: Applied to bone when person falls and strikes object or when person is struck by object
Indirect Force: Energy of a force transferred up or down extremity; results in injury farther along extremity
Twisting force: When someone gets hand or foot caught in wheel or gear
Closed Injury
No break in skin
Open Injury
Soft tissue adjacent to injury damaged and open
Appendicular Skeleton
Do not try to diagnose injury
Fracture
Any time bone is broken, chipped, cracked, or splintered
Dislocation
One end of a bone that is part of a joint is pulled or pushed out of place
Appendicular Skeleton
Sprain
Excessive twisting forces causes ligaments and tendons to stretch or tear
Strain
Caused by overexerting, overworking, overstretching, or tearing of a muscle
Angulated (deformed) Injuries
Extremity is bulging, bent, or angulated where it normally should be straight
Appendicular Skeleton
Signs-Symptoms of Extremity Injuries
Pain
Swelling
Discoloration
Deformity
Inability to move a joint or limb
Numbness or tingling sensation
Loss of distal pulse
Slow capillary refill
Grating
Sound of breaking at time of injury
Exposed bone
Appendicular Skeleton
Signs-Symptoms of Extremity Injuries
All injured extremities should be assessed for adequate circulation, sensation, motor function (CSM) before and after immobilization
If injury site is swollen and discolored, there is bleeding in tissue
If no distal pulse and extremity is pale and cool, circulation to extremity may be compromised
If extremity is blue, there is lack of circulation and lack of oxygen to limb
Appendicular Skeleton
Patient Assessment
Scene size-up:
Scene safety;
BSI precautions;
Don PPE;
Note MOI;
Total number of patients
Primary assessment:
Impression of environmental and patient;
Determine of patient needs to be moved and transported;
Assess ABCs and mental status;
Detect life threatening problems
Appendicular Skeleton
Emergency Care Steps
Take proper BSI precautions; perform primary assessment
Cut away clothing to expose injury site
Control bleeding if there is an open wound
Check for distal circulation, sensation, and motor functions in affected extremity
Immobilize extremity using manual stabilization of splints
Apply cold pack or ice pack to injury site to help reduce pain and swelling
Administer oxygen per local protocol
Assess patient's vital signs
Emotional support important when caring for patient with musculoskeletal injuries
Think About It
You are treating a young woman who has been struck by a car. She has an angulated lower leg fracture. You ask her if her neck or back hurts and she says "No."
How reliable is this answer?
How will you proceed?
Splinting
Splinting
Immobilizing injury, using device (piece of wood, cardboard, folded blanket); any object that can be used to restrict movement of injury
Manual stabilization
Using your hands to restrict movement of injured person or body part
Splinting
Application of splints allows reposition and transfer of patients while minimizing movement of injury
Complications resulting from splinting may include:
Pain
Damage to soft-tissues
Bleeding
Restricted blood flow
Closed injuries become open injuries
Splinting
Emergency Medical Responder Responsibilities
Detect and control life-threatening problems
Attempt to find all injuries and care for worst ones first
Splinting
General Rules for Splinting
Assess and reassure patient
Expose injury site
Control all major bleeding
Dress open wounds
Check distal circulation, sensation and motor function before and after splinting
Splint injuries before moving patient
Splinting
Splinting
Managing Angulated Injuries
Do only what you have been trained to do and what is allowed in your EMS system
If no distal pulse, and skin in distal extremity is pale or blue and cold, take action immediately to minimize potential permanent damage
Do not force limb if you meet resistance or if patient complains of too much pain
Apply soft splint and elevate limb by propping it on blanket roll or pillow
Provide oxygen per protocol
Splinting
Types of Splints
Soft Splints: Pillows, blankets, towels, cravats, dressings, triangle bandage, sling swathe
Rigid Splints: Plastic, metal, wood, or compressed cardboard; very little give or flexibility
Commercial Splints: Made of wood, aluminum, cardboard, foam, wire, or plastic
Pneumatic antishock garment (PASG): Special device for splinting suspected pelvic and femur fractures - local protocol
Inflatable Splints (Air Splints): used for patients with injuries to arm or lower leg bones
Improvised splints may be soft or rigid; made from variety of materials
Think About It
You are treating a patient with a broken femur following a motor-vehicle crash. Before you apply a traction splint, what other assessment elements should you consider?
Why might taking the time to apply a traction splint in this situation be ill-advised?
Patient Assessment
When careing for skeletal injuries, first priority is given to injury of spine
Skull
Rib Cage
Pelvis
Thighs
Any extremity
General Rules for Splinting
Have materials ready before splinting
If distal circulation is absent and local protocols allow, gently attempt to realign an angulated limb in anatomical position before splinting
Immobilize suspected fracture site and joints above and below injury site
Secure splints with cravats or roller gauze
Elevate extremity
Minimize effects of shock by maintaining body temperature and providing oxygen per local protocols
Management of Specific Extremity Injuries
Apply rigid splints for injuries to forearm and lower leg
Use soft or rigid splints for injuries to arm, elbow, wrist, or hand
Use soft splints for injuries to ankle or foot
Injuries to the Shoulder
Knocked-down shoulder (dropped): Injured shoulder will appear to droop
Anterior dislocation: Shoulder joint can be felt (even seen) bulging or protruding under skin at front of shoulder
Management of Specific Extremity Injuries
Management of Specific Extremity Injuries
Injuries to Upper Arm
Upper end (proximal) where shoulder joint is formed; along midshaft of bone; lower end (distal) where elbow joint formed
Deformity key sign of injury to this bone
Manual Stabilization
of an injured limb.
Injuries to Elbow
Joint formed by lower (distal), end of upper arm bone (humerus) and upper, (proximal), end of forearm bones
Immobilize elbow in position in which it is found
Management of Specific Extremity Injuries
Injuries to the Forearm, Wrist, and Hand
Most effective splint is rigid one; patient can be made comfortable with pillow splint
Injuries to the Fingers
Not all injuries to fingers require rigid splinting
Immobilize injured finger by taping finger to adjacent, uninjured finger; tongue depressor; aluminum splint; pen or pencil
Management of Specific Extremity Injuries
Lower Extremity Injuries
When patient has multiple injuries or multisystem trauma, totally immobilize him on long spine board or scoop (orthopedic) stretcher
Be sure you have proper equipment and sufficient number of rescue personnel on hand to assist
Lower Extremity Injuries
Pelvic injuries are serious; they can damage major blood vessels and internal organs
Pelvic girdle injuries may be managed with long spine boards, scoop stretchers and blankets
Pneumatic antishock garment (PASG) may be considered for immobilization. Check local protocol
Management of Specific Extremity Injuries
Lower Extremity Injuries
Anterior hip dislocation: Leg from hip to foot rotated outward (laterally) farther than uninjured side
Posterior hip dislocation: Leg rotated inward (medially); knee is usually bent
Management of Specific
Extremity Injuries
Lower Extremity Injuries
Injuries to upper leg or thigh bone (femur) can be life-threatening even when injury is closed; bleeding inside tissues can be severe
Traction splints: Mechanical devices that allow for application of constant traction of injured extremity
Management of Specific Extremity Injuries
Lower Extremity Injuries
You will not be able to tell if knee is fractured, dislocated, or both
Do not attempt to reposition or straighten injured knee
Management of Specific Extremity Injuries
Lower Extremity Injuries
Provide care for injuries to lower leg with rigid or soft splints
Boot-top Injury: Transverse fracture of tibia and/or fibia when skier falls forward off the ski tips
Rigid splints used for injuries to ankle or foot; soft splint most comfortable for patient
Immobilize in position found
Think About It
You are treating a person who requires airway management but he also has a severely bleeding open fracture of his leg
How would you establish the treatment priorities?
Under the circumstance, is treating the fracture important?
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