Musculoskeletal

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Musculoskeletal
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Muscle/Skeletal Function

• Give the body shape
• Protect the internal organs
• Provide for movement

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Muscles

• Three kinds
• Voluntary - skeletal
• Involuntary - smooth, diaphragm
• Cardiac - walls of the heart
• Ligaments - connect bone to bone
• Tendons - connect muscle to bone

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Injuries

• Fracture - broken bone
• Strain - muscle or tendon is overextended
• Sprain - joint injury or tearing of ligaments
• Dislocation - Displacement of bone from normal
  position in a joint
• Disease - Degeneration of bone (elderly)

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Mechanism of Injury

• Direct force - direct blow
• Indirect force - Impact on one end causes injury
  some distance away
• Twisting forces - one part of extremity stays
  stationary while the rest twists

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Assessment

• BSI
• Scene size-up - determine MOI
• Initial assessment - general impression of injury
• Focused history and physical exam
• Rapid trauma - assess joint above and below any
  bone injury
• Check DCAPBTLS

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SAMPLE History

• When did it occur?
• What happened?
• Where does it hurt?
• What did you feel at the time of the injury?
• May report feeling or hearing something snap

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2 Types of Bone or Joint Injuries

• Closed (simple)
• Skin over fracture site has not been broken
• May result in profuse internal bleeding
• Open - (compound)
• Skin over the fracture site has been broken
• Bone may or may not protrude through skin

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Signs and Symptoms

• Deformity
• Pain and tenderness
• Grating, or crepitus
• Swelling
• Disfigurement
• Severe weakness or loss of function
• Bruising
• Exposed bone ends
• Joint locked into position

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Emergency Medical Care

• If injury is life threatening, immobilize during
  initial assessment and transport
• BSI
• Big Os
• Maintain spinal immobilization
• Splint bone and joint injuries
• Do a PMS check before and after splinting
• Apply Cold packs
• Elevates extremity if possible
• Transport

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Common Complication from Injuries

• Damage
• Conversion - closed becomes open
• Restriction of blood flow
• Excessive bleeding
• Increased pain associated with movement
• Paralysis - spinal damage

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General Rules of Splinting

• Assess PMS before and after splinting
• Immobilize joints both above and below injury to
  long bone
• Immobilize both bones above and below an injury
  to a joint
• Remove or cot away all clothing around the injury
• YOU CANT TREAT WHAT YOU CANT SEE
• Remove all jewelry

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General Rules of Splinting Cont..

• Cover all wounds before splinting
• If deformity is severe with no distal pulses and
  cyanosis is present in the injured limb, align
  limb with gentle manual traction before
  splinting. Make only one attempt to align the
  extremity. If pain, resistance, or crepitus
  increase, stop.
• Never try to align a joint due to major nerves
  and arteries

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General Rules of Splinting Cont..

• Never replace protruding bones
• Pad splints
• Apply splint before moving the patient
• Hand or foot immobilized in a position of
  function
• When in doubt, splint injury
• Treat for shock
• Transport

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Splinting Equipment

• Rigid splints
• Traction splints
• Pressure splints/PASG
• Improvised splints
• Sling and swathe

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Traction Splinting

• Hare Traction/Sager
• Used for closed mid shaft femur fractures
• Provides counter-pull, alleviating pain, reduces
  blood loss, and minimizes further injury
• Pull is 10 of patients body weight
• Femur override or spasms, reduction
• If swollen, apply splint
• 1 liter of blood can be lost in each leg

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When Not to Use Traction Splint

• Injury within 1 to 2 inches of knee or ankle
• Knee is injured
• Hip is injured
• Pelvis is injured
• Partial amputation or avulsion with bone
  separation