Musculoskeletal Injuries

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Musculoskeletal Injuries

• Rock Springs Fire Department

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Introduction

• This course will cover musculoskeletal injuries
  as they apply to fractures, strains, sprains, and
  dislocations.
• Students will learn the anatomy of
  musculoskeletal injuries, and will have the
  knowledge to provide efficient emergency medical
  treatment of said injuries.

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Agenda

• Topics to be covered will be anatomy, types of
  injuries, patient treatment and splinting
  procedures.
• Students will learn, through discussion, the
  critical difference of when and when not to
  immobilize specific fractures and when to utilize
  whole body splinting.

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Agenda

• Students will also practice, through hands-on
  exercise, the treatment and immobilization of
  patients who have suffered musculoskeletal type
  injuries.

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Injury

• Musculoskeletal injuries occur when, through a
  mechanism of injury, a force is applied to the
  body doing damage to bones muscle and connective
  tissue. Remember, that when these injuries occur
  that there is a high likelihood of organs,
  vasculature, nerves and other tissue will also be
  damaged.

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Injury

• Immobilization, reduction of swelling, and whole
  patient care can effectively reduce the
  possibility of worsening an injury and damage to
  surrounding tissue until a diagnosis and surgical
  interventions can be achieved.

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Discussion.To Splint Or Not To Splint?

• Critical patients vs. non-critical
• Critical time should not be wasted immobilizing
  extremity fractures in patients who have
  compromised ABCs or have a deteriorated mental
  status.

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Overall Management Priorities

• 1. Manage life-threatening injuries.
• 2. Manage limb-threatening injuries.
• 3. Manage all other conditions.

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Overall Management Priorities

• Adherence to these priorities does not imply that
  extremity injuries should not be cared for or
  protected from further harm.
• It does mean that, in critical patients with
  extremity injuries that are not life threatening,
  abbreviated measures are used to care for the
  extremity injuries.

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Overall Management Priorities

• The easiest and most effective way to accomplish
  abbreviated care of extremity injuries in the
  critical patient is to immobilize the patient to
  a longboard.
• Spinal movement restriction will effectively act
  as a whole body splint.

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Spinal Movement Restriction
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Vocabulary

• Fracture - when a bone or set of bones are
  broken.
• Strain - an injury to a muscle or muscle and
  tendon, where it has become overextended or
  stretched.
• Sprain - an injury to a joint, where there is
  possible damage to or possible tearing of
  ligaments.

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Vocabulary

• Dislocation - The displacement of a bone from its
  normal position in a joint
• Tendon - connective tissue that connects muscle
  to bone.
• Ligament - connective tissue that connects bone
  to bone.

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Vocabulary

• Closed injury - an injury where the skin
  surrounding an injury is intact.
• Open injury - an injury in which the skin over
  the fracture site has been broken, the bone may
  be protruding through the wound.

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Signs and Symptoms

• Pain
• Swelling
• Deformity
• Severe weakness or loss of use
• Crepitus
• Patient heard a snap
• Numbness and tingling (parasthesia)

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Signs and Symptoms

• Joint locked into place
• Exposed bone ends
• Bruising
• Loss of pulses distal to injury
• Cyanosis distal to injury

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Caution

• Open fractures may not be as evident as you would
  think. They may present as a small laceration
  over the injury site.

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They May Only Have A Small Laceration
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They May not be like this.
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Or This
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Caution

• It is your duty to report to the receiving
  facility that the injury may have been open, or
  that bone ends were protruding at one time.

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Communicate!!!!
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Discussion

• How do we know whether he injury is a fracture,
  dislocation, strain or a sprain?
• We dont . The need to diagnose the specific
  type of bone or joint injury is not critical, and
  time should not be wasted trying to do so. Why?

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Critical Musculoskeletal Injuries

• Clavicle and rib fractures.
• Femur fractures.
• Pelvic fractures.
• Spinal Injuries.

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Treatment

• BSI
• Oxygen.How much?.Which device.
• Spinal PrecautionsMOI?

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Mechanism Of Injury
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Treatment

• Rapid trauma assessment.
• Manual immobilization.
• Evaluate PMS. Pulse Oximetery?
• Apply splint.
• Evaluate PMS.
• Continue to re-evaluate the immobilized
  extremity.

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Treatment

• Remove jewelry from extremityWhy?
• Apply cold to the injury to reduce swelling
• Elevate extremity to reduce swelling. Elevation
  of lower extremities is contraindicated when a
  spinal injury is suspected.
• Transport

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Splinting Guidelines

• Before and after splinting, pulses, motor
  function, and sensation distal to the injury
  should be evaluated. PMS should be re-evaluated
  every 15 minutes after.
• Manually immobilize the injured extremity until
  mechanical immobilization is achieved.
• Expose the injury site.
• Dress soft tissue injuries.

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Splinting Guidelines

• In cases of severe deformity or compromise in PMS
  findings. A single attempt may be made to align
  injured extremities. However, if resistance, an
  increase in pain, or crepitus are encountered
  splint the extremity in the position found.

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Splinting Guidelines

• In the event that there is a compromise in PMS
  distal to an injury to a joint, immobilize the
  extremity in the position found and consult
  medical direction.
• Do not intentionally replace protruding bone ends.

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Splinting Guidelines

• Pad splints prior to application
• Apply splint
• Ensure immobilization of the joint inferior and
  superior to the injury
• Immobilize hands and feet in the position of
  function.
• Evaluate PMS

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Splinting Guidelines

• If a compromise in PMS is found then loosen the
  fastening material on the splint and re-evaluate

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Types Of Splints

• Rigid Splints
• Pressure Splints
• Traction Splint
• Improvised splints

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Rigid Splints

• Commercially made splints
• Examples are the Timmins, Sam, and ladder splints.

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Traction Splints

• Commercially made splints that provide for a
  counter-pull against spasmatic muscles to achieve
  immobilization of femur fractures.
• Examples are the Hare, Sager, and Lots splints.

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Traction Splints - Contraindications

• The injury is within two inches of the knee
• The knee has also been injured
• The hip is injured
• The pelvis in injured
• There is a partial amputation

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Pressure Splints

• Splints that utilize air pressure to achieve
  immobilization.
• Examples are air, vacuum, and PASG.

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Improvised Splints

• Light, firm, rigid material that can be used to
  effectively immobilize an extremity.
• Examples are magazines, wooden planks, broom
  handles, pillow, blanket roll, etc..

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Sling and Swathe

• Used to immobilize shoulder and upper extremity
  injuries.

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What do we do for this?
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What are the concerns?

• MOI?
• Life threatening injuries?
• Dont focus in on gross injuries.
• Read your patient.
• PMS!!!!!!
• How do we splint?
• What joints need immobilized?

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What do we do for this?
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