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1. Injuries to Muscles and Bones Lesson 14
2. Musculoskeletal System Review Bones
Muscles
Tendons
Ligaments
3. Primary Functions of Musculoskeletal System Provides shape/support for body
Muscles acting on bones allow movement
Bones protect vital internal organs
4. Types of Muscles Skeletal muscles are voluntary
Smooth muscles are involuntary
Cardiac muscle is involuntary
All muscle activity controlled by nervous system
5. Mechanisms of Injury to Musculoskeletal System Direct force: force applied directly to body
Indirect force: force transferred from original body site along an extremity to another point
Twisting forces: part of body forced to move in unnatural direction
6. Factors Involved in Injuries The greater the force:
the more severe the injury
fracture/joint dislocation more likely
Patient’s age and health status
7. First Responders not responsible for determining type of musculoskeletal injury:
Fractures
Dislocations
Sprains
Muscle injuries Types of Musculoskeletal Injuries
8. Fractures The bone may be completely broken or only cracked
Closed fracture - skin not broken
Open fracture - open wound at site
9. Dislocations
10. Dislocations One or more bones at joint displaced from normal position
Ligaments holding bone are torn
Result from strong forces
Sometimes accompanied by bone fractures or other injuries
11. Dislocations continued Patient cannot use the joint due to pain/structural damage
Serious bleeding may result
Nearby nerves may be injured
With severe dislocation, joint/limb will look deformed
12. Sprains Joint injury involving ligament stretching/tearing
Typically occur when joint overextended
Can be mild or severe
Ankles, knees, wrists, fingers most common
Considerable swelling often occurs rapidly
13. Muscle Injuries Strains, contusions, cramps
Usually less serious than fractures/joint injuries
Many causes
14. Recognizing Musculoskeletal Injury Sometimes injury type is obvious
Often you will recognize musculoskeletal injury is present
Emergency care is same regardless of injury type
Usually not life threatening
May be serious and result in pain/disability
15. Assessment of Musculoskeletal Injuries Perform standard assessment
Ask patient what happened/what he/she felt
If large forces involved, consider potential for spinal injury
Expose injury site
Amount of pain/swelling not indicator of injury severity
Immediate medical treatment if no circulation/possible nerve damage
16. Assess for Circulation, Sensation, And Movement (CSM) Below the Injury Site Check pulse below injury
Check skin color and temperature.
Touch fingers/toes
Does patient feel touch, tingling sensation, numbness.
Have patient wiggle fingers/toes
17. Signs and Symptoms
18. Signs and Symptoms Abnormal sensation (numbness, tingling)
Inability to move area
Difference in temperature
19. Preventing Movement Movement causes injury, pain, swelling
Bone movement further injures soft tissues
Movement generally increases blood flow - may increase internal bleeding/ swelling
Manually stabilize or splint injured area
20. Emergency Care of Musculoskeletal Injuries Perform standard patient care
Control any life threats
Allow patient to be in position of comfort
Cover open wounds with sterile dressing
Apply cold pack
Don’t replace protruding bones
21. Emergency Care of Musculoskeletal Injuries Continued Stabilize injured extremity manually
Support above and below injury
If appropriate, splint extremity
Follow local protocol re: oxygen
22. Splinting
23. Splinting Movement may worsen musculoskeletal injury and cause more pain
Splint injured arm or leg if risk of area being moved (unless help expected quickly)
Always splint an extremity before transporting victim
24. Splinting Helps prevent further injury
Reduces pain
Minimizes bleeding and swelling
25. Types of Splints Rigid splints
Soft splints
Air splints (inflatable splints)
Pneumatic splints
Anatomic splints
26. Rigid Splint Board
Plastic or metal
Rolled newspaper or magazine
Thick cardboard
27. Soft Splint Pillow
Folded blanket or towel
Triangular bandage folded into sling
28. Anatomic Splint Bandage injured leg or finger to uninjured one
29. Commercial Splints Many commercial splints are available
30. Securing Splints Use bandages, strips of cloth, Velcro®
Use knots that can be untied
Don’t secure with tape
31. Guidelines for All Splints Dress open wounds
Splint only if it doesn’t cause more pain
Splint in position found
Immobilize entire area
Pad between splint and skin
32. Guidelines for Slings Use sling to prevent movement and to elevate extremity
Splint injury first
If you splint injury in position found and this position makes use of sling difficult – do not use sling
33. Guidelines for Slings continued Do not move arm into position for sling if it causes pain
A cold pack can be used inside sling
Do not cover fingers inside sling
34. Skill: Applying Arm Sling and Swathe
36.
40. Shoulder Injuries Involve clavicle, scapula, or joint structures
Clavicle is most frequently fractured bone
Scapula fractures are rare
Shoulder dislocations are common
41. Splinting Shoulder Injuries Goal is to stabilize area from trunk to upper arm
Use soft splint. Do not move extremity
Assess for circulation, sensation, and movement
42. Shoulder Injuries Pad hollow between body and arm
Apply sling and binder to support and immobilize arm
if this causes pain use larger soft splint
43. Upper Arm Injuries Immobilize humerus fractures with rigid splint
Treat fractures near shoulder with soft splint
44. Splinting Upper Arm Injuries Stabilize bone between shoulder and elbow
Assess circulation, sensation, movement in hand/fingers
Apply rigid splint along outside of arm
45. Splinting Upper Arm Injuries continued Tie above injury and at elbow
Support wrist with sling and wide swathe
If it causes pain to raise wrist for a sling, use long rigid splint
46. Elbow Injuries Sprains and dislocations are common
Fractures occur above or below elbow
Patient unable to move joint
47. Splinting Elbow Injuries If elbow bent, apply rigid splint from upper arm to wrist
If more support needed, use sling at wrist and binder around chest
48. Splinting Elbow Injuries If elbow straight, apply rigid splint from upper arm to hand
If more support needed, use binders around chest and upper arm and lower arm and waist
49. Skill: Splinting a Forearm
54. Wrist Injuries Sprains
Fractures
55. Splinting Wrist Injuries Goal is to stabilize from forearm to hand
Soft splint and sling often sufficient
Rigid splint provides more support
Assess circulation, sensation, movement in hand and fingers
56. Wrist Injuries Apply rigid splint on palm side of arm from forearm past fingertips
Tie above and below wrist
Leave fingers uncovered
Support forearm and wrist with sling and apply binder around upper arm and chest
57. Hand Injuries May be injured by direct blow
Fractures occur when patient punches something with closed fist
58. Splinting Hand Injuries Goal is immobilization of hand
Use soft or rigid splint
Place roll of gauze in palm
Bandage entire hand
Place rigid splint on palm side of hand. Pad between hand and splint
Support further with sling and swathe
59. Finger Injuries Fractures and dislocations
Often splint not required
Use rigid splint or anatomic splint
60. Splinting Finger Injuries Use soft splint if finger cannot be straightened without pain
Don’t manipulate finger into normal position
Use rigid splint, secured with tape
Tape finger to adjoining finger with gauze in between
61. Lower Extremity Injuries Larger forces are typically involved
Forces may also cause spinal injury
Assess patient, without moving extremity
Femur fracture can damage femoral artery
62. Hip and Pelvis Injuries Fractures and dislocations
A hip fracture = fracture of top part of femur
Fractures more common in elderly
Bleeding and pain may be severe
Dislocations occur at any age
Falls
Vehicular crashes
Blows to body
63. Hip Injuries Do not move patient
Immobilize leg and hip in position found
Pad between legs and bandage together (unless this causes more pain)
Treat for shock but do not elevate legs
64. Upper Leg Injuries Femur fractures serious
Severe pain/shock may occur
Keep patient from moving
Use rigid splint if lying down with leg supported by ground
Use folded blankets/coats to immobilize leg in position found
65. Splinting Upper Leg Injuries Anatomic splint
Rigid splints
66. Splinting Upper Leg Injuries continued Check circulation and sensation in foot and toes
Put rigid splint on each side of leg
Pad body areas and voids
Inside splint should extend from groin past foot
Outside splint should extend from armpit past foot
67. Traction Splint for Femur Fractures Traction splint maintains continual pull on femur to keep bone ends in normal position
First Responders usually assist other EMS personnel
68. Knee Injuries Sprains
Dislocations
Caused by sports injuries, motor vehicle crashes, falls
Femur, tibia or fibula fractures indistinguishable from knee injuries
69. Splinting Knee Injuries Splint in position found
Apply soft splint by rolling blanket or placing pillow around knee
If knee straight, make anatomical splint
70. Splinting the Knee If possible, put rigid splint on both sides of leg
Pad body areas and voids
Check circulation and sensation in foot and toes first and periodically after splinting
71. Splinting the Knee If knee is straight apply two splints along both sides of knee
If knee is bent, splint in position found
Tie splints with cravats or bandages
72. Lower Leg Injuries Many causes
Either or both bones of lower leg can be fractured
73. Lower Leg Injuries Rigid splint applied the same as for knee injury
Three-sided cardboard splint can be used
74. Skill: Splinting the Leg (Anatomic)
79. Ankle Injuries Commonly a sprain occurring when foot forcefully twisted to one side
Fractures or dislocations
Often involve torn ligaments and nerve/blood vessel damage
80. Splinting Ankle Injuries Soft splint usually best
Assess circulation, sensation, movement in toes
81. Foot Injuries Commonly caused by direct blows/falls
Involve almost any bone/ligament of foot
Treat same as ankle injuries
Toe fractures can be very painful
82. Splinting Foot Injuries Usually no splinting required
Use pillow splint as for ankle injury if:
toe is significantly bent
more than one toe involved
foot is very painful
83. Rib Fractures Typically caused by blunt trauma to chest
More common in lower ribs and along side
Cause severe pain, discoloration, swelling
Pain often sharper upon breathing in
Patient may breathe shallowly and hold/support area
84. Splinting Rib Injuries Goal is primarily supportive
Have patient sit/stand in easy breathing position
Support ribs with pillow or soft padding loosely bandaged over area and under arm
Immobilize arm with sling and swathe
Monitor breathing