Ch. 11-Musculoskeletal Injuries

1. Ch. 11-Musculoskeletal Injuries 1

2. 11.1 The Musculoskeletal System 1. It gives shape or form to the body. 2. It supports the body, allowing it to stand erect. 3. It provides the basis for locomotion, or movement, by giving muscles a place to attach, and it contains joints (where bones are joined together by ligaments) that allow movement. 4. It forms protection for major body organs, such as the brain (skull), the heart and lungs (rib cage), pelvic organs, and the spinal cord (vertebrae). 2

3. First Aid Care (RICE) 1. Rest—have the victim stay off the injured part completely and not use the joint at all. 2. Ice—cold relieves pain and prevents or reduces selling and inflammation. Immediately put cold packs, crushed ice, or cold towels on the injured area, or immerse it in ice water for 20 to 30 minutes at a time every 2 hours. 3. Compression—to limit internal bleeding and compress fluid from the injury site, wrap a compression bandage (usually an elastic one) in an overlapping spiral that supports the entire injured area. 4. Elevation—limits circulation, reduces swelling, and encourages lymphatic drainage. Sprains Signs and symptoms include: • Pain • Swelling • Deformity • Discoloration of the skin • Inability to use the affected part normally 3

4. Vocab • Sprain- An injury in which ligaments are stretched and partially or completely torn • Dislocation- An injury in which the joint comes apart and stays apart; the bone ends are no longer in contact with each other • Strain- An injury to a muscle that occurs when the muscle is stretched beyond its normal range of motion, causing the muscle to tear • Cramp- Uncontrolled spasm of a muscle • Contusion- A bruise to the tissue of a muscle • Paresthesia- Pricking or tingling sensation that indicates loss of circulation 4

5. First Aid Care Activate the EMS system immediately, then: 1. Immobilize all dislocations in the position found. Splint above and below the dislocated joint with an appropriate splint that will keep the joint immobile. 2. Use the RICE method. 3. Treat for shock; keep the victim warm and quiet and in the position most comfortable. Dislocations Signs and symptoms include: • pain • feeling of pressure over the involved joint • loss of motion in the joint • deformity 5

6. Strains • 1. Place the victim in a comfortable position that takes pressure off the strained muscles. • 2. Apply cold directly to the strained area, as described in step 2 of the RICE system. • 3. Activate the EMS system or transport the victim to a medical facility. 6

7. Cramps 1. Have the victim gently stretch the cramping muscle; gradual lengthening of the muscle can relieve the cramp by lengthening the muscle fibers. 2. Apply steady, firm pressure to the cramping muscle with the heel of your hand. 3. Apply an ice pack over the cramped muscle. 4. Try using an acupressure point: pinch the upper lip hard to relieve cramping of a calf muscle. 5. If the cramp occurs during or after heavy physical activity, have the victim drink a commercial electrolyte drink or lightly salted water (1⁄4 teaspoon of salt dissolved in a quart of water). 7

8. PROGRESS CHECK 1. An injury in which ligaments are stretched and partially or completely torn is a ____________. (sprain/strain/dislocation) 2. A soft-tissue injury or muscle spasm around a joint is a ____________. (sprain/strain/dislocation) 3. You should care for sprains and dislocations as if they were ____________. (life threatening/fractures/strains) 4. Treat a cramp with ____________. (gentle massage/firm massage/stretching) 8

9. 11.3 Injuries to Bones • Closed (simple), in which the overlying skin is intact; no wound is nearby. • Open (compound), in which the skin over the fracture site has been damaged or broken, either by the ends of the bone or by the blow that broke the bone; the bone might or might not protrude through the wound and you might or might not be able to see the bone through the wound. The greatest threat in a compound fracture is to the soft tissue and organs that lie around the bone ends. 9

10. Mechanisms of Injury • Direct Force • Indirect Force • Twisting Force 10

11. First Aid Care for fractures 1. Gently remove any clothes that cover the injured area. Cut clothing at the seams to avoid unnecessary movement of the injured area. 2. Support the injured part; gently remove clothing and jewelry around the injury site without moving the injured area. 3. Cover any open wounds with sterile dressings to control bleeding and prevent infection. Gently wipe away dirt and debris, and irrigate the exposed bone end with clean water. 4. Assess blood flow and nerve function. 5. If there is severe deformity or angulation, apply minimal traction—a firm, steady pull to bring the limb into more normal alignment—except for crushing injuries; immobilize joints above and below the fracture. 6. Check distal pulses and capillary refill and sensation after the splint is in place to make sure circulation is still adequate. 7. Use the RICE procedure. 11

12. PROGRESS CHECK 1. In assessing for fractures, it is important to consider the ____________ as well as the signs and symptoms. (history/mechanism of injury/pain) 2. Though fractures may be the most obvious and dramatic injuries suffered by a victim, they are often not the most ____________ ones. (life-threatening/easy-to-manage/painful) 3. Before you try to identify fractures, you should complete ____________. (artificial ventilation/chest compressions/the primary survey) 4. The most important first aid care for suspected fracture is ____________. (control of bleeding/immobilization/replacing bone ends) 5. ____________ helps minimize damage to soft tissue, surrounding nerves, and blood vessels by broken bone ends. (Immobilization/Splinting/Compression) 6. If the forearm is fractured, you should also immobilize the __________. (upper arm/shoulder/wrist and elbow) 7. You ____________ try to straighten the wrist, elbow, knee, or shoulder. (should/should not) 12

13. Rules for Splinting • Do not splint if it will cause more pain for the victim. • Both before and after you apply the splint, assess the pulse and sensation below the injury. • Immobilize the joints both above and below the injury. • Splint an injury in the position you found it. • Remove or cut away all clothing around the injury site with a pair of bandage scissors so you won’t accidentally move the fractured bone ends and complicate the injury. Remove all jewelry around the fracture site. • Cover all wounds, including open fractures, with sterile dressing before applying a splint • If there is a severe deformity or the distal extremity is cyanotic or lacks pulses, align the injured limb with gentle traction before splinting, following the guidelines above. • Never intentionally replace protruding bone ends. • Pad the splint to prevent pressure and discomfort to the victim. • Apply the splint before trying to move the victim. • When in doubt, splint the injury. • If the victim shows signs of shock, maintain body temperature as needed, align the victim in the normal anatomical position and arrange for immediate transport without taking the time to apply a splint. 13

14. Types of Splints • Rigid Splints • Traction Splints • Improvised Splints 14

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16. Hazards of Improper Splinting • Compress the nerves, tissues, and blood vessels under the splint, aggravating the existing injury and causing new injury • Delay the transport of a victim who has a life-threatening injury • Reduce distal circulation, threatening the extremity • Aggravate the bone or joint injury by allowing movement of the bone fragments or bone ends or by forcing bone ends beneath the skin surface • Cause or aggravate damage to the tissues, nerves, blood vessels, or muscles as a result of excessive bone or joint movement 16

17. Special Considerations in Splinting • Splinting a Long Bone • Splinting a Joint 17

18. PROGRESS CHECK 1. You should not apply a splint if it will cause more ____________ for the victim. (pain/disability/deformity) 2. You should assess the victim’s ____________ both before and after you apply a splint. (breathing/pulses/level of consciousness) 3. You should immobilize ____________ both above and below the injury. (bones/joints/tissues) 18