Musculoskeletal System & Emergencies

Functions of the Musculoskeletal System Gives the body shape Protects internal organs Provides for movement Consists of more than 600 muscles

Anatomy Muscles - provide movement & generate heat. Ligaments - connect bone to bone injury = sprain Tendons - connect bone to muscle injury = strain Bones - protection & shape

The Skeletal System Gives form to the body Protects vital organs Consists of 206 bones Acts as a framework for attachment of muscles Designed to permit motion of the body

The Skull Note that text on graphic may be difficult to read.

The Neck

The Spinal Column Note that text on graphic may be difficult to read

The Thorax Note that text on graphic may be difficult to read

The Pelvis Note that text on graphic may be difficult to read

The Lower Extremity Hip Thigh Knee Leg Ankle Foot Note that text on graphic may be difficult to read

The Upper Extremity Shoulder girdle Arm Elbow Forearm Wrist Hand Note that text on graphic may be difficult to read

Joints Note that images are missing. Will any text accompany the images?

Types of Muscle (1 of 2) Skeletal (voluntary) muscle Attached to the bones of the body Smooth (involuntary) muscle Carry out the automatic muscular functions of the body

Types of Muscle (2 of 2) Cardiac muscle Involuntary muscle Has own blood supply and electrical system Can tolerate interruptions of blood supply for only very short periods

Injuries Sprain Strain Dislocation Closed fracture Open fracture

Sprains & Strains Sprain Strain Joint injury with tearing of ligaments Stretching or tearing of a muscle

S/S Pain Edema and Ecchymosis Joint instability Treatment: - immobilize, ice, & elevate if possible

Dislocation A disruption of a joint, in which the bone ends are no longer in contact and the supporting ligaments are torn

S/S of a Dislocation Marked deformity Edema Pain Tenderness on palpation Complete loss of joint function Distal numbness Treatment - immobilize, ice, elevate if possible.

Fractures Closed fracture Nondisplaced fracture Open fracture does not break the skin Open fracture External wound Nondisplaced fracture Simple crack Displaced fracture deformity

Closed fracture Signs & symptoms Pain Edema Possible deformity Contusion Loss of motion false motion Crepitus Guarding Treatment - immobilize, ice, elevate if possible.

Open fracture Signs & symptoms Pain Deformity Break in skin and/or exposed bone Treatment - dressing, immobilize, ice, & elevate if possible

Old terminology Simple & compound

Types of Fractures Green stick Spiral Transverse Comminuted Pathologic Epiphyseal

complications of fx blood vessel & nerve damage Fat embolus disability or deformity

Bleeding (internal) Bones have a blood supply! Fractures bleed internally - Femur - 1 liter Pelvis - 1 liter Tibia - 500 cc

Other considerations What is beneath fracture site? open fracture Joint involved?

Tips & other stuff Angulation or angulated extremity Depressed skull fracture Basilar skull fracture Flail Chest

Hip Injury Hip Fracture – classic presentation Hip Dislocation Shortened, externally rotated Hip Dislocation Usually flexed and internally rotated Requires significant force

TX draw-sheet method Make NO attempt to straighten leg Support with rolled blankets Prevent hip movement

Assessment of injured extremities PMSC Pulse Movement Sensation Capillary refill Cold, blue, pulseless extremity has circulation problem

ALWAYS CHECK DISTAL FUNCTION BEFORE & AFTER SPLINTING !!!!! AND DOCUMENT WHAT YOU FOUND !!

Splinting Why we splint... relieve pain reduce tissue/vessel damage during movement

Types of splints Self splinting Pillows, blankets, & items of clothing Sling & swath Rigid Cardboard plastic ladder Air or vacuum Traction

Traction splints Closed, mid-shaft femur fracture without hip, knee, or ankle injury.

General Principles of Splinting (1 of 2) Remove clothing area PMSC Dress all wounds Do not move the patient before splinting

General Principles of Splinting (2 of 2) Immobilize the joints Pad rigid splints Maintain manual immobilization. Realign angulations PRN When in doubt, splint Reassess PMSC Immobilize all suspected spinal injuries in a neutral in-line position* *pain, resistance, crepitus

Realignment issues NEVER REALIGN A JOINT NEVER REALIGN A INJURY WITH GOOD DISTAL FUNCTION Only pulseless, longbone fractures

Basic Realignment Steps Have all equipment ready & in place Explain procedure to patient In 1 move, with gentle traction, align extremity (goal is anatomical position) Use the least amount of force necessary. If resistance is met or pain increases, splint in deformed position. Reassess distal function

Remember No matter how bad the fracture our priorities are the ABC’s

Hazards of Improper Splinting Further damage Delay in transport Reduction of distal circulation Aggravation of the injury Injury to tissue, nerves, blood vessels, or muscle

end Questions???