1 Musculoskeletal System Temple College EMS Professions

2 Musculoskeletal System w Bones w Muscles w Cartilages w Tendons w Ligaments

3 Skeleton w Support against gravity w Movement w Protection w Production of blood cells w Storage of calcium, phosphorus

4 Skull w Cranium Frontal Parietal Temporal Occipital w Face Mandible Maxilla Zygoma Nasal bones

5 Spinal Column w Cervical: 7 vertebrae w Thoracic: 12 vertebrae w Lumbar: 5 vertebrae w Sacrum: 5 vertebrae (fused) w Coccyx: 4 vertebrae (fused)

6 Thorax w 12 pairs of ribs w Sternum w Protects heart, lungs

7 Pelvis w Bony ring w Two innominate bones, each made of 3 fused bones Ilium Ischium Pubis

8 Lower Extremity w Femur (largest bone in body) w Patella (knee cap) w Tibia (shin bone) w Fibula w Tarsals w Metatarsals w Phalanges

9 Upper Extremity w Shoulder girdle Scapula Clavicle w Humerus w Radius w Ulna w Carpals w Metacarpals w Phalanges

10 Muscles w Maintain posture, allow movement w 3 types: Skeletal (Striated) Smooth (Involuntary) Cardiac

11 Skeletal Muscles w Voluntary muscles w Attach to bones by tendons that cross joints w Shortening of muscle moves joint

12 Smooth Muscles w Carry out involuntary movements w Located in walls of: GI tract GU tract Respiratory tract Blood vessels

13 Cardiac Muscle w Found only in heart w Automaticity w Can initiate own contractions without external stimulation

14 Joints w Joining points of bones w Bone-ends covered with cartilage w Ligaments connect bone-to-bone w Inner surface of joint capsule lined with synovial membrane Produces synovial fluid Lubricates joint

15 Extremity Trauma Temple College EMS Professions

16 Fracture w Break in bone’s continuity

17 Fracture Causes w Direct force w Indirect force w Twisting forces (torsion) w Diseases of bones (pathological fractures) Osteoporosis Tumors

18 Open vs. Closed Fractures w Closed = skin over fracture site intact w Open = break in skin over fracture site Bone ends do not have to be exposed Small opening in skin communicating with fracture site = open fx Open fractures more serious due to external blood loss, possible infection

19 Fractures One of the most important things we do in EMS is prevent closed fractures from becoming open ones

20 Fracture Types w Transverse: fracture is at 90 o angle to shaft w Oblique: fracture is at an angle other than 90 o to shaft w Spiral: fracture coils through shaft of bone like a spring

21 Fracture Types w Impacted: bone ends driven into each other w Comminuted: bone broken into > 3 pieces

22 Fracture Types w Greenstick Shaft of bone not completely broken Compressed on one side, splintered outward on other What group of patients does this type of fracture occur in?

23 Fracture Signs w Deformity w Tenderness Usually point tenderness Overlies fracture site w Inability to use limb Reliable sign of significant injury if present Reverse is not true

24 Fracture Signs w Swelling, ecchymosis w Exposed fragments w Crepitus Grating of bone ends May be heard or felt Do NOT actively seek

25 Dislocation w Displacement of bones from normal positions at joint

26 Dislocation Signs w Deformity w Swelling, ecchymosis about joint w Pain/tenderness in joint w Loss of motion usually perceived as “locked” joint

27 Sprains w Partial, temporary dislocations w Result in tearing of ligaments w Bone ends NOT displaced from normal positions

28 Sprain Signs w Tenderness w Swelling, ecchymosis w Inability to use extremity w No deformity

29 Sprains Degree of joint dislocation at time of injury cannot be determined during exam Extensive damage to neural or vascular structures may have occurred

30 Strains w “Muscle pull” w Injury to musculotendenous unit w Pain on active motion w Pain not present on passive motion

31 Assessment w Perform initial (primary) assessment w Locate, treat life-threats w Assess for injuries of head, chest, abdomen, pelvis w Assess distal neurovascular function

32 Assessment w With exception of pelvic, possibly femur fractures, orthopedic injuries are NOT life- threatening. w Do NOT let spectacular orthopedic injury distract you from ABCs w It’s the unobvious things that kill patients!

33 Assessment w Evaluation must ALWAYS be done of distal neurovascular function. Pulse Skin color Capillary refill Sensation Movement

34 Management w Splinting Prevents further movement at injury site Limits tissue damage, bleeding Eases pain

35 Management w It is difficult to differentiate fractures, dislocations and sprains w When in doubt SPLINT

36 Principles of Splinting w Do NOT move patients before splinting unless patient is in danger w Remove clothes to allow inspection of limb w Note, record distal neurovascular function before, after splinting

37 Principles of Splinting w Cover wounds with dry, sterile compression dressings w Fractures: splint joint above, below fracture w Dislocations: splint bone above, below joint

38 Principles of Splinting w Minimize movement w Support injury until splinting completed w Pad splint to avoid local pressure

39 Principles of Splinting w Angulated fractures Realign before splinting If resistance, pain encountered stop, immobilize as is w Dislocations Splint as is unless circulation compromised Attempt to reposition once to restore pulse If resistance, pain encountered stop, immobilize as is