1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 20, Section 2 Musculoskeletal Injuries: Assessment

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 20.2.1 Describe the general assessment of MS injuries. 20.2.2 Describe the signs and symptoms of MS injuries. 20.2.3 List specific injuries involving the arm and leg. 20.2.4 Describe and demonstrate how to assess each specific arm or leg injury.

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Assessment Upper Extremity Injuries Lower Extremity Injuries Axial Skeleton Injuries

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update What do the vitals tell you about the patient’s current condition? What actions might you take for the pulseless arm? Why was the traction splint called for? What transportation options would be used at your area?

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Standard assessment procedures – ABCDs, SAMPLE, and vitals ◦ Determine number of patients ◦ Use MOI to point to possible injuries ◦ Look for guarding continued

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment continued

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Thorough physical exam – DCAP- BTLS continued Copyright E. M. Singletary, MD ◦ Pain/point tenderness, deformity, swelling are common signs and symptoms ◦ Evaluate each side separately

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Note CMS distal to injury Palpate injured area last Expose injury site ◦ On scene to control bleeding ◦ In aid room to shield from weather, for modesty Formulate management plan Reassess vitals/CMS

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Copyright Mike Halloran

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Signs and Symptoms of Common MS Injuries Sprain, strain, ruptured tendon Fracture ◦ Closed? Open? Dislocation Signs and symptoms ◦ Pain – worsens when moved ◦ Bruising, wounds, skin “gaps” or “tents” ◦ Decreased motion ◦ Crepitus

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Signs and Symptoms of Common MS Injuries Copyright E. M. Singletary, MD Copyright John Dobson

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Upper Extremity Injuries Falling onto outstretched hand, elbow, shoulder may cause these Assess from scapula to fingertips ◦ Scapula – SC joint ◦ Clavicle - AC joint ◦ Shoulder ◦ Humerus – elbow joint ◦ Radius/ulna – wrist joint ◦ Hand, fingers, joints continued

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Upper Extremity Injuries Clavicle is frequently fractured Sternoclavicular (SC) joint dislocation (posterior) may be life threatening Shoulder (AC) separation / dislocation differ in character and severity ◦ Anterior dislocations more common Scapula fractures require severe MOI Humerus fractures may result in nerve damage continued

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Upper Extremity Injuries Detecting Injury Type ◦ Patients with A/C injuries, clavicle fractures, scapular fractures, and humeral head and neck fractures generally hold their arm against their abdomen; patients with posterior shoulder dislocations hold their arm against their abdomen and will not let you bring the arm away from the abdomen (external rotation). By contrast, patients with anterior dislocated shoulders hold their arm out and up. Thus the position in which a patient holds the injured arm can help you identify the possible injury. continued

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Upper Extremity Injuries Elbow fractures involve bones – dislocations lock joints, CMS issues Radius and/or ulna may fracture Wrist fracture may involve distal radius/ulna (Colles) or carpal bones Skier’s thumb common ligament injury continued

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Upper Extremity Injuries continued Copyright Edward McNamara Copyright E. M. Singletary, MD

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Upper Extremity Injuries Hand bones may fracture or dislocate Amputations may occur

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lower Extremity Injuries Assess from pelvis to toes ◦ Hip joint – femur ◦ Knee joint ◦ Tibia/fibula – ankle joint ◦ Foot, toes, joints Femur connects to pelvis at hip joint – may dislocate and/or fracture Femur fractures involve high energy trauma continued

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lower Extremity Injuries continued

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lower Extremity Injuries Knee ligament/cartilage injuries are common ◦ True dislocation is an emergency Patellas may fracture or dislocate Tib and/or fib may fracture Ankle may sprain, fracture, dislocate ◦ Location gives clue to injury type Foot injury takes many forms

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Lower Extremity Injuries

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Axial Skeleton Injuries Take precedence over extremity injuries ◦ Severe extremity bleeding treated in primary exam Details are in the next chapter