1. Refresher 2003 Common Outdoor Injury Management

2. Instructors This PowerPoint was developed to be used as an instructor- aid for the 2003 OEC Fall Refresher. Please MODIFY its contents to meet your patrol’s needs. A mini-presentation is a good teaching style for this exercise. Your review should not take more than 30 minutes – maximum!

3. Refresher 2003 Common Outdoor Injury Management

4. Common Outdoor Injury Management Objectives Review mechanisms and patterns of traumatic injury Review mechanisms and patterns of traumatic injury Illustrate the types of injury that occur to the skeleton, soft tissue, and skeletal support structures Illustrate the types of injury that occur to the skeleton, soft tissue, and skeletal support structures Explain the general principles of wound care and the emergency care for musculoskeletal injuries Explain the general principles of wound care and the emergency care for musculoskeletal injuries

5. Mechanism of Injury

6. Mechanism of Injury Types of Trauma

7. Penetrating Trauma Penetrating Trauma Compression (Blunt) Trauma Compression (Blunt) Trauma Bending Trauma Bending TraumaHyperflexionHyperextension

8. Nail in Index Finger

9. Mechanism of Injury Types of Trauma Penetrating Trauma Penetrating Trauma Compression (Blunt) Trauma Compression (Blunt) Trauma Bending Trauma Bending TraumaHyperflexionHyperextension

10. Severe Contusion of Foot

11. Mechanism of Injury Types of Trauma Penetrating Trauma Penetrating Trauma Compression (Blunt) Trauma Compression (Blunt) Trauma Bending Trauma Bending TraumaHyperflexionHyperextension

12. Cervical (C5-C6) Fracture Dislocation

13. Mechanism of Injury Types of Trauma Penetrating Trauma Penetrating Trauma Compression (Blunt) Trauma Compression (Blunt) Trauma Bending Trauma Bending TraumaHyperflexionHyperextension

14. Dorsal Dislocation, Long Finger Middle Joint (PIP Joint)

15. Mechanism of Injury Types of Trauma Rotational Trauma Rotational Trauma Distraction Trauma Distraction Trauma Crush Trauma Crush Trauma Deceleration Trauma Deceleration Trauma Acceleration Trauma Acceleration Trauma

16. Normal Tibia Left Normal Tibia Left SpiralFractureTibia Right Right

17. Mechanism of Injury Types of Trauma Rotational Trauma Rotational Trauma Distraction Trauma Distraction Trauma Crush Trauma Crush Trauma Deceleration Trauma Deceleration Trauma Acceleration Trauma Acceleration Trauma

18. Dislocation of Right Shoulder

19. Mechanism of Injury Types of Trauma Rotational Trauma Rotational Trauma Distraction Trauma Distraction Trauma Crush Trauma Crush Trauma Deceleration Trauma Deceleration Trauma Acceleration Trauma Acceleration Trauma

20. Train Crush Injury, Leg

21. Mechanism of Injury Types of Trauma Rotational Trauma Rotational Trauma Distraction Trauma Distraction Trauma Crush Trauma Crush Trauma Deceleration Trauma Deceleration Trauma Acceleration Trauma Acceleration Trauma

22. Deceleration Trauma

23. Mechanism of Injury Types of Trauma Rotational Trauma Rotational Trauma Distraction Trauma Distraction Trauma Crush Trauma Crush Trauma Deceleration Trauma Deceleration Trauma Acceleration Trauma Acceleration Trauma

24. Car struck from behind “accelerates” passengers, producing an extension injury to the neck! Acceleration Trauma

25. Mechanism of Injury Types of Force

26. Direct Force Direct Force Indirect Force Indirect Force Twisting Force Twisting Force High Energy Force High Energy Force

27. Direct Mid-Shaft Fracture, Femur

28. Mechanism of Injury Types of Force Direct Force Direct Force Indirect Force Indirect Force Twisting Force Twisting Force High Energy Force High Energy Force

29. Indirect Posterior Dislocation, Elbow

30. Mechanism of Injury Types of Force Direct Force Direct Force Indirect Force Indirect Force Twisting Force Twisting Force High Energy Force High Energy Force

31. Twisting Subtalar Dislocation, Ankle Twisting Subtalar Dislocation, Ankle

32. Mechanism of Injury Types of Force Direct Force Direct Force Indirect Force Indirect Force Twisting Force Twisting Force High Energy Force High Energy Force

33. High Energy Fractured Pelvis High Energy Fractured Pelvis

35. Types of Injury Types of Injury

36. Types of Injury Fracture Types of Injury Fracture Any break in the continuity of a bone Any break in the continuity of a bone May vary from a simple crack to a completely shattered bone May vary from a simple crack to a completely shattered bone

37. Fracture Classification Closed/OpenIncomplete/CompleteNon-Displaced/Displaced

38. Closed Fracture, Closed Fracture, Base of Thumb Base of Thumb Closed Dorsally Angulated Closed Dorsally Angulated Forearm Fracture Forearm Fracture

39. Open Fracture, Tibia Open Fracture, Forearm Open Fracture, Forearm

40. Open Fractures Are More Serious! Open Fractures Are More Serious! Blood loss Blood loss Potential contamination with risk of infection Potential contamination with risk of infection

41. Fracture Classification Fracture Classification Closed/OpenIncomplete/CompleteDisplaced/Displaced

42. Incomplete Fracture, Distal Radius

43. Complete Fracture, Femur

44. Fracture Classification Fracture Classification Closed/OpenIncomplete/CompleteNon-Displaced/Displaced

45. Non-Displaced Fracture, Distal Tibia and Fibula

46. Displaced Forearm Fractures

47. Other Types of Fracture Other Types of Fracture Comminuted – fractured into more than two segments Pathologic – fracture through diseased bone Epiphyseal – fracture passes through the growth plate

48. Comminuted Femur Fracture

49. Other Types of Fracture Comminuted – fractured into more than two segments Pathologic – fracture through diseased bone Epiphyseal – fracture passes through the growth plate

50. Pathologic Lytic lesion (darker = tumor) in proximal phalanx of finger, with associated transverse fracture

51. Other Types of Fracture Comminuted – fractured into many pieces Pathologic – fracture through diseased bone Epiphyseal – fracture through the growth plate

52. Epiphyseal (growth-line) Fracture, Distal Femur

53. Signs of a Fracture Signs of a Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

55. Seven Signs of Fracture Seven Signs of Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

56. Fractured Patella

57. Seven Signs of Fracture Seven Signs of Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

58. Angulated Fracture, Radius and Ulna

59. Seven Signs of Fracture Seven Signs of Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

60. Crepitus In a complete fracture, the sounds of bone ends clicking or rubbing against each other; denotes an unstable fracture!

61. Seven Signs of Fracture Seven Signs of Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

62. Open Ankle Fracture

63. Seven Signs of Fracture Seven Signs of Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

64. False Motion The unusual visual sensation of observing motion at a long bone fracture site where “there is no joint!”

65. Seven Signs of Fracture Seven Signs of Fracture Tenderness Tenderness Swelling and Ecchymosis Swelling and Ecchymosis Deformity Deformity Crepitus Crepitus Exposed Fragments Exposed Fragments False Motion False Motion Inability to Use the Limb Inability to Use the Limb

66. Fracture, Right Clavicle Right Arm Protected

67. Seven Signs of Fracture The presence of any one of the seven fracture signs just listed is sufficient to assess this injury!

68. Types of Injury Dislocation Disruption of a joint such that the bone ends are no longer in normal contact Disruption of a joint such that the bone ends are no longer in normal contact Must have torn ligaments and joint capsule Must have torn ligaments and joint capsule

69. Signs of Dislocation Signs of Dislocation Tenderness Tenderness Deformity (usually marked) Deformity (usually marked) Swelling and Ecchymosis Swelling and Ecchymosis Loss of normal joint motion Loss of normal joint motion

70. Common Dislocations Common Dislocations Shoulder Shoulder Finger Finger Hip Hip Elbow Elbow

71. Anterior Dislocation, Right Shoulder

72. Common Dislocations Common Dislocations Shoulder Shoulder Finger Finger Hip Hip Elbow Elbow

73. Dislocation, Middle Joint (PIP Joint), Ring Finger

74. Common Dislocations Common Dislocations Shoulder Shoulder Finger Finger Hip Hip Elbow Elbow

75. Posterior Hip Dislocation

76. Common Dislocations Common Dislocations Shoulder Shoulder Finger Finger Hip Hip Elbow Elbow

77. Posterior Elbow Dislocation

78. Types of Injury Fracture-Dislocation Types of Injury Fracture-Dislocation A combined injury with joint dislocation and an adjacent bone fracture A combined injury with joint dislocation and an adjacent bone fracture

79. Fracture–Dislocation, Ankle

80. Types of Injury Sprain Partial or complete temporary joint dislocation Partial or complete temporary joint dislocation Ligaments are torn partially or completely Ligaments are torn partially or completely May produce as much structural damage as a dislocation May produce as much structural damage as a dislocation

81. Sprain, Left Ankle

82. Types of Injury Strain “Muscle Pull” “Muscle Pull” Stretching or tearing of muscle, or muscle fascia (covering) Stretching or tearing of muscle, or muscle fascia (covering) Occurs frequently in the lower back secondary to poor posture and poor abdominal muscle control Occurs frequently in the lower back secondary to poor posture and poor abdominal muscle control

83. Assessing Musculoskeletal Injuries MOI on Approach MOI on Approach ABC’s ABC’s Injury History (“What happened?”) Injury History (“What happened?”) Palpation of injury site -- Palpation of injury site -- “Take one finger and show me where it hurts!” “Take one finger and show me where it hurts!”

84. DCAP-BTLS Deformities Deformities Contusions Contusions Abrasions Abrasions Puncture Wounds Puncture Wounds Burns Burns Tenderness Tenderness Lacerations Lacerations Swelling Swelling

85. Evaluation of Distal Neurovascular Function (CMS) Pulse (circulation) Pulse (circulation) Motor Function Motor Function Sensation Sensation

86. Radial Pulse Posterior Tibial Pulse Radial Pulse Posterior Tibial Pulse

87. Evaluation of Distal Neurovascular Function (CMS) Pulse (circulation) Pulse (circulation) Motor Function Motor Function Sensation Sensation

88. Extension Flexion Extension Flexion Ankle Dorsiflexion Ankle Plantar Flexion Ankle Dorsiflexion Ankle Plantar Flexion

89. Evaluation of Distal Neurovascular Function (CMS) Pulse (circulation) Pulse (circulation) Motor Function Motor Function Sensation Sensation

90. Medial and Medial Foot Lateral Foot Lateral Hand Medial and Medial Foot Lateral Foot Lateral Hand

91. Principles of Musculoskeletal Injury Management Principles of Musculoskeletal Injury Management ABC’s ABC’s Evaluate distal neurovascular function Evaluate distal neurovascular function Dress all wounds Dress all wounds Splint all suspected injuries Splint all suspected injuries Prepare patient for transport Prepare patient for transport

92. Injury Management All open wounds should be covered with a dry sterile compression dressing

94. Injury Management Splinting Immobilizes the Injury and: Reduces Pain Reduces Pain Facilitates Transport Facilitates Transport Prevents further damage to blood vessels, nerves and skin adjacent to the injury Prevents further damage to blood vessels, nerves and skin adjacent to the injury Decreases Bleeding Decreases Bleeding

95. Principles of Splinting Check and record CMS Check and record CMS Dress all wounds Dress all wounds Immobilize the joints above and below a suspected fracture Immobilize the joints above and below a suspected fracture With injuries at or near joints, immobilize the bones above and below the injury With injuries at or near joints, immobilize the bones above and below the injury Stabilize the injury site during splint application Stabilize the injury site during splint application

96. Principles of Splinting Use gentle in-line manual traction to realign displaced long bone fractures Use gentle in-line manual traction to realign displaced long bone fractures Expect to encounter increased pain and some resistance when attempting to realign a deformed limb Expect to encounter increased pain and some resistance when attempting to realign a deformed limb Immobilize all suspected spinal injuries in a neutral in-line position on a spineboard Immobilize all suspected spinal injuries in a neutral in-line position on a spineboard

97. Principles of Splinting If the patient demonstrates major signs of shock, align the limb as close to its normal anatomic alignment as possible on a spineboard (immobilization of total body), and provide rapid transport If the patient demonstrates major signs of shock, align the limb as close to its normal anatomic alignment as possible on a spineboard (immobilization of total body), and provide rapid transport

98. Total Body Immobilization

99. When in doubt: When in doubt: SPLINT! SPLINT!

100. Rigid Splints Quick Splint Cardboard Splint Ladder Splint SAM Splint Rigid Splints Quick Splint Cardboard Splint Ladder Splint SAM Splint

101. Soft Splints Air Splint Vacuum Splint Sling and Swathe Blanket Roll Soft Splints Air Splint Vacuum Splint Sling and Swathe Blanket Roll

102. Traction Splint

103. When standard splints are unavailable, improvisation is better than doing nothing!

104. UPPER EXTREMITY UPPER EXTREMITY All fractures can be immobilized by securing the extremity to the chest!

105. LOWER EXTREMITY LOWER EXTREMITY All fractures can be immobilized by securing the injured extremity to the opposite lower extremity!

106. The End