1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Musculoskeletal Injuries Chapter 11

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Review of the Musculoskeletal System Injuries to Muscles and Bones Spinal Injuries Head Injuries Splinting Review of the Musculoskeletal System Injuries to Muscles and Bones Spinal Injuries Head Injuries Splinting

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Musculoskeletal Injuries Injuries to muscles, bones, and their associated ligaments Occur frequently –Can be isolated or one of multiple injuries May be quite painful and dramatic –Don’t forget priorities Are not usually life threatening Injuries to muscles, bones, and their associated ligaments Occur frequently –Can be isolated or one of multiple injuries May be quite painful and dramatic –Don’t forget priorities Are not usually life threatening

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Musculoskeletal Injuries The goal of First Responder management of musculoskeletal injuries is to prevent further damage, which is important in minimizing permanent disability and reducing pain.

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Review of the Musculoskeletal System

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Function Provides shape Protection of internal organs Movement Provides shape Protection of internal organs Movement

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Can you identify? –Skull –Face –Vertebrae –Ribs –Pelvis –Lower extremities –Upper extremities –Skull –Face –Vertebrae –Ribs –Pelvis –Lower extremities –Upper extremities

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Spinal Column The Spinal Column Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cervical (7) Thoracic (12) Lumbar (5) Sacral (5) Coccyx (4)

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Thorax Sternum Xiphoid process Manubrium Ribs Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. The Pelvis Ilium Ischium Pubic symphysis Acetabulum Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Upper extremity Lower extremity Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Muscles Voluntary, or skeletal

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Muscles Voluntary, or skeletal Involuntary, or smooth Cardiac Voluntary, or skeletal Involuntary, or smooth Cardiac

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Injuries to Muscles and Bones

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Injuries Primary mechanisms responsible –Direct force –Indirect force –Torsion, or twisting force Primary mechanisms responsible –Direct force –Indirect force –Torsion, or twisting force

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Injuries Classification of musculoskeletal injuries –Open –Closed Classification of musculoskeletal injuries –Open –Closed

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Injuries What do you observe in this photo? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

18. Injuries Swelling can be seen in the ankle Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

19. X-Ray of ankle with no fracture. Dx: Sprained Ankle X-Ray of ankle with no fracture. Dx: Sprained Ankle Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

20. Signs and Symptoms Deformity/Angulation Pain/Tenderness Grating Swelling Bruising Exposed bone ends Locked joint Deformity/Angulation Pain/Tenderness Grating Swelling Bruising Exposed bone ends Locked joint Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

21. Open Fracture Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

22. Management Scene size-up Use body substance isolation precautions If no threats to life or possibility of spinal injury, allow the patient to assume a comfortable position Apply a cold pack to the injury site Stabilize the extremity Scene size-up Use body substance isolation precautions If no threats to life or possibility of spinal injury, allow the patient to assume a comfortable position Apply a cold pack to the injury site Stabilize the extremity

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Stabilization Provide support above and below the site of the injury Cover open wounds with a dry, sterile dressing Pad the area to prevent pressure When in doubt, stabilize Provide support above and below the site of the injury Cover open wounds with a dry, sterile dressing Pad the area to prevent pressure When in doubt, stabilize Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

24. Musculoskeletal Injuries Failure to stabilize an injured extremity can result in increased pain for the patient and possible additional tissue damage.

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Musculoskeletal Injuries Do not attempt to straighten an angulated extremity Never replace protruding bone ends back into wound If in doubt…STABILIZE!! Do not attempt to straighten an angulated extremity Never replace protruding bone ends back into wound If in doubt…STABILIZE!!

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Spinal Injuries

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Spinal Injuries May cause permanent disability or even death It is critical to recognize mechanisms of injury that can produce spinal trauma May cause permanent disability or even death It is critical to recognize mechanisms of injury that can produce spinal trauma Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

28. Mechanisms of Injury Any mechanism that produces violent impact on head, neck, torso or pelvis Incidents that produce sudden forces to neck or torso Any fall Any mechanism that produces violent impact on head, neck, torso or pelvis Incidents that produce sudden forces to neck or torso Any fall Ejection or fall from motorized or otherwise powered transportation device Shallow-water diving incidents Assume with any unresponsive trauma patient

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Signs and Symptoms Concerning mechanism of injury Altered mental status/unresponsive Loss of sensation/movement in any extremity “Pins and needles” feeling Pain/tenderness in neck/back Difficulty breathing Loss of bowel/bladder control Concerning mechanism of injury Altered mental status/unresponsive Loss of sensation/movement in any extremity “Pins and needles” feeling Pain/tenderness in neck/back Difficulty breathing Loss of bowel/bladder control

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assessment Consider the MOI Maintain manual stabilization of the head and neck Ask : –What happened? –Does your neck or back hurt? –Where does it hurt? –Are you able to move your hands and feet Consider the MOI Maintain manual stabilization of the head and neck Ask : –What happened? –Does your neck or back hurt? –Where does it hurt? –Are you able to move your hands and feet

31. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Does your neck or back hurt? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

32. Unresponsive Patient Use jaw-thrust maneuver Assist breathing if needed Obtain information from witnesses The primary complications to which you should be alert are ineffective breathing and paralysis Use jaw-thrust maneuver Assist breathing if needed Obtain information from witnesses The primary complications to which you should be alert are ineffective breathing and paralysis

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Spinal Injuries Make sure the scene is safe Use body substance isolation Establish and maintain manual control of the head and neck Make sure the scene is safe Use body substance isolation Establish and maintain manual control of the head and neck Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

34. Spinal Injuries Use jaw-thrust Assess all 4 extremities for pulse, ability to move, and sensation Use jaw-thrust Assess all 4 extremities for pulse, ability to move, and sensation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

35. Head Injuries

36. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Head Injuries Classified as either open or closed –Open when there is a laceration or penetrating wound to the forehead or scalp May be significant bleeding –Usually can be controlled Classified as either open or closed –Open when there is a laceration or penetrating wound to the forehead or scalp May be significant bleeding –Usually can be controlled

37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Head Injuries Watch for external signs of injury to the skull Can be bleeding within the skull Watch for external signs of injury to the skull Can be bleeding within the skull

38. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Scalp Injuries Can bleed significantly Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

40. Traumatic Brain Injury (TBI) Often immediately life threatening May cause –Altered mental status –Unresponsiveness with loss of airway control –Abnormal breathing or respiratory arrest –Vomiting –Changes in blood pressure and pulse rate Often immediately life threatening May cause –Altered mental status –Unresponsiveness with loss of airway control –Abnormal breathing or respiratory arrest –Vomiting –Changes in blood pressure and pulse rate

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Management Ensure scene safety and take BSI Maintain the airway with jaw-thrust maneuver Assess breathing and assist ventilations as needed Control bleeding Monitor mental status Ongoing assessment Ensure scene safety and take BSI Maintain the airway with jaw-thrust maneuver Assess breathing and assist ventilations as needed Control bleeding Monitor mental status Ongoing assessment

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Splinting

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Splinting Stabilize Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

44. Splinting Check distal circulation, motion, and sensation Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

45. Splinting Apply splint Re-check circulation, motion, and sensation after splint is applied Apply splint Re-check circulation, motion, and sensation after splint is applied Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

46. Splinting Examples Splinting Examples

47. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Ankle Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

48. Knee Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

49. Lower Leg Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

50. Finger Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

51. Forearm Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

52. Traction Splint Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

53. Shoulder Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

54. Elbow Injury Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

55. Sling and Swathe Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

56. Summary After management of airway, breathing, and circulation, the First Responder will assess the patient for additional injuries, including injuries to the muscles and bones.

57. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary Most musculoskeletal injuries are painful, but not life threatening, but there are exceptions –Fractures of the femur and pelvis –Cervical spine injury Proper care of musculoskeltal injuries is important to minimize risk of further injury and permanent disability and to minimize pain. Most musculoskeletal injuries are painful, but not life threatening, but there are exceptions –Fractures of the femur and pelvis –Cervical spine injury Proper care of musculoskeltal injuries is important to minimize risk of further injury and permanent disability and to minimize pain.

58. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary In caring for a patient with a musculoskeletal injury, remember the priority of care is “life over limb.” –Treat life-threatening airway, breathing, and circulation problems first, then manage musculoskeletal trauma In caring for a patient with a musculoskeletal injury, remember the priority of care is “life over limb.” –Treat life-threatening airway, breathing, and circulation problems first, then manage musculoskeletal trauma

59. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions? Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.