26)musculoskeletal care
TRANSCRIPT
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Musculoskeletal Care
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Skeletal System
• 14% total body weight• Function
• Shape, Movement, Storage (Calcium, Phosphorus, Iron)
• Protection of organs• Blood cell production• Endocrine Regularion
• Components• Bones
• Mineralized osseous tissue• Cartilage
• Soft connective tissue/Collagen• Flexible support
• Tendons• Attach muscle to bone• Collagen, Elastin, Proteogylcans
• Ligaments• Attach bone to bone • Collagen
• Axial Skeleton• Skull, vertebral column, thoracic cage
• Appendicular Skeleton• Upper limbs, pelvic girdle, lower limbs
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Axial SkeletonSkull
• Skull• 22 bones• Cranium + Face• Encases brain• Brain + CSF + Vessels
• Little space• Facial Bones
• Orbits• Eyes
• Nasal Bones• Maxilla
• Upper Jaw• Zygomatics
• Cheekbones • Mandible
• Lower Jaw
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Axial SkeletalVertebral Column
• Function• Support
• Components • 33 Vertebrae• Intervertebral disks
• Divisions of Vertebrae• Cervical (C-) = 7 Neck
• C1 = Atlas• C2 = Axis
• Thoracic (T-)= 12 Chest• Lumbar (L-)= 5 Lower Back• Sacral (S-)= 5 Back of pelvis (fused) • Coccyx (C-)= 4 Tailbone (fused)
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Axial Skeletal Thoracic Cage
• Function• Protection of thoracic cavity• Supports shoulder girdle
• Components • 12 pairs of ribs
• 1-10 attach to sternum• 11-12 “float”
• Sternum • Manubrium• Body• Xiphoid process
• Costal cartilage• Connect ribs to sternum
• Thoracic vertebrae (12)
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Appendicular SkeletonUpper Extremities
• Clavicle• Scapula• Acromion (Tip of shoulder)• Humerus • Olecranon (elbow)• Radius• Ulna• Carpals (wrist)• Metacarpals (hands)• Phalanges (fingers)
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Appendicular SkeletonLower Extremities
• Greater Trochanter (head of femur)• Acetabulum (socket of hip)• Femur (thigh)• Patella (knee)• Tibia (shin)• Fibula (lower leg)• Medial/Lateral malleolus (ankle)• Tarsals and metatarsals (foot)• Calcaneus (heel)• Phalanges (toes)
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Appendicular SkeletonPelvis
• Function• Support and protection
• Components • Ilium
• Wings • Pubis
• Anterior portion• Ischium
• Inferior portion• Sacrum• Coccyx
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Joints
• Definition• 2 or more bones connecting to bones
• Types• Ball and socket
• Hip/Shoulder• Wide Range of motion
• Hinge• Elbow/knee• Motion in 1 plane• Flexion and extension only
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Types of Force
• Direct• Energy applied directly to an area• GSW shattering bone• Falling person landing on feet• Sports injuries
• Indirect• Force transmitted along axes of
bone• Injury at a location other than
point of impact• i.e. Person falling on
outstretched hand • Twisting
• Twisting force transmitted along axes of bone
• i.e. A scatter who plants skates in the middle of turn
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Types of Fractures
• Fracture• A break in the continuity of a bone
• Complete• Two bone ends widely separated
• Incomplete• Hairline crack along the bone
• Open• Breakage of skin at the fracture site• Exposed to the outside
environment• Closed
• No break of the skin over the fracture site
• No environmental exposure
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Open Fractures
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Closed Fractures
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Injuries to LigamentsTendons
• Sprains• Injuries to ligaments• Usually due to stretching forces
• Strains• Injuries to:
• Muscle• Tendons• “You can tend a strain”
• Usually due to stretching forces• Dislocation
• Displacement of a bone in joint from its normal position
• Stretching/tearing of joint ligaments must also occur
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Musculoskeletal CareAssessment
• BSI/Scene Safety• Determine MOI
• Lap belt injuries- Possible abd complications• Starburst – Possible head trauma• Etc.
• Initial assessment• ABC’s• Major bleeds/Life threats• C-Spine
• Focused Hx/Px• More info on MOI• Events prior to accident
• Seatbelts worn• Airbags deployed• Did pt trip and fall• Did pt become dizzy/ALOC and fall• Etc.
• DCAP-BTLS• Vitals• On-going assessment
Seatbelt Injury
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Bone/Joint InjuriesS/S
• Deformity• Angulation• Pain and tenderness
• Sometimes referred distal/proximal to injury
• i.e. Hip fx- pain in knee• Crepitus
• Bone ends rubbing against each other• Swelling
• Fluid/blood loss • Discoloration/Bruising • Exposed bone ends• Joint locked into position
• Possible dislocation • Loss of use
• Do not force movement against pt complaints
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Bone/Joint InjuriesBlood Loss
• Bleeding• CAN BE LIFETHREATING COMPLICATION!• Radius or Ulna - 250-500 ml• Humerus - 500-759 ml• Pelvis - 1500-3000 ml• Femur - 1000-2000 ml• Tibia and fibula - 500-1000 ml
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Bone/Joint InjuriesVascular Injuries
• Vascular Injuries • Injuries to blood vessels • Pinching, tearing, spasms,
compression, occlusion by clots
• Loss of distal blood flow • Assessment
• Distal Pulses• Skin color/temp• Capillary refill time• Pain• Numbness, Tingling,
Prickling,• Sensory loss• Paralysis distal to injury
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Bone/Joint InjuriesPeripheral Nerve Injuries
• Peripheral Nerve Injuries • Injured more often than
arteries• Tearing, Pinching, Stretch,
Compression, of a nerve• S/S
• Numbness• Pain• Abnormal sensation• Loss of motor ability
• Assessment• Pulse• Motor• Sensation
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Bone/Joint InjuriesInternal Organ Injuries
• Injuries to Internal Organs• Forces transmitted to underlying organs
• Thorax• Flail segment • Hemothorax• Pneumothorax
• Open • Closed• Tension
• Traumatic asphyxia • Rupture of:
• Spleen• Liver
• Pelvis• Bladder• Urethra• Rectum• Lower intestine• Reproductive organs
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Bone/Joint Injuries Care
• BSI• O2• Splinting
• After life threats have been treated
• Cold pack • Reduces swelling in:• Painful• Swollen• Deformed
• Elevation of extremity
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Bone/Joint InjuriesSplinting
• Reasons• Prevents motion of:
• Bone fragments• Bone ends• Angulated bones
• Minimizes:• Damage to –muscles – nerves – blood vessels• Conversion of closed fx to open fx• Compression of blood vessels due to bone ends• Excessive bleeding• Pain with movement• Paralysis of extremity due to spinal injury
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Splint Types
• Sling and Swathe • Sling- Triangular bandage supporting weight of injured arm • Swathe – Triangular bandage binding upper arm to chest wall
• Rigid Splints• Rigid material often padded• Applied to both sides of injury• Secured with roller bandages or cravats
• Traction Splints• Metal frame with pulley system • Apply traction to lower extremity fx• Used for femur fx
• Pneumatic Splints (Air, Vacuum)• Plastic splints filled with air• Circumferential support
• Improvised Splints• Blankets, magazines, cardboard, notebooks, pillows, etc…
• Pneumatic Anti Shock Garment• Air splint for lower extremity/pelvis fx
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General Rules of Splinting
• Assess PMS distal to injury:• Prior to• After splinting
• Immobilize the joint• Above and Below injury
• Remove clothing• Cover open wounds
• Sterile dressings• Splint joint injuries in position found
UNLESS:• If severe deformity or cyanosis:
• Align with gentle traction before splinting
• If resistance is met or pt complains of increased pain – Splint in position
• Do not intentionally replace protruding bone ends
• Cover with moistened sterile dressing
• Cover with dry sterile dressing • Pad each splint
• Prevents further pain• Splint the injury
• When in doubt…• When feasible and no life threats
• If pt in shock:• Align in normal anatomical position• TRANSPORT• Total body immobilization= Long
Back Board (LBB)
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Splinting Precautions
• Compression of:• -Nerve – Tissues - Vessels
• Delay of transport• Critical pt = LBB
• Reduction of distal circulation• If applied too tight
• Aggravation of: (if too loose)• Bone/joint injury• Nerves• Vessels• Tissue
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Long Bone Splinting
• Splints:• Rigid splint, Air Splint, Sling and Swathe, Long Board Splint
• Locations: • Arms and Legs
• BSI• Apply manual stabilization• Assess PMS• If severe deformity or cyanosis:
• Align with gentle traction before splinting• Measure splint• Immobilize 1 joint above and 1 joint below
• Secure ENTIRE injured extremity • Immobilize hand/foot in position of function• Reassess PMS
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Measure Apply/Secure Immobilize Joint Above and Below injury
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Splinting of Joints
• BSI• Manual stabilization• Assess PMS• If distal extremity lacks
pulse or is cyanotic• Align with gentle traction
if no resistance
• Immobilize site of injury• Immobilize bone above
and below injury• Reassess PMS
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Traction Splinting
• Indication:• Painful, swollen, deformed mid-thigh• No joint or lower leg injury
• Contraindication:• Injury close to the knee• Injury to the knee• Injury to hip• Injured pelvis• Partial amputation
• Avulsion with bone separation• Distal limb is connected by a margin of tissue• Traction would risk separation
• Lower leg/ankle injury
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Traction Splinting
• BSI• Manual stabilization• Assess PMS• Apply ankle hitch – (Ankle) = Distal immobilization• Apply manual traction • Adjust splint length to length of uninjured leg• Position splint under injured leg• Apply ischial strap –(Groin) = Proximal immobilization• Apply mechanical traction• Release manual traction• Position/secure straps
• 2 Above the knee• 2 Below the knee • DO NOT PLACE DIRECTLY OVER SITE OF INJURY
• Reassess ischial strap and ankle hitch • Reassess PMS• Secure torso to LBB
• Immobilized hip • Secure splint to LBB
• Prevents movement of splint
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Manual Stabilization
Manual Traction Apply ankle hitch.
Continue manual traction
Place splint under injured leg
Apply ischial strap Apply mechanical tractionRelease manual traction
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Position straps: 2 above knee, 2 below knee
Reassess PMS
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That does it…
REMEMBER: ASSESS PMS BEFORE/AFTER IMMOBILIZATION