musculoskeletal trauma. sections introduction to musculoskeletal trauma anatomy and physiology of...
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Musculoskeletal Musculoskeletal TraumaTrauma
SectionsSections
Introduction to Musculoskeletal Trauma Anatomy and Physiology of the
Musculoskeletal System Pathophysiology of the Musculoskeletal
System Musculoskeletal Injury Assessment Musculoskeletal Injury Management
Introduction to Musculoskeletal Trauma Anatomy and Physiology of the
Musculoskeletal System Pathophysiology of the Musculoskeletal
System Musculoskeletal Injury Assessment Musculoskeletal Injury Management
Millions of Americans experience annually.
Multiple MOI Falls, Crashes, Violence, etc Multi-system trauma
Millions of Americans experience annually.
Multiple MOI Falls, Crashes, Violence, etc Multi-system trauma
Introduction to Introduction to Musculoskeletal Musculoskeletal
InjuriesInjuries
Skeletal Tissue & Structure Protects organs Allows for efficient movement Stores salts and other materials needed for
metabolism Produces RBC’s
Skeletal Tissue & Structure Protects organs Allows for efficient movement Stores salts and other materials needed for
metabolism Produces RBC’s
Anatomy & Physiology Anatomy & Physiology of the Musculoskeletal of the Musculoskeletal
SystemSystem
Musculoskeletal Musculoskeletal SystemSystem Bone Structure
Diaphysis Epiphysis
End of a long bone Metaphysis
Between epiphysis and diaphysis
Growth plate Medullary Canal
Contains bone marrow Periosteum
Fibrous covering of diaphysis Cartilage
Connective tissue that provides a smooth articulation surface for other bones.
Bone Structure Diaphysis Epiphysis
End of a long bone Metaphysis
Between epiphysis and diaphysis
Growth plate Medullary Canal
Contains bone marrow Periosteum
Fibrous covering of diaphysis Cartilage
Connective tissue that provides a smooth articulation surface for other bones.
Figure 7-1
Joint Structure Joint
Where bones interact
Synarthrosis A joint that does not permit movement
Diarthroses (Synovial Joints) Monaxial: hinge or pivot joints Biaxial: gliding, sliding, or saddle joints Triaxial: Ball & socket joints
Ligaments Joint Capsule
Synovial fluid
Joint Structure Joint
Where bones interact
Synarthrosis A joint that does not permit movement
Diarthroses (Synovial Joints) Monaxial: hinge or pivot joints Biaxial: gliding, sliding, or saddle joints Triaxial: Ball & socket joints
Ligaments Joint Capsule
Synovial fluid
Anatomy & Physiology Anatomy & Physiology of the Musculoskeletal of the Musculoskeletal
SystemSystem
Skeletal Organization 206 Bones Axial Skeleton
Head, Thorax & Spine
Appendicular Skeleton Upper Extremities Lower Extremities
Skeletal Organization 206 Bones Axial Skeleton
Head, Thorax & Spine
Appendicular Skeleton Upper Extremities Lower Extremities
Anatomy & Physiology Anatomy & Physiology of the Musculoskeletal of the Musculoskeletal
SystemSystem
Bone Aging Birth to Adult (18-20)
Transition from flexible to firm bone
Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature
Bone Aging Birth to Adult (18-20)
Transition from flexible to firm bone
Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature
Anatomy & Physiology Anatomy & Physiology of the Musculoskeletal of the Musculoskeletal
SystemSystem
Muscular Tissue & Structure
600 muscle groups
Muscular Tissue & Structure
600 muscle groups
Anatomy & Anatomy & Physiology of Physiology of
the the MusculoskeleMusculoskele
tal Systemtal System
(continued)
Types of muscles Smooth Striated Cardiac
Types of muscles Smooth Striated Cardiac
Anatomy & Anatomy & Physiology of Physiology of
the the MusculoskeleMusculoskele
tal Systemtal System
Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain
Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain
Pathophysiology of Pathophysiology of the Musculoskeletal the Musculoskeletal
SystemSystem
Joint Injury Sprain Subluxation Dislocation
Bone Injury Open Fracture Closed Fracture Hairline Fracture Impacted Fracture
Joint Injury Sprain Subluxation Dislocation
Bone Injury Open Fracture Closed Fracture Hairline Fracture Impacted Fracture
Pathophysiology of Pathophysiology of the Musculoskeletal the Musculoskeletal
SystemSystem
Pediatric Considerations Flexible nature
Geriatric Considerations Osteoporosis
Pathological Fractures Pathological diseases
Pediatric Considerations Flexible nature
Geriatric Considerations Osteoporosis
Pathological Fractures Pathological diseases
Pathophysiology of Pathophysiology of the Musculoskeletal the Musculoskeletal
SystemSystem
General Considerations with musculoskeletal injuries
Neurological compromise Decreased stability Muscle spasm
Bone Repair Cycle Osteocytes produce osteoblasts Deposition of salts Increasing strength of matrix
General Considerations with musculoskeletal injuries
Neurological compromise Decreased stability Muscle spasm
Bone Repair Cycle Osteocytes produce osteoblasts Deposition of salts Increasing strength of matrix
Pathophysiology of Pathophysiology of the Musculoskeletal the Musculoskeletal
SystemSystem
Inflammatory & Degenerative Conditions
Bursitis Tendinitis Arthritis
Osteoarthritis• Degenerative
Rheumatoid Arthritis• Chronic, systemic, progressive, debilitating
Gout• Inflammation of joints produced by accumulation of uric
acid crystals
Inflammatory & Degenerative Conditions
Bursitis Tendinitis Arthritis
Osteoarthritis• Degenerative
Rheumatoid Arthritis• Chronic, systemic, progressive, debilitating
Gout• Inflammation of joints produced by accumulation of uric
acid crystals
Pathophysiology of Pathophysiology of the Musculoskeletal the Musculoskeletal
SystemSystem
Scene Size-up Initial Assessment
Categories of urgency Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal
injuries
Rapid Trauma Assessment Focused H&P
6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
Detailed Physical Exam Ongoing Assessment Sports Injury Consideration
Scene Size-up Initial Assessment
Categories of urgency Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal
injuries
Rapid Trauma Assessment Focused H&P
6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
Detailed Physical Exam Ongoing Assessment Sports Injury Consideration
Musculoskeletal Musculoskeletal Injury AssessmentInjury Assessment
General Principles Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function
General Principles Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function
Musculoskeletal Musculoskeletal Injury ManagementInjury Management
Splinting Devices Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids
Vacuum Splints Air Sprints Cravats or Velcro Splints
Fracture Care Joint Care Muscular & Connective Tissue Care
Splinting Devices Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids
Vacuum Splints Air Sprints Cravats or Velcro Splints
Fracture Care Joint Care Muscular & Connective Tissue Care
Musculoskeletal Musculoskeletal Injury ManagementInjury Management
Care for Specific Fractures Pelvis
Scoop Stretcher PASG Fluid Resuscitation
Femur Traction Splints PASG Fracture versus hip dislocation
Care for Specific Fractures Pelvis
Scoop Stretcher PASG Fluid Resuscitation
Femur Traction Splints PASG Fracture versus hip dislocation
Musculoskeletal Musculoskeletal Injury ManagementInjury Management
Care Specific Fractures Tibia/Fibula Clavicle
Most frequently fractured bone in the body Transmitted to 1st and 2nd rib Alert for lung injury
Humerus Radius/Ulna
Care Specific Fractures Tibia/Fibula Clavicle
Most frequently fractured bone in the body Transmitted to 1st and 2nd rib Alert for lung injury
Humerus Radius/Ulna
Musculoskeletal Musculoskeletal Injury ManagementInjury Management
Care for Specific Joint Injuries Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger
Care for Specific Joint Injuries Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger
Musculoskeletal Musculoskeletal Injury ManagementInjury Management
Joint Injuries
Alert for neurological Compromise
Soft & Connective Tissue Injuries Tendon Ligament Muscle
Soft & Connective Tissue Injuries Tendon Ligament Muscle
Musculoskeletal Musculoskeletal Injury ManagementInjury Management
Nitrous Oxide 50% O2:50% N2O Non-explosive Effects dissipate in
2-5 minutes Easily diffused into
air filled spaces in body.
Dose Inhaled & self
administered
Onset 1-2 minutes
Nitrous Oxide 50% O2:50% N2O Non-explosive Effects dissipate in
2-5 minutes Easily diffused into
air filled spaces in body.
Dose Inhaled & self
administered
Onset 1-2 minutes
Musculoskeletal Injury Musculoskeletal Injury ManagementManagementMedicationsMedications
Diazepam Benzodiazepine Antianxiety Analgesic Dose
5-15 mg titrated
Onset 10-15 minutes
Duration 15-60 minutes
Counter Agent Flumazenil
Diazepam Benzodiazepine Antianxiety Analgesic Dose
5-15 mg titrated
Onset 10-15 minutes
Duration 15-60 minutes
Counter Agent Flumazenil
Morphine Sulfate Opiate alkaloid Reduces vascular volume and cardiac preload Do not administer to hypovolemic patients Dose
2mg IVP slow Counter Agent
Narcan
Morphine Sulfate Opiate alkaloid Reduces vascular volume and cardiac preload Do not administer to hypovolemic patients Dose
2mg IVP slow Counter Agent
Narcan
Musculoskeletal Injury Musculoskeletal Injury ManagementManagementMedicationsMedications
(continued)
Musculoskeletal Injury Musculoskeletal Injury ManagementManagementMedicationsMedications
Meperidine Demerol Narcotic Analgesic Dose
50-100 mg
Counter Agent Narcan
Meperidine Demerol Narcotic Analgesic Dose
50-100 mg
Counter Agent Narcan
Nalbuphine Nubain Narcotic Analgesic Equivalent to Morphine Dose
2-5 mg
Onset 2-3 minutes
Duration 3-6 hours
Nalbuphine Nubain Narcotic Analgesic Equivalent to Morphine Dose
2-5 mg
Onset 2-3 minutes
Duration 3-6 hours
Musculoskeletal Injury Musculoskeletal Injury ManagementManagementMedicationsMedications
Other Injury Consideration Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support
Other Injury Consideration Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support
Musculoskeletal Musculoskeletal Injury ManagementInjury Management