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Musculoskeletal Trauma

Musculoskeletal Trauma. Chapter 8. Objectives. Establish the principles for assessing the patient with MSK injuries Establish treatment priorities Identify the importance of MSK injuries in the multiply injured patient. Key Questions.

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Musculoskeletal Trauma

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  1. Musculoskeletal Trauma Chapter 8

  2. Objectives • Establish the principles for assessing the patient with MSK injuries • Establish treatment priorities • Identify the importance of MSK injuries in the multiply injured patient

  3. Key Questions • How do musculoskeletal injuries impact on the primary survey? • What are my prioriries? • What are my management principles?

  4. Impact on primary survey • C - Circulation • External bleeding • Occult blood loss: • Long bone fractures • Pelvic fractures

  5. Primary survey management • The 3 S’s • Stop the bleeding • Splint the extremity • Stabilize the pelvis

  6. Why is splinting useful? • Prevents further blood loss and injury • May restore or maintain perfusion • Relieves pain • Important during evaluation • Do not delay

  7. What are my early concerns? • Vascular compromise • Open fractures

  8. Assess and manage vascular compromise • Reduce fracture • Splint fracture • Assess by Doppler if available • Obtain consult • Consider angiography if available

  9. Assessment aids • Mechanism of injury • Blunt or penetrating • Energy forces involved • Crush or deceleration • Associated factors • Injury patterns such as pelvic or diaphragmatic • Time of injury • Time from injury to definitive treatment • Location of injury • Where injury occurred

  10. Manage open fractures • Apply appropriate splint • Cleanse/debride • Consider time factor • Obtain orthopedic consult

  11. Secondary survey • Look • Feel • Listen • FOR WHAT?

  12. For What? • Look • Deformity • Pain • Tenderness • Wound • Feel • Crepitus • Skin flaps • Neuro deficit • Pulses • Listen • Doppler • Bruit

  13. Secondary survey • What X-rays do I need • Any suspected areas • One joint above and below • When do I obtain them • When patient is stable

  14. Compartment syndrome • Tibia and forearm fractures • Vascular and bony injuries • Injuries immobilized in tight dressings or casts • Severe crush injuries to muscle • Burn injuries

  15. Recognize compartment syndrome • Pain: out of keeping with injury • Paresthesia • Pallor • Paralysis • Pulse loss (late) • Tissue pressures > 35 to 45 mmHg

  16. What are the pitfalls? • Occult fractures • Vascular injury • Compartment syndrome • Minor injuries • Antocoagulation • Altered sensorium

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