INJURIES TO MUSCLES AND BONES

1. LESSON 18 INJURIES TO MUSCLES AND BONES

2. Introduction • Trauma patients often have considerable musculoskeletal injuries • With significant mechanisms of injury, bones may fracture and joints may be injured • Injuries may result in pain, disability and life-threatening bleeding

3. Musculoskeletal System Review • Bones • Muscles • Tendons • Ligaments

4. Primary Functions of Musculoskeletal System • Provide shape and support for body • Muscles acting on bones allow movement • Bones protect vital internal organs

5. Skeletal muscles  voluntary Smooth muscles  involuntary Cardiac muscle  involuntary All muscle activity controlledby nervous system Types of Muscles

6. Mechanisms of Injury to Musculoskeletal System • Direct force: force applied directly to body • Indirect force: force transferred from original body site along an extremity to another point • Twisting forces: part of body forced to move in unnatural direction

7. Factors Involved in Injuries • The greater the force: • The more likely the injury • Fracture/Joint dislocation severity more likely • Patient’s age and health status

8. Types of Musculoskeletal Injuries • Fractures • Dislocations • Sprains • Muscle injuries EMRs need not determine type of musculoskeletal injury:

9. Bone may be completely broken or only cracked Closed fracture  skin not broken Open fracture  open wound at site Fractures

10. Dislocations

11. Dislocations (continued) • One or more bones at joint displaced from normal position • Ligaments holding bone are torn • Result from strong forces • Sometimes accompanied by bone fractures or other injuries • Can be very painful

12. Dislocations (continued) • Patient cannot use joint due to pain or structural damage • Serious bleeding may result • Nearby nerves may be injured • With severe dislocation, joint or limb will look deformed

13. Sprains • Joint injury involving ligament stretching and tearing • Typically occur when joint is overextended • Can be mild or severe • Ankles, knees, wrists, fingers most common • Considerable swelling often occurs rapidly

14. Muscle Injuries • Strains, contusions, cramps • Usually less serious than fractures and joint injuries • Many causes

15. Recognizing Musculoskeletal Injury • Sometimes injury type is obvious • Often you will recognize musculoskeletal injury if present • Emergency care is same regardless of injury type • Usually not life-threatening • May be serious and result in pain and disability

16. Assessment ofMusculoskeletal Injuries • Perform standard assessment • Ask patient what happened and what was felt • If large forces involved, consider potential for spinal injury • Expose injury site carefully • Amount of pain and swelling not indicator of injury severity • Immediate medical treatment if no circulation or possible nerve damage

17. Check pulse below injury Check skin color and temperature Touch fingers or toes Does patient feel touch, tingling sensation, numbness? Have patient wiggle fingers or toes Assess for Circulation, Sensation and Movement (CSM) Below the Injury Site

18. Signs and Symptoms of Musculoskeletal Injury

19. Signs and Symptoms of Musculoskeletal Injury(continued) • Pain and tenderness • Abnormal sensation (numbness, tingling) • Inability to move area • Joint locked into position • Impaired function or circulation • Difference in temperature from opposite extremity

20. Preventing Movement • Movement causes injury, pain, swelling • Bone movement further injures soft tissues • Movement generally increases blood flow - may increase internal bleeding and swelling • Manually stabilize or splint injured area

21. Emergency Care ofMusculoskeletal Injuries • Perform standard patient care • Control any life threats • Allow patient to be in position of comfort • Cover open wounds with sterile dressing • Apply cold pack with skin barrier • Don’t replace protruding bones

22. Emergency Care of Musculoskeletal Injuries (continued) • Stabilize injured extremity manually • Support above and below injury • If appropriate, splint extremity • Follow local protocol for oxygen • With traumatic amputation of a body part, care for amputated part after stabilizing patient

23. Splinting

24. Splinting • Movement may worsen musculoskeletal injury and cause more pain • Splint injured arm or leg if risk of area being moved (unless help expected quickly) • Always splint an extremity before patient is transported

25. Splinting (continued) • Helps prevent further injury • Reduces pain • Minimizes bleeding and swelling

26. Types of Splints • Rigid splints • Soft splints • Air splints (inflatable splints) • Pneumatic splints • Anatomic splints • Improvised splints

27. Board Plastic or metal Rolled newspaper or magazine Thick cardboard Rigid Splint

28. Pillow Folded blanket or towel Triangular bandage folded into sling Soft Splint

29. Bandage injured leg or finger to uninjured one Anatomic Splint

30. Commercial Splints

31. Securing Splints • Use bandages, strips of cloth, Velcro • Use knots that can be untied • Don’t secure with tape to skin

32. Guidelines for All Splints • Dress open wounds • Splint only if it doesn’t cause more pain • Splint in position found • Immobilize entire area (joints above and below injury) • Pad between splint and skin • Assess CSM before and after splinting • Put splints on both sides of fracture if possible • Apply cold pack to injury around splint

33. Guidelines for Slings • Use sling to prevent movement and to elevate extremity • Splint injury first • If you splint injury in position found and this position makes use of sling difficult  do not use sling

34. Guidelines for Slings (continued) • Do not move arm into position for sling if it causes pain • A cold pack can be used inside sling • Do not cover fingers inside sling

35. Skill: Applying Arm Sling and Swathe

36. Secure point of bandage at elbow

37. Position triangular bandage

38. Bring lower end of bandage to opposite side of neck

39. Tie the ends

40. Tie swathe bandage over sling and around chest

41. Shoulder Injuries • Involve clavicle, scapula or joint structures • Clavicle is most frequently fractured bone • Scapula fractures are rare • Shoulder dislocations are common

42. Splinting Shoulder Injuries • Goal is to stabilize area from trunk to upper arm • Use soft splint; do not move extremity • Assess for circulation, sensation and movement

43. Splinting Shoulder Injuries (continued) • Pad hollow between body and arm • Apply sling and swathe to support and immobilize arm – if this causes pain use larger pillow

44. Upper Arm Injuries • Immobilize humerus fractures with rigid splint • Treat fractures near shoulder with soft splint

45. Splinting Upper Arm Injuries • Stabilize bone between shoulder and elbow • Assess circulation, sensation, movement in hand and fingers • Apply rigid splint along outside of arm

46. Splinting Upper Arm Injuries (continued) • Tie splint above injury and at elbow • Support wrist with sling and wide swathe • If it causes pain to raise wrist for a sling, use long rigid splint

47. Elbow Injuries • Sprains and dislocations are common • Fractures occur above or below elbow • Patient unable to move joint

48. Splinting Elbow Injuries • If elbow bent, apply rigid splint from upper arm to wrist • If more support needed, use sling at wrist and swathe around chest

49. Splinting Elbow Injuries(continued) • If elbow straight, apply rigid splint from upper arm to hand • If more support needed, use swathes around chest and upper arm and lower arm and waist

50. Skill: Splinting a Forearm