Chapter 13

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					Chapter 14: Injuries to Muscles and Bones
             Cognitive Objectives

5-3.1 Describe the function of the musculoskeletal system.
5-3.2 Differentiate between an open and a closed painful,
      swollen, deformed injury.
5-3.3 List the emergency medical care for a patient with a
      painful, swollen, deformed extremity.
5-3.4 Relate mechanism of injury to potential injuries of the
      head and spine.

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             Cognitive Objectives

5-3.5 State the signs and symptoms of a potential spine
5-3.6 Describe the method of determining if a responsive
      patient may have a spine injury.
5-3.7 List the signs and symptoms of injury to the head.
5-3.8 Describe the emergency medical care for injuries to
      the head.

                                                            (2 of 2)
             Affective Objectives

5-3.9 Explain the rationale for the feeling patients who
       have need for immobilization of the painful, swollen,
       deformed extremity.
5-3.10 Demonstrate a caring attitude towards patients with
       a musculoskeletal injury who request emergency
       medical services.

                                                          (1 of 2)
             Affective Objectives

5-3.11 Place the interests of the patient with a
       musculoskeletal injury as the foremost consideration
       when making any and all patient care decisions.
5-3.12 Communicate with empathy to patients with a
       musculoskeletal injury, as well as with family
       members and friends of the patient.

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          Psychomotor Objectives
5-3.13 Demonstrate the emergency medical care of a
       patient with a painful, swollen, deformed extremity.
5-3.14 Demonstrate opening the airway in a patient with
       suspected spinal cord injury.
5-3.15 Demonstrate evaluating a responsive patient with a
       suspected spinal cord injury.
5-3.16 Demonstrate stabilizing of the cervical spine.
 Knowledge and Attitude Objectives

1. Describe the mechanisms of injury for musculoskeletal
2. Describe the need for body substance isolation
   techniques when examining or treating patients with
   musculoskeletal injuries.

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 Knowledge and Attitude Objectives
3. Explain how to splint the following sites and injuries:
   • Shoulder girdle             • Pelvic fracture
   • Dislocation of the          • Hip injury
     shoulder                    • Injury to the thigh
   • Elbow injury                • Knee injury
   • Injury to the forearm       • Leg injury
   • Injury to the hand,         • Injury to the ankle or foot
     wrist, or fingers

                                                             (2 of 4)
 Knowledge and Attitude Objectives

4. Explain the two types of head injuries.
5. Describe the treatment of facial injuries.
6. Explain the mechanism of spine injuries.

                                                (3 of 4)
 Knowledge and Attitude Objectives

7. Describe the signs, symptoms, and treatment of the
   following injuries:
    • Fractured ribs
    • Flail chest
    • Penetrating chest wound

                                                        (4 of 4)
                 Skill Objectives

1. Perform body substance isolation techniques when
   treating a patient with musculoskeletal injuries.
2. Examine a patient with musculoskeletal injuries.
3. Evaluate the circulation and sensation of a patient with
   an extremity injury.
4. Treat injuries of the face.

                                                          (1 of 2)
            Skill Objectives

5. Treat the following injuries of the chest:
    • Fractured ribs
    • Flail chest
    • Penetrating chest injuries

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     Injuries to Muscles and Bones

• First responders
  encounter many types of
  musculoskeletal injuries.
• Providing proper care at
  the scene can prevent
  additional injury and
      The Skeletal System

• Consists of 206 bones
• Four functions:
   1. Supports the body
   2. Protects vital structures
   3. Assists in body movement
   4. Manufactures red blood cells
     Divisions of the Skeletal System

•   Head              • Rib cage
•   Spinal column     • Pelvis
•   Shoulder girdle   • Lower extremity
•   Upper extremity

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Divisions of the Skeletal System

                                   (2 of 2)
• Consists of a series of separate bones called vertebrae
• Spinal cord
   – Nerves that carry messages to and from brain
   – Passes through hole in center of each vertebra
• Primary support structure for the entire body
               Muscular System

• Provides support and movement
• Muscles are attached to bones by tendons.
• Body has three types of muscles:
   – Voluntary (skeletal): Controlled by person
   – Involuntary (smooth): Cannot be controlled by person
   – Cardiac: Found only in the heart
            Mechanism of Injury

• How injuries occur
• Causes of musculoskeletal injuries:
   – Direct force
   – Indirect force
   – Twisting force
• PSDE = Painful, swollen, deformed extremity

• Two types:
   – Open
   – Closed
• Both kinds injure adjacent
  soft tissues.
• Can result in bleeding
         Dislocations and Sprains
• Dislocations
   – A disruption tears the supporting ligaments of the
   – Very painful to move
• Sprains
   – Joint injury caused by excessive stretching of
     supporting ligaments
   – A partial dislocation
        Body Substance Isolation

• Patients with musculoskeletal injuries may have
  open wounds.
• Wear approved gloves.
• Use heavy rescue gloves if responding to scene
  involving broken glass.
       Signs and Symptoms
       of Extremity Injuries
•   Pain at injury site
•   Open wound
•   Swelling and discoloration (bruising)
•   Inability to move extremity
•   Deformity or angulation
•   Tenderness at injury site
          Exam of an Injured Limb

• Check an injured limb for:
   – Open wounds
   – Bleeding
   – Swelling
   – Deformity
   – Bruising

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          Exam of an Injured Limb

• Check the extremity for:
   – Pulse
   – Capillary refill
   – Sensation
   – Movement

                                    (2 of 2)
              Treatment of
          Musculoskeletal Injuries
• All limb injuries are treated the same way in the field:
   – Cover open wounds.
   – Control bleeding if necessary.
   – Splint limb.
           Principles of Splinting

• Remove clothing.
• Assess limb.
• Cover all open
  wounds with dressing.
• Do not attempt to
  move before splinting.
• Immobilize joint above
  and below injury.

• Rigid splints
   – Made from firm material (padded boards)
• Soft splints
   – Inflatable, clear plastic
• Traction splints
   – Holds a lower extremity fracture in alignment
                 Elbow Injuries
• Do not move an injured elbow from the position in which
  you find it.
• Pillow splints help
  stabilize injured elbows.
                   Hip Injuries

• Hip fractures
   – Occur at the upper end of the femur
   – Osteoporosis causes bones to become more fragile.
• Dislocated hips
   – Extremely painful
             Injuries of the Thigh

• A fractured femur is very unstable and usually produces
  significant deformity.
• Often much bleeding and swelling
• Treat for shock and help prevent further injury.
            Injuries to the Head
• Common causes of death, paralysis, and permanent
  brain injury
• May occur from many different kinds of trauma
• Types:
   – Closed head injury
   – Open head injury
            Signs and Symptoms
               of Head Injuries
•   Confusion                  • Paralysis
•   Unusual behavior           • Seizures
•   Unconsciousness            • External head trauma:
•   Decreasing consciousness      – Bleeding
•   Nausea or vomiting            – Bumps
•   Unequal pupils                – Contusions
         Treatment of Head Injuries

•   Stabilize head in a neutral position.
•   Maintain an open airway using the jaw-thrust technique.
•   Support patient’s breathing.
•   Monitor circulation.

                                                          (1 of 2)
        Treatment of Head Injuries

• Check to see if CSF or blood is seeping from wound,
  nose, or ears.
• Control bleeding.
• Examine and treat other
  serious injuries.
• Arrange for prompt transport.

                                                        (2 of 2)
    Treatment of Facial Injuries

•   Stabilize head in a neutral position.
•   Maintain an open airway.
•   Support breathing as needed.
•   Monitor circulation.
•   Control bleeding.
•   Look for and stabilize other serious injuries.
•   Arrange for prompt transport.
             Injuries to the Spine

• Mechanisms of injury
  – Pressure on spinal cord from displaced vertebrae,
    swelling, or bleeding
  – Cord is severed, resulting in paralysis.
  – Gunshot wounds
  – Falls, motor vehicle collisions, and stabbing

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Injuries to the Spine

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             Signs and Symptoms
               of Spinal Injuries
• Laceration, bruise, or other sign of injury to head, neck,
  or spine
• Tenderness
• Extremity weakness, paralysis, or loss of movement
• Loss of sensation or tingling in any part of the body
  below neck
        Treatment of Spinal Injuries

•   Stabilize head and neck in neutral position.
•   Maintain an open airway.
•   Support patient’s breathing.
•   Monitor circulation.
•   Assess pulse, movement, and sensation in all

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        Treatment of Spinal Injuries

•   Examine and treat other serious injuries.
•   Do not move patient.
•   Assist in immobilizing patient onto a longboard.
•   Arrange for prompt transport to an appropriate medical

                                                             (2 of 2)
     Motorcycle and Football Helmets

• In most instances, helmets do not have to be removed.
• Only remove helmet if:
   – Face mask or visor interferes with adequate
     ventilation or airway management.
   – Helmet is too loose, making immobilization

                                                          (1 of 2)
     Motorcycle and Football Helmets

• If you remove a football
  helmet, you should also
  remove the shoulder pads.
• You may have to provide
  extra padding to maintain
  neutral position.

                                       (2 of 2)
             Injuries to the Chest

• Chest cavity contains lungs, heart, and several major
  blood vessels.
• Chest cavity is protected by chest wall.
• Chest wall is made up of the ribs, cartilage, and chest
• Common chest injuries include rib fractures, flail chest,
  and penetrating wounds.
    Treatment of Rib Fractures

•   Place a pillow against injured ribs.
•   Prevent excessive movement.
•   Administer high-flow oxygen.
•   Arrange for transport to hospital.
                      Flail Chest

•   Three or more ribs are broken in at least two places.
•   Injured part moves opposite chest wall.
•   Place a pillow firmly over flail section.
•   Monitor breathing.
•   Monitor and support ABCs.
    Penetrating Chest Wounds

• Results from penetration of chest wall by an object
• Introduces air and blood between lung and chest
• May result in lung collapse
• Severe blood loss into chest cavity can produce
  hemorrhagic shock.

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Penetrating Chest Wounds

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   Treatment of Penetrating
        Chest Wounds
• Quickly seal an open chest wound with an
  occlusive dressing.
• Administer high-flow oxygen.
• Monitor breathing.
• Stabilize any impaled object.
• Prepare for transport.