musculoskeletal by AdiMcbSslbahagia


Muscle/Skeletal Function
 Give the body shape
 Protect the internal organs
 Provide for movement
   Three kinds
     Voluntary  - skeletal
     Involuntary - smooth, diaphragm
     Cardiac - walls of the heart

 Ligaments - connect bone to bone
 Tendons - connect muscle to bone
   Fracture - broken bone
   Strain - muscle or tendon is overextended
   Sprain - joint injury or tearing of ligaments
   Dislocation - Displacement of bone from normal
    position in a joint
   Disease - Degeneration of bone (elderly)
Mechanism of Injury
 Direct force - direct blow
 Indirect force - Impact on one end causes
  injury some distance away
 Twisting forces - one part of extremity stays
  stationary while the rest twists
 Scene size-up - determine MOI
 Initial assessment - general impression of
 Focused history and physical exam
     Rapid trauma - assess joint above and below
      any bone injury
     Check DCAPBTLS
SAMPLE History
 When did it occur?
 What happened?
 Where does it hurt?
 What did you feel at the time of the injury?
     May   report feeling or hearing something snap
2 Types of Bone or Joint Injuries
   Closed (simple)
     Skinover fracture site has not been broken
     May result in profuse internal bleeding

   Open - (compound)
     Skinover the fracture site has been broken
     Bone may or may not protrude through skin
Signs and Symptoms
   Deformity
   Pain and tenderness
   Grating, or crepitus
   Swelling
   Disfigurement
   Severe weakness or loss of function
   Bruising
   Exposed bone ends
   Joint locked into position
Emergency Medical Care
   If injury is life threatening, immobilize during initial
    assessment and transport
   BSI
   Big’ O’s
   Maintain spinal immobilization
   Splint bone and joint injuries
      Do a PMS check before and after splinting
   Apply Cold packs
   Elevates extremity if possible
   Transport
Common Complication from Injuries

 Damage
 Conversion - closed becomes open
 Restriction of blood flow
 Excessive bleeding
 Increased pain associated with movement
 Paralysis - spinal damage
General Rules of Splinting
   Assess PMS before and after splinting
   Immobilize joints both above and below injury to
    long bone
   Immobilize both bones above and below an injury
    to a joint
   Remove or cot away all clothing around the injury
      Remove all jewelry
General Rules of Splinting Cont..
   Cover all wounds before splinting
   If deformity is severe with no distal pulses and
    cyanosis is present in the injured limb, align limb
    with gentle manual traction before splinting. Make
    only one attempt to align the extremity. If pain,
    resistance, or crepitus increase, stop.
   Never try to align a joint due to major nerves and
General Rules of Splinting Cont..
   Never replace protruding bones
   Pad splints
   Apply splint before moving the patient
   Hand or foot immobilized in a position of function
   When in doubt, splint injury
   Treat for shock
   Transport
Splinting Equipment
 Rigid splints
 Traction splints
 Pressure splints/PASG
 Improvised splints
 Sling and swathe
Traction Splinting
   Hare Traction/Sager
   Used for closed mid shaft femur fractures
   Provides counter-pull, alleviating pain, reduces
    blood loss, and minimizes further injury
   Pull is 10% of patient’s body weight
   Femur override or spasms, reduction
   If swollen, apply splint
   1 liter of blood can be lost in each leg
When Not to Use Traction Splint
 Injury within 1 to 2 inches of knee or ankle
 Knee is injured
 Hip is injured
 Pelvis is injured
 Partial amputation or avulsion with bone

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