Musculoskeletal system & Emergencies

Musculoskeletal System
& Emergencies

Musculoskeletal system & Emergencies
Functions of the
Musculoskeletal System
Gives the body shape
Protects internal organs
Provides for movement
Consists of more than 600 muscles
Musculoskeletal system & Emergencies
Anatomy
Muscles - provide movement &
generate heat.
Ligaments - connect bone to bone
injury = sprain
Tendons - connect bone to muscle
injury = strain
Bones - protection & shape
Musculoskeletal system & Emergencies
The Skeletal System
Gives form to the body
Protects vital organs
Consists of 206 bones
Acts as a framework for attachment of
muscles
Designed to permit motion of the body
Musculoskeletal system & Emergencies
The Skull
Musculoskeletal system & Emergencies
The Neck
Musculoskeletal system & Emergencies
The Spinal Column
Musculoskeletal system & Emergencies
The Thorax
Musculoskeletal system & Emergencies
The Pelvis
Musculoskeletal system & Emergencies
The Lower Extremity
Hip
Thigh
Knee
Leg
Ankle
Foot
Musculoskeletal system & Emergencies
The Upper Extremity
Shoulder girdle
Arm
Elbow
Forearm
Wrist
Hand
Musculoskeletal system & Emergencies
Joints
Musculoskeletal system & Emergencies
Types of Muscle (1 of 2)
Skeletal (voluntary) muscle
Attached to the bones of the body
Smooth (involuntary) muscle
Carry out the automatic muscular
functions of the body
Musculoskeletal system & Emergencies
Types of Muscle (2 of 2)
Cardiac muscle
Involuntary muscle
Has own blood supply and electrical
system
Can tolerate interruptions of blood
supply for only very short periods
Musculoskeletal system & Emergencies
Injuries
Sprain
Strain
Dislocation
Closed fracture
Open fracture
Musculoskeletal system & Emergencies
Sprains & Strains
Sprain
Joint injury with tearing of ligaments
Strain
Stretching or tearing of a muscle
Musculoskeletal system & Emergencies
S/S

Pain
Edema and Ecchymosis
Joint instability
Treatment: - immobilize, ice, &
elevate if possible

Musculoskeletal system & Emergencies
Dislocation
A disruption of a joint, in which the
bone ends are no longer in contact and
the supporting ligaments are torn
Musculoskeletal system & Emergencies
S/S of a Dislocation
Marked deformity
Edema
Pain
Tenderness on palpation
Complete loss of joint function
Distal numbness
Treatment - immobilize, ice, elevate if
possible.
Musculoskeletal system & Emergencies
Fractures
Closed fracture
does not break the
skin

Open fracture
External wound
Nondisplaced
fracture
Simple crack

Displaced fracture
deformity
Musculoskeletal system & Emergencies
Closed fracture
Signs & symptoms
Pain
Edema
Possible deformity
Contusion
Loss of motion
false motion
Crepitus
Guarding
Treatment - immobilize, ice, elevate if possible.
Musculoskeletal system & Emergencies
Open fracture
Signs & symptoms
Pain
Deformity
Break in skin and/or exposed bone

Treatment - dressing, immobilize, ice, &
elevate if possible
Musculoskeletal system & Emergencies
Old terminology
Simple & compound

Musculoskeletal system & Emergencies
Types of Fractures
Green stick
Spiral
Transverse
Comminuted
Pathologic
Epiphyseal
Musculoskeletal system & Emergencies
complications of fx
blood vessel & nerve damage

Fat embolus

disability or deformity
Musculoskeletal system & Emergencies
Bleeding (internal)
Bones have a blood supply!

Fractures bleed internally -
Femur - 1 liter
Pelvis - 1 liter
Tibia - 500 cc
Musculoskeletal system & Emergencies
Other considerations
What is beneath fracture site?

open fracture

Joint involved?
Musculoskeletal system & Emergencies
Tips & other stuff
Angulation or angulated extremity
Depressed skull fracture
Basilar skull fracture
Flail Chest
Musculoskeletal system & Emergencies
Hip Injury
Hip Fracture classic presentation
Shortened, externally rotated
Hip Dislocation
Usually flexed and internally rotated

Requires significant force
Musculoskeletal system & Emergencies
TX
draw-sheet method
Make NO attempt to straighten leg
Support with rolled blankets
Prevent hip movement
Musculoskeletal system & Emergencies
Assessment of injured
extremities
PMSC
Pulse
Movement
Sensation
Capillary refill

Cold, blue, pulseless extremity has
circulation problem
Musculoskeletal system & Emergencies
ALWAYS CHECK DISTAL
FUNCTION BEFORE &
AFTER SPLINTING !!!!!

AND DOCUMENT WHAT YOU
FOUND !!

Musculoskeletal system & Emergencies
Splinting
Why we splint...

relieve pain
reduce tissue/vessel damage
during movement
Musculoskeletal system & Emergencies
Types of splints
Self splinting
Pillows, blankets, & items of clothing
Sling & swath
Rigid
Cardboard
plastic
ladder
Air or vacuum
Traction
Musculoskeletal system & Emergencies
Traction splints
Closed, mid-shaft femur fracture
without hip, knee, or ankle injury.
Musculoskeletal system & Emergencies
General Principles of
Splinting (1 of 2)
Remove clothing area
PMSC
Dress all wounds
Do not move the patient
before splinting
Musculoskeletal system & Emergencies
General Principles of
Splinting (2 of 2)
Immobilize the joints
Pad rigid splints
Maintain manual immobilization.
Realign angulations PRN
When in doubt, splint
Reassess PMSC
Immobilize all suspected spinal
injuries in a neutral in-line position*
*pain, resistance, crepitus
Musculoskeletal system & Emergencies
Realignment issues
NEVER REALIGN A JOINT

NEVER REALIGN A INJURY WITH
GOOD DISTAL FUNCTION

Only pulseless, longbone fractures
Musculoskeletal system & Emergencies
Basic Realignment Steps
Have all equipment ready & in place
Explain procedure to patient
In 1 move, with gentle traction, align
extremity (goal is anatomical position)
Use the least amount of force necessary.
If resistance is met or pain increases, splint
in deformed position.
Reassess distal function
Musculoskeletal system & Emergencies
Remember
No matter how bad the fracture our
priorities are the ABCs
Musculoskeletal system & Emergencies
Hazards of Improper
Splinting
Further damage
Delay in transport
Reduction of distal circulation
Aggravation of the injury
Injury to tissue, nerves, blood
vessels, or muscle
Musculoskeletal system & Emergencies
end
Questions???