Musculoskeletal Injuries

Rock Springs Fire Department

 Introduction
◆ This course will cover musculoskeletal
injuries as they apply to fractures, strains,
sprains, and dislocations.
◆ Students will learn the anatomy of
musculoskeletal injuries, and will have the
knowledge to provide efficient emergency
medical treatment of said injuries.
 Agenda
◆ Topics to be covered will be anatomy, types
of injuries, patient treatment and splinting
procedures.
◆ Students will learn, through discussion, the
critical difference of when and when not to
immobilize specific fractures and when to
utilize whole body splinting.
 Agenda
◆ Students will also practice, through hands-
on exercise, the treatment and
immobilization of patients who have
suffered musculoskeletal type injuries.
 Injury

◆ Musculoskeletal injuries occur when,

through a mechanism of injury, a force is
applied to the body doing damage to bones
muscle and connective tissue. Remember,
that when these injuries occur that there is a
high likelihood of organs, vasculature,
nerves and other tissue will also be
damaged.
 Injury
◆ Immobilization, reduction of swelling, and
whole patient care can effectively reduce
the possibility of worsening an injury and
damage to surrounding tissue until a
diagnosis and surgical interventions can be
achieved.
 Discussion….To Splint Or Not
To Splint?
◆ Critical patients vs. non-critical
◆ Critical time should not be wasted
immobilizing extremity fractures in patients
who have compromised ABC’s or have a
deteriorated mental status.
 Overall Management
Priorities
1. Manage life-threatening injuries.
2. Manage limb-threatening injuries.
3. Manage all other conditions.
 Overall Management
Priorities
◆ Adherence to these priorities does not imply
that extremity injuries should not be cared
for or protected from further harm.
◆ It does mean that, in critical patients with
extremity injuries that are not life
threatening, abbreviated measures are used
to care for the extremity injuries.
 Overall Management
Priorities
◆ The easiest and most effective way to
accomplish abbreviated care of extremity
injuries in the critical patient is to
immobilize the patient to a longboard.
◆ Spinal movement restriction will effectively
act as a whole body splint.
Spinal Movement Restriction
 Vocabulary
◆ Fracture - when a bone or set of bones are
broken.
◆ Strain - an injury to a muscle or muscle and
tendon, where it has become overextended or
stretched.
◆ Sprain - an injury to a joint, where there is
possible damage to or possible tearing of
ligaments.
 Vocabulary
◆ Dislocation - The displacement of a bone
from its normal position in a joint
◆ Tendon - connective tissue that connects
muscle to bone.
◆ Ligament - connective tissue that connects
bone to bone.
 Vocabulary
◆ Closed injury - an injury where the skin
surrounding an injury is intact.
◆ Open injury - an injury in which the skin
over the fracture site has been broken, the
bone may be protruding through the wound.
 Signs and Symptoms
◆ Pain
◆ Swelling
◆ Deformity
◆ Severe weakness or loss of use
◆ Crepitus
◆ Patient heard a snap
◆ Numbness and tingling (parasthesia)
 Signs and Symptoms
◆ Joint locked into place
◆ Exposed bone ends
◆ Bruising
◆ Loss of pulses distal to injury
◆ Cyanosis distal to injury
 Caution
◆ Open fractures may not be as evident as you
would think. They may present as a small
laceration over the injury site.
They May Only Have A Small
Laceration
They May not be like this.
Or This
 Caution
◆ It is your duty to report to the receiving
facility that the injury may have been open,
or that bone ends were protruding at one
time.
Communicate!!!!
 Discussion
◆ How do we know whether he injury is a
fracture, dislocation, strain or a sprain?
◆ We don’t . The need to diagnose the
specific type of bone or joint injury is not
critical, and time should not be wasted
trying to do so. Why?
 Critical Musculoskeletal
Injuries
◆ Clavicle and rib fractures.
◆ Femur fractures.
◆ Pelvic fractures.
◆ Spinal Injuries.
 Treatment
◆ BSI
◆ Oxygen….How much?….Which device.
◆ Spinal Precautions……MOI?
Mechanism Of Injury
 Treatment
◆ Rapid trauma assessment.
◆ Manual immobilization.
◆ Evaluate PMS. Pulse Oximetery?
◆ Apply splint.
◆ Evaluate PMS.
◆ Continue to re-evaluate the immobilized extremity.
 Treatment
◆ Remove jewelry from extremity…Why?
◆ Apply cold to the injury to reduce swelling
◆ Elevate extremity to reduce swelling.
Elevation of lower extremities is
contraindicated when a spinal injury is
suspected.
◆ Transport
 Splinting Guidelines
◆ Before and after splinting, pulses, motor
function, and sensation distal to the injury
should be evaluated. PMS should be re-
evaluated every 15 minutes after.
◆ Manually immobilize the injured extremity
until mechanical immobilization is achieved.
◆ Expose the injury site.
◆ Dress soft tissue injuries.
 Splinting Guidelines
◆ In cases of severe deformity or compromise
in PMS findings. A single attempt may be
made to align injured extremities.
However, if resistance, an increase in pain,
or crepitus are encountered splint the
extremity in the position found.
 Splinting Guidelines
◆ In the event that there is a compromise in
PMS distal to an injury to a joint,
immobilize the extremity in the position
found and consult medical direction.
◆ Do not intentionally replace protruding
bone ends.
 Splinting Guidelines
◆ Pad splints prior to application
◆ Apply splint
◆ Ensure immobilization of the joint inferior
and superior to the injury
◆ Immobilize hands and feet in the position of
function.
◆ Evaluate PMS
 Splinting Guidelines
◆ If a compromise in PMS is found then
loosen the fastening material on the splint
and re-evaluate
 Types Of Splints
◆ Rigid Splints
◆ Pressure Splints
◆ Traction Splint
◆ Improvised splints
 Rigid Splints
◆ Commercially made splints
◆ Examples are the Timmins, Sam, and ladder
splints.
 Traction Splints
◆ Commercially made splints that provide for
a counter-pull against spasmatic muscles to
achieve immobilization of femur fractures.
◆ Examples are the Hare, Sager, and Lots
splints.
 Traction Splints -
Contraindications
◆ The injury is within two inches of the knee
◆ The knee has also been injured
◆ The hip is injured
◆ The pelvis in injured
◆ There is a partial amputation
 Pressure Splints
◆ Splints that utilize air pressure to achieve
immobilization.
◆ Examples are air, vacuum, and PASG.
 Improvised Splints
◆ Light, firm, rigid material that can be used
to effectively immobilize an extremity.
◆ Examples are magazines, wooden planks,
broom handles, pillow, blanket roll, etc..
 Sling and Swathe
◆ Used to immobilize shoulder and upper
extremity injuries.
What do we do for this?
 What are the concerns?
◆ MOI?
◆ Life threatening injuries?
◆ Don’t focus in on gross injuries.
◆ Read your patient.
◆ PMS!!!!!!
◆ How do we splint?
◆ What joints need immobilized?
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