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Refresher 2003
Common Outdoor Injury
Management
Instructors
This PowerPoint was developed to
be used as an instructor- aid for the
2003 OEC Fall Refresher. Please
MODIFY its contents to meet your
patrol’s needs. A mini-presentation
is a good teaching style for this
exercise. Your review should not
take more than 30 minutes –
maximum!
Refresher 2003
Common Outdoor Injury
Management
Common Outdoor Injury
Management
Objectives



Review mechanisms and patterns of
traumatic injury
Illustrate the types of injury that
occur to the skeleton, soft tissue, and
skeletal support structures
Explain the general principles of
wound care and the emergency care
for musculoskeletal injuries
Mechanism of Injury
Mechanism of Injury
Types of Trauma
Mechanism of Injury
Types of Trauma
 Penetrating
Trauma
 Compression (Blunt) Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Nail in Index Finger
Mechanism of Injury
Types of Trauma
 Penetrating
Trauma
 Compression (Blunt) Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Severe Contusion of Foot
Mechanism of Injury
Types of Trauma
 Penetrating
Trauma
 Compression (Blunt) Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Cervical
(C5-C6)
Fracture
Dislocation
Mechanism of Injury
Types of Trauma
 Penetrating
Trauma
 Compression (Blunt) Trauma
 Bending Trauma
Hyperflexion
Hyperextension
Dorsal
Dislocation,
Long Finger
Middle Joint
(PIP Joint)
Mechanism of Injury
Types of Trauma
 Rotational
Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Normal
Tibia
Left
Spiral
Fracture
Tibia
Right
Mechanism of Injury
Types of Trauma
 Rotational
Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Dislocation of Right
Shoulder
Mechanism of Injury
Types of Trauma
 Rotational
Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Train Crush Injury, Leg
Mechanism of Injury
Types of Trauma
 Rotational
Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Deceleration Trauma
Mechanism of Injury
Types of Trauma
 Rotational
Trauma
 Distraction Trauma
 Crush Trauma
 Deceleration Trauma
 Acceleration Trauma
Car struck from behind
“accelerates” passengers,
producing an extension injury
to the neck!
Acceleration Trauma
Mechanism of Injury
Types of Force
Mechanism of Injury
Types of Force
 Direct
Force
 Indirect Force
 Twisting Force
 High Energy Force
Direct
Mid-Shaft Fracture, Femur
Mechanism of Injury
Types of Force
 Direct
Force
 Indirect Force
 Twisting Force
 High Energy Force
Indirect
Posterior Dislocation, Elbow
Mechanism of Injury
Types of Force
 Direct
Force
 Indirect Force
 Twisting Force
 High Energy Force
Twisting
Subtalar Dislocation, Ankle
Mechanism of Injury
Types of Force
 Direct
Force
 Indirect Force
 Twisting Force
 High Energy Force
High Energy
Fractured Pelvis
Types of Injury
Types of Injury
Fracture
•
Any break in the continuity
of a bone
•
May vary from a simple
crack to a completely
shattered bone
Fracture Classification
Closed/Open
Incomplete/Complete
Non-Displaced/Displaced
Closed Fracture,
Base of Thumb
Closed
Dorsally
Angulated
Forearm Fracture
n Fracture, Tibia
Fracture, Forearm
Open Fractures Are More
Serious!
 Blood
 Potential
loss
contamination
with risk of infection
Fracture Classification
Closed/Open
Incomplete/Complete
Displaced/Displaced
Incomplete Fracture,
Distal Radius
Complete Fracture, Femur
Fracture Classification
Closed/Open
Incomplete/Complete
Non-Displaced/Displaced
Non-Displaced Fracture,
Distal Tibia and Fibula
Displaced Forearm Fractures
Other Types of Fracture
Comminuted – fractured into
more than two segments
Pathologic – fracture through
diseased bone
Epiphyseal – fracture passes
through the growth plate
Comminuted Femur
Fracture
Other Types of Fracture
Comminuted – fractured into
more than two segments
Pathologic – fracture through
diseased bone
Epiphyseal – fracture passes
through the growth plate
Pathologic
Lytic lesion (darker = tumor)
in proximal phalanx of finger,
with associated transverse
fracture
Other Types of Fracture
Comminuted – fractured into
many pieces
Pathologic – fracture through
diseased bone
Epiphyseal – fracture through
the growth plate
Epiphyseal (growth-line) Fracture,
Distal Femur
Signs of a Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Seven Signs of Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Fractured Patella
Seven Signs of Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Angulated Fracture,
Radius and Ulna
Seven Signs of Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Crepitus
In a complete fracture, the sounds
of bone ends clicking or rubbing
against each other; denotes an
unstable fracture!
Seven Signs of Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Open Ankle Fracture
Seven Signs of Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
False Motion
The unusual visual sensation of
observing motion at a long bone
fracture site where
“there is no joint!”
Seven Signs of Fracture
 Tenderness
 Swelling
and Ecchymosis
 Deformity
 Crepitus
 Exposed Fragments
 False Motion
 Inability to Use the Limb
Fracture, Right Clavicle
Right Arm Protected
Seven Signs of Fracture
The presence of
any one
of the
seven fracture signs just listed
is sufficient to assess this injury!
Types of Injury
Dislocation


Disruption of a joint such that
the bone ends are no longer in
normal contact
Must have torn ligaments and
joint capsule
Signs of Dislocation
 Tenderness
 Deformity
(usually marked)
 Swelling and Ecchymosis
 Loss of normal joint motion
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Anterior Dislocation, Right
Shoulder
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Dislocation, Middle Joint
(PIP Joint), Ring Finger
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Posterior Hip Dislocation
Common Dislocations
 Shoulder
 Finger
 Hip
 Elbow
Posterior Elbow Dislocation
Types of Injury
Fracture-Dislocation
A combined injury with
joint dislocation and an
adjacent bone fracture
Fracture–Dislocation, Ankle
Types of Injury
Sprain
 Partial
or complete
temporary joint dislocation
 Ligaments are torn
partially or completely
 May produce as much
structural damage as a
dislocation
Sprain, Left Ankle
Types of Injury
Strain
“Muscle Pull”
 Stretching or tearing
of muscle, or muscle
fascia (covering)
 Occurs frequently in
the lower back
secondary to poor
posture and poor
abdominal muscle
control

Assessing
Musculoskeletal Injuries
MOI on Approach
 ABC’s
 Injury History (“What happened?”)
 Palpation of injury site -
“Take one finger and
show me where it hurts!”
DCAP-BTLS
 Deformities
 Contusions
 Abrasions
 Puncture
Wounds
 Burns
 Tenderness
 Lacerations
 Swelling
Evaluation of Distal
Neurovascular Function
(CMS)
 Pulse
(circulation)
 Motor Function
 Sensation
Radial Pulse
Posterior Tibial
Pulse
Evaluation of Distal
Neurovascular Function
(CMS)
 Pulse
(circulation)
 Motor Function
 Sensation
Extension
Ankle Dorsiflexion
Flexion
Ankle Plantar Flexion
Evaluation of Distal
Neurovascular Function
(CMS)
 Pulse
(circulation)
 Motor Function
 Sensation
Medial and
Lateral Hand
Medial Foot
Lateral Foot
Principles of
Musculoskeletal Injury
Management
 ABC’s
 Evaluate
distal neurovascular
function
 Dress all wounds
 Splint all suspected injuries
 Prepare patient for transport
Injury Management
All
open wounds
should be covered with a
dry sterile compression
dressing
Injury Management
Splinting Immobilizes the
Injury and:
 Reduces
Pain
 Facilitates Transport
 Prevents further damage to
blood vessels, nerves and
skin adjacent to the injury
 Decreases Bleeding
Principles of Splinting
Check and record CMS
 Dress all wounds
 Immobilize the joints above and
below a suspected fracture
 With injuries at or near joints,
immobilize the bones above and
below the injury
 Stabilize the injury site during
splint application

Principles of Splinting
Use gentle in-line manual traction to
realign displaced long bone fractures
 Expect to encounter increased pain
and some resistance when
attempting to realign a deformed
limb
 Immobilize all suspected spinal
injuries in a neutral in-line position
on a spineboard

Principles of Splinting

If the patient demonstrates
major signs of shock, align the
limb as close to its normal
anatomic alignment as possible
on a spineboard (immobilization
of total body), and provide rapid
transport
Total Body
Immobilization
When in doubt:
SPLINT!
Rigid Splints
Quick Splint
Cardboard Splint
Ladder Splint
SAM Splint
Soft Splints
Air Splint
Sling and Swathe
Vacuum Splint
Blanket Roll
Traction Splint
When standard splints
are unavailable,
improvisation
is better than doing
nothing!
UPPER
EXTREMITY
All fractures can
be immobilized
by securing the
extremity to the
chest!
LOWER EXTREMITY
All fractures can be immobilized by
securing the injured extremity to
the opposite lower extremity!
The End