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Emergency Medical Training Services
Emergency Medical Technician – Paramedic Program Outlines
Outline Topic: Musculoskeletal Injuries
(6 questions on trauma exam from this outline)
Musculoskeletal Trauma
DEFINITIONS
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Anatomic Positioning – Standing erect, arms to side, palms up.
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Open Reduction – use of surgery to place bones.
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Internal Fixation – wires, pins, screws to place bones.
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Crepitus – Bones grinding against each other. Like ribs and CPR.
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Cravats – goes around an extremity.
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Sling – goes around neck to hold up arm.
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Swathe – goes around torso.
SKELETAL SYSTEM
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Approximately 206 bones.
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Provides structure and protection.
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Ligaments support bone to bone.
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Tendons support muscle to bone.
Revised: 11/2013
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Bones have a rich supply of blood, the larger the bone the more bleeding possible.
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The lining of the bone has the nerves (periosteum). This is why a fracture hurts.
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Young children are more flexible, injuries are more of a twisting motion.
Problems associated with musculoskeletal Injuries
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Hemorrhage.
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Instability.
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Loss of tissue.
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Contamination.
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Interruption of blood supply.
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Nerve damage.
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Long term disability.
BONE CLASSIFICATION
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Long bones – humorous, femur.
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Short bones – fingers, toes, wrist.
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Flat bones – sternum, ribs, skull, scapula.
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Irregular or odd shaped bones – vertebrae.
MUSCULAR SYSTEM
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Approximately 600 muscles.
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Support movement of the skeletal system.
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Point of origin – doesn’t move during contraction.
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Point if insertion – the bone that moves during contraction.
MUSCLES CELLS
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Skeletal muscle (voluntary or striated) – found in skeletal movement.
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Involuntary muscle (smooth) – control body organs. Vessels, GI
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Cardiac muscle (heart) – sensitive to O2 levels and has automaticity.
MECHANISM OF INJURY
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Direct force – bat to body.
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Indirect force – a fall and the wrist tries to catch the body.
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Twisting force – football tackle that spins your body but the shoes are planted.
FRACTURE INJURIES
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Open (compound) fracture – skin is open.
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Closed (simple) fracture - skin is closed.
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Unstable – bone moves freely.
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Impacted – jammed together.
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Angulated – major curves.
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Dislocation – frozen joint or locked joint.
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Greenstick - children bones flex like a greenstick.
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Spiral - twists around the bone.
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Transverse - Horizontal fx right across the bone.
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Oblique - Diagonal fx right through the bone.
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Comminuted - splintered into pieces fx.
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Growth plate (epiphyseal plate) fractures in children. Five types. If not treated may result in permanent
angulations or deformity of bone.
OPEN FRACTURES
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Most common open fractures are tibia and fibula.
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Most commonly fractured bone open or closed is the clavicle.
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Do not put back in, unless it goes in on its own.
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Traction splint are specifically designed for femur mid-shaft fx.
CLOSED FRACTURES
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Hemorrhage into soft tissue.
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Since skin is still closed Compartment Syndrome can take place.
DISLOCATION
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Known as a frozen or locked joint.
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Possible nerve, vessel damage.
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50% of dislocated knees and elbows have nerve damage. If knee or elbow try to splint as found.
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Spontaneously reduce or relocated – popped back in.
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Subluxation is the pulling of the joint apart and goes back in.
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Luxation is a complete dislocation.
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Tendon (muscle) pulled.
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Days to weeks to heal.
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Lifting something heavy.
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Ligament damage.
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Can take up to 8 months to heal.
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Twisted an ankle on a sidewalk.
STRAIN
SPRAIN
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“I heard it pop.”
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3 degrees of sprains; 1st = no joint instability. 2nd = swelling and bruising but joint intact. 3rd =
ligaments completely torn.
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Splint, ice for first 24 hours and x-ray.
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Inflammation of bursa (small, fluid filled sac that acts as a cushion at pressure points. Knees, shoulders,
Bursitis
and elbows most common.
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Results from pressure, friction, or slight injury to membranes surrounding joint.
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Care: Rest, ice and pain meds.
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Inflammation of a tendon. Often caused by injury.
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Pain, tenderness, sometimes restriction of movement.
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Nonsteroidal antiinflammatory most common treatment.
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Inflammation of joint. Referred to as joint disease because many factor cause this.
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Pain, swelling, stiffness, and redness.
Tendonitis
Arthritis
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Rheumatoid arthritis - most severe. Autoimmune disorder.
ASSESSMENT – what to look for
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Swelling - indicates inflammation for protection and/or hemorrhage.
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Unusual color – indicates contusion or hematoma. Purple, black, blue.
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Unusual position – angulations, shorter than other side, false movement.
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Feel – Bone ends grinding known as Crepitus.
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Loss of Nerve Supple – PMS problems.
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Loss if Pulses – distal cold and discolored.
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Capillary refill – may be delayed if blood supple is affected.
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Pain – Hurts with motion.
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Pain and Swelling is considered broken until x-ray.
RULES FOR BASIC SPLINTING
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PMS checks before and after.
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Remove clothing in affected area.
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Open wounds dressed and bandaged before splinting.
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Open fractures with open site should use dry-sterile dressings.
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Do not put back in bones that have come out unless they went in on its own.
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Pad the splints.
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No knots on the body to dig into tissue.
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Try to align the injured part into a more protective position if vulnerable. IF NO CREPITUS, MAJOR PAIN,
OR FROZEN JOINT IS OBSERVED.
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Try to keep knees and elbows as found. If not contraindicated try to bring the elbow to a 90 degree
position to the body and use a sling and swathe. If not contraindicated try to leave a little natural flex in
the knee joint while splinting with rigid splints or air splints.
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Ice for first 24 hours minimum to reduce swelling.
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During physical exam look for;
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D-deformity
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C-contusions
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A-abrasion
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P-punctures
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B-burns
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T-tenderness
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L-lacerations
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S-swelling
DCAP-BTLS
HEMORRHAGE COMPLICATION
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After ABC – control major bleeding.
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Follow four steps to control bleeding. Tib/Fib fx bleeds about 500mL, Femur fx bleeds about 1000mL,
Pelvis bleeds about 2000mL - give or take depending on textbook.
Always an unstable pelvis is a priority over a femur on exams.
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If multiple life threatening injuries are present a fracture is not an immediate priority. Place on long back
board if that bad.
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PASG is preferred for tib/fib bleeding control because it splints and provides direct pressure.
PMS COMPLICATION
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If no distal PMS the EMT has one chance to gently align the extremity with gentle traction and splint
when pulse returns. If still no pulse splint as is and transport.
SPLINTS
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Hard – like a board. “Something you would not like across your face.”
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Soft – pillow. “Something you would like across your face.”
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Air (Pneumatic) splints – like PASG but made for body parts.
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Traction – used only on isolated mid shaft femur fractures with no other injury.
Hip/pelvis Fracture splinting
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PASG as splint
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Long back board with padding.
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Leg/hip shorter than the other leg and rotated supports dislocation.