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Chapter 8 Establish the principles for assessing the patient with MSK injuries Establish treatment priorities Identify the importance of MSK injuries in the multiply injured patient How do musculoskeletal injuries impact on the primary survey? What are my prioriries? What are my management principles? C - Circulation External bleeding Occult blood loss: ◦ Long bone fractures ◦ Pelvic fractures The 3 S’s ◦ Stop the bleeding ◦ Splint the extremity ◦ Stabilize the pelvis Prevents further blood loss and injury May restore or maintain perfusion Relieves pain ◦ Important during evaluation ◦ Do not delay Vascular compromise Open fractures Reduce fracture Splint fracture Assess by Doppler if available Obtain consult Consider angiography if available Mechanism of injury ◦ Blunt or penetrating Energy forces involved ◦ Crush or deceleration Associated factors ◦ Injury patterns such as pelvic or diaphragmatic Time of injury ◦ Time from injury to definitive treatment Location of injury ◦ Where injury occurred Apply appropriate splint Cleanse/debride Consider time factor Obtain orthopedic consult Look Feel Listen FOR WHAT? Look ◦ ◦ ◦ ◦ Deformity Pain Tenderness Wound Feel ◦ ◦ ◦ ◦ Crepitus Skin flaps Neuro deficit Pulses Listen Doppler Bruit What X-rays do I need ◦ Any suspected areas ◦ One joint above and below When do I obtain them ◦ When patient is stable Tibia and forearm fractures Vascular and bony injuries Injuries immobilized in tight dressings or casts Severe crush injuries to muscle Burn injuries Pain: out of keeping with injury Paresthesia Pallor Paralysis Pulse loss (late) Tissue pressures > 35 to 45 mmHg Occult fractures Vascular injury Compartment syndrome Minor injuries Antocoagulation Altered sensorium
