© 2011 National Safety Council 18-1 INJURIES TO MUSCLES AND BONES LESSON 18

© 2011 National Safety Council 18-1

INJURIES TOMUSCLES AND BONES

LESSON 18


Introduction

• Trauma patients often have considerable musculoskeletal injuries

• With significant mechanisms of injury, bones may fracture and joints may be injured

• Injuries may result in pain, disability and life-threatening bleeding


Musculoskeletal System Review

• Bones

• Muscles

• Tendons

• Ligaments


Primary Functions of Musculoskeletal System

• Provide shape and support for body

• Muscles acting on bones allow movement

• Bones protect vital internal organs


Types of Muscles

• Skeletal muscles voluntary

• Smooth muscles involuntary

• Cardiac muscle involuntary

• All muscle activity controlledby nervous system


Mechanisms of Injury to Musculoskeletal System

• Direct force: force applied directly to body

• Indirect force: force transferred from original body site along an extremity to another point

• Twisting forces: part of body forced to move in unnatural direction


Factors Involved in Injuries

• The greater the force:

- The more likely the injury

- Fracture/Joint dislocation severity more likely

• Patient’s age and health status


• Fractures

• Dislocations

• Sprains

• Muscle injuries

Types of Musculoskeletal Injuries

EMRs need not determine type of musculoskeletal injury:


Fractures

• Bone may be completely broken or only cracked

• Closed fracture skin not broken

• Open fracture open wound at site


Dislocations


Dislocations (continued)

• One or more bones at joint displaced from normal position

• Ligaments holding bone are torn

• Result from strong forces

• Sometimes accompanied by bone fractures or other injuries

• Can be very painful


Dislocations (continued)

• Patient cannot use joint due to pain or structural damage

• Serious bleeding may result

• Nearby nerves may be injured

• With severe dislocation, joint or limb will look deformed


Sprains

• Joint injury involving ligament stretching and tearing

• Typically occur when joint is overextended

• Can be mild or severe

• Ankles, knees, wrists, fingers most common

• Considerable swelling often occurs rapidly


Muscle Injuries

• Strains, contusions, cramps

• Usually less serious than fractures and joint injuries

• Many causes


Recognizing Musculoskeletal Injury

• Sometimes injury type is obvious

• Often you will recognize musculoskeletal injury if present

• Emergency care is same regardless of injury type

• Usually not life-threatening

• May be serious and result in pain and disability


Assessment ofMusculoskeletal Injuries

• Perform standard assessment

• Ask patient what happened and what was felt

• If large forces involved, consider potential for spinal injury

• Expose injury site carefully

• Amount of pain and swelling not indicator of injury severity

• Immediate medical treatment if no circulation or possible nerve damage


Assess for Circulation, Sensation and Movement (CSM) Below the Injury Site

1. Check pulse below injury

2. Check skin color and temperature

3. Touch fingers or toes

4. Does patient feel touch, tingling sensation, numbness?

5. Have patient wiggle fingers or toes


Signs and Symptoms of Musculoskeletal Injury


Signs and Symptoms of Musculoskeletal Injury (continued)

• Pain and tenderness

• Abnormal sensation (numbness, tingling)

• Inability to move area

• Joint locked into position

• Impaired function or circulation

• Difference in temperature from opposite extremity


Preventing Movement

• Movement causes injury, pain, swelling

• Bone movement further injures soft tissues

• Movement generally increases blood flow - may increase internal bleeding and swelling

• Manually stabilize or splint injured area


Emergency Care ofMusculoskeletal Injuries

• Perform standard patient care

• Control any life threats

• Allow patient to be in position of comfort

• Cover open wounds with sterile dressing

• Apply cold pack with skin barrier

• Don’t replace protruding bones


Emergency Care of Musculoskeletal Injuries (continued)

• Stabilize injured extremity manually

• Support above and below injury

• If appropriate, splint extremity

• Follow local protocol for oxygen

• With traumatic amputation of a body part, care for amputated part after stabilizing patient


Splinting


Splinting

• Movement may worsen musculoskeletal injury and cause more pain

• Splint injured arm or leg if risk of area being moved (unless help expected quickly)

• Always splint an extremity before patient is transported


Splinting (continued)

• Helps prevent further injury

• Reduces pain

• Minimizes bleeding and swelling


Types of Splints

• Rigid splints

• Soft splints

• Air splints (inflatable splints)

• Pneumatic splints

• Anatomic splints

• Improvised splints


Rigid Splint

• Board

• Plastic or metal

• Rolled newspaper or magazine

• Thick cardboard


Soft Splint

• Pillow

• Folded blanket or towel

• Triangular bandage folded into sling


Anatomic Splint

Bandage injured leg or finger to uninjured one


Commercial Splints


Securing Splints

• Use bandages, strips of cloth, Velcro

• Use knots that can be untied

• Don’t secure with tape to skin


Guidelines for All Splints

• Dress open wounds

• Splint only if it doesn’t cause more pain

• Splint in position found

• Immobilize entire area (joints above and below injury)

• Pad between splint and skin

• Assess CSM before and after splinting

• Put splints on both sides of fracture if possible

• Apply cold pack to injury around splint


Guidelines for Slings

• Use sling to prevent movement and to elevate extremity

• Splint injury first

• If you splint injury in position found and this position makes use of sling difficult do not use sling


Guidelines for Slings (continued)

• Do not move arm into position for sling if it causes pain

• A cold pack can be used inside sling

• Do not cover fingers inside sling


Skill: Applying Arm Sling and Swathe


1. Secure point of bandage at elbow


2. Position triangular bandage


3. Bring lower end of bandage to opposite side of neck


4. Tie the ends


5. Tie swathe bandage over sling and around chest


Shoulder Injuries

• Involve clavicle, scapula or joint structures

• Clavicle is most frequently fractured bone

• Scapula fractures are rare

• Shoulder dislocations are common


Splinting Shoulder Injuries

• Goal is to stabilize area from trunk to upper arm

• Use soft splint; do not move extremity

• Assess for circulation, sensation and movement


Splinting Shoulder Injuries (continued)

• Pad hollow between body and arm

• Apply sling and swathe to support and immobilize arm – if this causes pain use larger pillow


Upper Arm Injuries

• Immobilize humerus fractures with rigid splint

• Treat fractures near shoulder with soft splint


Splinting Upper Arm Injuries

• Stabilize bone between shoulder and elbow

• Assess circulation, sensation, movement in hand and fingers

• Apply rigid splint along outside of arm


Splinting Upper Arm Injuries (continued)

• Tie splint above injury and at elbow

• Support wrist with sling and wide swathe

• If it causes pain to raise wrist for a sling, use long rigid splint


Elbow Injuries

• Sprains and dislocations are common

• Fractures occur above or below elbow

• Patient unable to move joint

© 2011 National Safety Council4818-48

Splinting Elbow Injuries

• If elbow bent, apply rigid splint from upper arm to wrist

• If more support needed, use sling at wrist and swathe around chest


Splinting Elbow Injuries (continued)

• If elbow straight, apply rigid splint from upper arm to hand

• If more support needed, use swathes around chest and upper arm and lower arm and waist


Skill: Splinting a Forearm


1. Support arm and check circulation


2. Position arm on rigid splint


3. Secure splint

4. Put splinted arm in sling and swathe


5. Check circulation


Wrist Injuries

• Sprains

• Fractures


Splinting Wrist Injuries

• Goal is to stabilize from forearm to hand

• Soft splint and sling often sufficient

• Rigid splint provides more support

• Assess circulation, sensation, movement in hand and fingers


Splinting Wrist Injuries (continued)

• Apply rigid splint on palm side of arm from forearm past fingertips

• Tie above and below wrist

• Leave fingers uncovered

• Support forearm and wrist with sling and apply binder around upper arm and chest


Hand Injuries

• May be injured by direct blow

• Fractures occur when patient punches something with closed fist


Splinting Hand Injuries

• Goal is immobilization of hand – use soft or rigid splint

• Place roll of gauze in palm

• Bandage entire hand leave fingers exposed if possible to check CSM

• Place rigid splint on palm side of hand; pad between hand and splint

• Support further with sling and swathe


Finger Injuries

• Fractures and dislocations

• Often a splint is not required

• Use rigid splint or anatomic splint


Splinting Finger Injuries

• Use soft splint if finger cannot be straightened without pain

• Don’t manipulate finger into normal position

• Use rigid splint, secured with tape or anatomic splint by taping finger to adjoining finger with gauze in between


Lower Extremity Injuries

• Larger forces are typically involved – forces may also cause spinal injury

• Assess patient without moving extremity

• Femur fracture can damage femoral artery and cause life-threatening bleeding


Hip and Pelvis Injuries

• Fractures and dislocations

• Hip fracture: fracture of top part of femur

• Fractures more common in elderly due to osteoporosis

• Bleeding and pain may be severe

• Dislocations can occur at any age:

- Falls

- Vehicular crashes

- Blows to body


Splinting Hip and Pelvis Injuries

• Do not move patient

• Immobilize leg and hip in position found

• Pad between legs and bandage together (unless this causes more pain)

• Treat for shock but do not elevate legs


Upper Leg Injuries

• Femur fractures are serious

• Severe pain and shock may occur

• Keep patient from moving

• Rigid splint unnecessary if patient is lying down with leg supported by ground

• Use folded blankets or coats to immobilize leg in position found


Splinting Upper Leg Injuries

• Anatomic splint

• Rigid splints


Splinting Upper Leg Injuries (continued)

• Check circulation and sensation in foot and toes

• Put rigid splint on each side of leg

- Pad body areas and voids

- Inside splint should extend from groin past foot

- Outside splint should extend from armpit past foot


Anatomic Splinting of Leg Injuries

1. Gently slide 4 or 5 bandages under both legs but not over injury

2. Put padding between legs

3. Do not move injured leg

4. Gently slide uninjured leg next to injured leg

5. Tie bandages

6. Check circulation again


Traction Splintfor Femur Fractures

• Traction splint maintains continual pull on femur to keep bone ends in normal position

• EMRs may assist other EMS personnel


Knee Injuries

• Sprains

• Dislocations

• Caused by:

- Sports injuries- Motor vehicle crashes- Falls

• Femur, tibia or fibula fractures are indistinguishable from knee injuries


Splinting Knee Injuries

• Splint in position found

• Apply soft splint by rolling blanket or placing pillow around knee

• If knee straight, make anatomical splint


Splinting Knee Injuries (continued)

• If possible, put rigid splint on both sides of leg

• Pad body areas and voids

• Check circulation and sensation in foot and toes first and periodically after splinting


• If knee is straight, apply 2 splints along both sides of knee

• If knee is bent, splint in position found

• Tie splints with cravats or bandages

Splinting Knee Injuries (continued)


• Commonly caused by:

- Sports

- Motor vehicle crashes

- Falls

• Either or both bones of lower leg can be fractured

Lower Leg Injuries


Lower Leg Injuries (continued)

• Rigid splint applied the same as for knee injury

3-sided cardboard splint can be used


Skill: Splinting the Leg (Anatomic)


1. Check circulation

2. Gently slide 4 to 5 strips of bandages under both legs


3. Pad between legs


4. Gently slide uninjured leg next to injured leg


5. Tie bandages and check circulation


Ankle Injuries

• Sprain may occur when foot is forcefully twisted to one side

• Fractures or dislocations

• Often involve torn ligaments and nerve or blood vessel damage


Splinting Ankle Injuries

• Soft splint usually best

• Gently remove the shoe to assess circulation, sensation, movement in toes

• Tie pillow around foot and lower leg

• For minor ankle injury not requiring splinting, elastic roller bandage may be used for compression


Applying a Figure-8Bandage to the Ankle

• Anchor starting end of bandage

• Turn bandage diagonally across top of foot and around ankle, and bring bandage around in a figure-8

• Continue with overlapping figure-8 turns

• Fasten end of bandage with clips, tape or safety pins


Foot Injuries

• Commonly caused by:

- Direct blows

- Falls

• Involve almost any bone or ligament of foot

• Treat same as ankle injuries

• Toe fractures can be very painful


Splinting Foot Injuries

• Usually no splinting required

• Use pillow splint as for ankle injury if:

Toe is significantly bent

More than 1 toe involved

Foot is very painful


Rib Fractures

• Typically caused by blunt trauma to chest

• More common in lower ribs and along side

• Cause severe pain, discoloration, swelling

• Pain often sharper upon breathing in

• Patient may breathe shallowly and hold or support area


Splinting Rib Injuries

• Goal is primarily supportive

• Have patient sit or stand in position for easy breathing

• Support ribs with pillow or soft padding loosely bandaged over area and under arm

• Immobilize arm with sling and swathe

• Monitor breathing

Documents

© 2011 National Safety Council 18-1 INJURIES TO MUSCLES AND BONES LESSON 18