Archive for February 2009



MUSCULOSKELETAL INJURIES

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Fractures - any break in the continuity of a bone. It can be open or closed fracture.

Closed injury - one in which the overlying skin is intact. Proper splinting helps prevent closed injury fracture from becoming an open fracture.

Open injury - one in which the skinhas been broken or torn either from the
inside by the injured bone or from the outside by the object that caused the penetrating wound with the associated bone injury.

Dislocation - injury in which a bone is move out of its normal position in a joint and remains that way.

Sprain - injury in which ligaments (bone to bone) are stretched or partially torn, commonly associated with joint injuries.

Strain-injury in which a muscle or a muscle and tendon (bone to bone) are over extended.


Signs and Symptoms of a Muscle Injury
1. Deformities or angulation: compare with opposite limb
2. Pain and tenderness upon palpation or movement
3. Crepitus (grating)- a sound or feeling of broken bone ends rubbing together
4. Swelling
5. Bruising or discoloration
6. Exposed bone ends
7. Joint locked in position- reduced motor ability or reduced ability to articulate joint.
8. Numbness and paralysis- may occur distal to side of injury caused by bone pressing on anerve.
9. Circulatory compromise distal to injury evidenced by alteration in skin color, temperature, pulse or capillary refill.
Splinting - applying a device to stabilize any painful, swollen,or deformed body part.

Reasons for splinting includes:

1. To prevent motion of bone fragments or dislocated joints
2. To reduce pain and suffering
3. To minimize damage to the soft tissue
4. To prevent closed fracture from becoming an open fracture
5. To minimize blood loss or shock


Six basic type of Splinting






Six basic types of splints

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1. rigid splint
3. traction splint
4. sling & swathe
5. improvise splint
6. anatomical splint

 General rules for splinting:

1. Always communicate your plans with your patient, if possible ask permission.

2. Before immobilizing an injured extremity expose and control bleeding.

3. Always cut away clothing around the injury site before immobilizingthe joint.Remove all jewellery from the site and below it.

4. Assess pulse, motor function and sensation (PMS).

5. If limb is severely deformed or distal circulation is compromised (cyanosis) Distal to fracture site or no distal pulse, align the bone with gentle tractioning (pulling). If pain or creptus worsen, discontinue. Always follow local protocol.

6. Do not attempt to push protruding bone end back intoplace. However, when realigning may slip back into place. Make a note if this occurs.

7. For patient's comfort and proper immobilization, pad voids between the body and the splint, since many rigid splints do not conform to body curves.

8. Pad the splint before applying it.

9. If a joint is injured, immobilize it and the bones above and below.

10. Splint as you found it.


 
 



Soft Tissue Injuries

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Other Injuries: Musculoskeletal Injuries


Soft Tissue Injuries - commonly referred to as wounds, are injuries to the skin, muscles, nerves, and bloods vessel.

Close wounds - injury to the soft tissue beneath unbroken skin.

Pre - hospital treatment for Closed Wounds:
Used universal precaution, active EMS and secure the scene.





1. Apply "RICE" method: Rest, Ice, Compress and Elevate.
2. Monitor the patient for any rapid change in vital signs that might indicate
internal bleeding, which should be treated by a physician.
3. Treat for shock
4. Transport the patient as soon as possible.

To recognize Closed Wounds are the following:

1. swelling
2. tenderness
3. discoloration
4. possible deformity

Open wounds - a soft tissue injury resulting in breaking of the skin.

Pre - hospital treatment for Open Wounds:

Used universal precautions, active EMS and secure the secene.
1. Expose the wound. Remove all clothing and expose soft tissue. Avoid removing clothing by pulling it over the
patient's head. Best method is to remove clothing by cutting with trauma scissors.
2. Control bleeding. Begin with direct pressure or indirect pressure and elevation. If wound continues to bleed use a
pressure point. Use a tourniquet only as a last result.
3. Prevent contsamination. Remove debris and contamination around the surface of the wound. Do not try to remove
embedded particles.
4. Dress and bandage.
5. Cover the paient.
6. Treat for shock.
7.Transport the patient as soon as possible.