Self Explanatory.

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Musculoskeletal
System
& Emergencies

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Functions of the Musculoskeletal
System
 Gives the body shape
 Protects internal organs
 Provides for movement
 Consists of more than 600 muscles

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Anatomy
 Muscles - provide movement &
generate heat.
 Ligaments - connect bone to bone
injury = sprain
 Tendons - connect bone to muscle
injury = strain
 Bones - protection & shape

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The Skeletal System
 Gives form to the body
 Protects vital organs
 Consists of 206 bones
 Acts as a framework for attachment of muscles
 Designed to permit motion of the body

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The Skull

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The Neck

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The Spinal Column

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The Thorax

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The Pelvis

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The Lower Extremity
 Hip
 Thigh
 Knee
 Leg
 Ankle
 Foot

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The Upper Extremity
 Shoulder girdle
 Arm
 Elbow
 Forearm
 Wrist
 Hand

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Joints

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Types of Muscle (1 of 2)
 Skeletal (voluntary) muscle
 Attached to the bones of the body
 Smooth (involuntary) muscle
 Carry out the automatic muscular functions of
the body

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Types of Muscle (2 of 2)
 Cardiac muscle
 Involuntary muscle
 Has own blood supply and electrical system
 Can tolerate interruptions of blood supply for
only very short periods

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Injuries
 Sprain
 Strain
 Dislocation
 Closed fracture
 Open fracture

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Sprains & Strains
 Sprain
 Joint injury with tearing of ligaments
 Strain
 Stretching or tearing of a muscle

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S/S
 Pain
 Edema and Ecchymosis
 Joint instability
 Treatment: - immobilize, ice, & elevate
if possible

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Dislocation
 A disruption of a joint, in which the bone
ends are no longer in contact and the
supporting ligaments are torn

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S/S of a Dislocation
 Marked deformity
 Edema
 Pain
 Tenderness on palpation
 Complete loss of joint function
 Distal numbness
 Treatment - immobilize, ice, elevate if
possible.

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Fractures
 Closed fracture
 does not break the
skin
 Open fracture
 External wound
 Nondisplaced
fracture
 Simple crack
 Displaced fracture
 deformity

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Closed fracture
 Signs & symptoms
 Pain
 Edema
 Possible deformity
 Contusion
 Loss of motion
 false motion
 Crepitus
 Guarding
 Treatment - immobilize, ice, elevate if possible.

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Open fracture
 Signs & symptoms
 Pain
 Deformity
 Break in skin and/or exposed bone
 Treatment - dressing, immobilize, ice, &
elevate if possible

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Old terminology
 Simple & compound

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Types of Fractures
 Green stick
 Spiral
 Transverse
 Comminuted
 Pathologic
 Epiphyseal

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complications of fx
 blood vessel & nerve damage
 Fat embolus
 disability or deformity

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Bleeding (internal)
 Bones have a blood supply!
 Fractures bleed internally -
 Femur - 1 liter
 Pelvis - 1 liter
 Tibia - 500 cc

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Other considerations
 What is beneath fracture site?
 open fracture
 Joint involved?

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Tips & other stuff
 Angulation or angulated extremity
 Depressed skull fracture
 Basilar skull fracture
 Flail Chest

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Hip Injury
 Hip Fracture – classic presentation
 Shortened, externally rotated
 Hip Dislocation
 Usually flexed and internally rotated
 Requires significant force

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TX
 draw-sheet method
 Make NO attempt to straighten leg
 Support with rolled blankets
 Prevent hip movement

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Assessment of injured extremities
 PMSC
 Pulse
 Movement
 Sensation
 Capillary refill
Cold, blue, pulseless extremity has circulation
problem

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ALWAYS CHECK DISTAL
FUNCTION BEFORE &
AFTER SPLINTING !!!!!
AND DOCUMENT WHAT YOU
FOUND !!

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Splinting
 Why we splint...
 relieve pain
 reduce tissue/vessel damage during
movement

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Types of splints
 Self splinting
 Pillows, blankets, & items of clothing
 Sling & swath
 Rigid
 B-splints
 Sam splints
 vacuum
 Traction

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Traction splints
 Closed, mid-shaft femur fracture without
hip, knee, or ankle injury.

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General Principles of
Splinting (1 of 2)
 Remove clothing area
 PMSC (pulse, movement,
sensation, cap refill)
 Dress all wounds
 Do not move the patient before
splinting

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General Principles of
Splinting (2 of 2)
 Immobilize the joints
 Pad rigid splints
 Maintain manual immobilization.
 Realign angulations PRN
 When in doubt, splint
 Reassess PMSC
 Immobilize all suspected spinal injuries in
a neutral in-line position*
*pain, resistance, crepitus

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Hazards of Improper Splinting
 Further damage
 Delay in transport
 Reduction of distal circulation
 Aggravation of the injury
 Injury to tissue, nerves, blood
vessels, or muscle

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Realignment issues
 NEVER REALIGN A JOINT
 NEVER REALIGN A INJURY WITH GOOD
DISTAL FUNCTION
 Only pulseless, longbone fractures

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Basic Realignment Steps
 Have all equipment ready & in place
 Explain procedure to patient
 In 1 move, with gentle traction, align
extremity (goal is anatomical position)
 Use the least amount of force necessary.
 If resistance is met or pain increases, splint in
deformed position.
 Reassess distal function

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Remember
 No matter how bad the fracture our
priorities are the ABC’s

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Questions and
Answers
???