L3 Musculoskeletal Injuries V3 May 2022 PDF

Support the management of trauma in the Emergency and Urgent Care Setting Component 8 Musculoskeletal Injuries  Musculoskeletal Injuries – Component 8 OBJECTIVE Understand signs and symptoms, complications and treatment for Musculoskeletal...

Support the management of trauma in the Emergency and Urgent Care Setting Component 8 Musculoskeletal Injuries  Musculoskeletal Injuries – Component 8 OBJECTIVE Understand signs and symptoms, complications and treatment for Musculoskeletal injuries. Explain interventions that may be required Describe time critical injuries and when action should be taken.  Musculoskeletal Injuries – Component 8 Injuries involving the musculoskeletal (M/S) system are very common and include injuries from sprains to fractures. Patients with injuries to the musculoskeletal system are likely to be distressed and in pain, therefore consider, when clinically possible, early pain management. © Department of Clinical Education & Standards 3  Musculoskeletal Injuries – Component 8 Mechanism of injury (MOI) It is Important that you determine the exact mechanism of injury. A good way to do this is to produce a mental image of the DIRECTION, MAGNITUDE and DURATION OF FORCE that was applied to the injured limb or joint. Evidence says that a good review of the MOI can help to predict injury patterns. © Department of Clinical Education & Standards 4  Musculoskeletal Injuries – Component 8 Direct force A bone breaks at the point of impact when the force is too great for the soft tissues to absorb and dissipate it © Department of Clinical Education & Standards 5  Musculoskeletal Injuries – Component 8 Indirect force A force applied to a region of the body is transmitted through the skeleton until it reaches the structurally weakest point causing a bone or bones to # © Department of Clinical Education & Standards 6  Musculoskeletal Injuries – Component 8 REMEMBER Do NOT be distracted from assessing less visible but life threatening problems, however dramatic the M/S injuries are in appearance. For example: Airway obstruction Compromised breathing Spinal injury Remember your C A c B C’s © Department of Clinical Education & Standards 7  Musculoskeletal Injuries – Component 8 Musculoskeletal injuries Amputations / Partial Amputations Fractures (#) Dislocations Strains Sprains © Department of Clinical Education & Standards 8  Musculoskeletal Injuries – Component 8 Amputations, partial amputations and de-gloving Re-implantation following amputation or reconstruction following partial amputation MAY be possible, as long as the amputated parts are maintained and transported in the best condition possible : The Amputated Body Part Remove any gross contamination Cover the part(s) with a moist field dressing Secure in a sealed plastic bag Place the bag on ice – DO NOT place body parts in direct contact with the ice as this can cause tissue damage, the aim is to keep the temperature low and not freezing © Department of Clinical Education & Standards 9  Musculoskeletal Injuries – Component 8 Amputations, partial amputations and de-gloving The Patient DO NOT irrigate grossly contaminated wounds with saline Immobilise a partially amputated limb in a position of normal anatomical alignment Where possible dress the injured limb to prevent further contamination Apply a saline soaked dressing covered with a occlusive layer Pain management, if required – Entonox or ask a senior clinician for advanced pain management. © Department of Clinical Education & Standards 10  Musculoskeletal Injuries – Component 8 Fracture : A break or breaks in the bone… or where The level of kinetic energy is great enough to create a deformation of a bone or bones. © Department of Clinical Education & Standards 11  Musculoskeletal Injuries – Component 8 Signs and symptoms Pain Swelling Erythema (redness) Deformity Are all associated with injuries to the M/S system and can usually be easily identifiable. © Department of Clinical Education & Standards 12  Musculoskeletal Injuries – Component 8 Types of Fractures There are 2 main types of fracture. These are open and closed. © Department of Clinical Education & Standards 13 Musculoskeletal Injuries – Component 8 Closed # Sometimes called a simple fracture. A fracture where no puncturing of the skin has occurred. © Department of Clinical Education & Standards 14  Musculoskeletal Injuries – Component 8 Compound # (Open) A fracture with an wound at the site of injury, caused by bone pushing through the skin. © Department of Clinical Education & Standards 15  Musculoskeletal Injuries – Component 8 Pathological Fractures In older people injuries can occur from relatively minor trauma (e.g. falls from standing height can lead to femoral fracture.) Accompanying illnesses such as cancer that involve bones (breast , lung and prostate) or osteoporosis, may result in fractures from minor injuries. © Department of Clinical Education & Standards 16  Musculoskeletal Injuries – Component 8 Dislocations The abnormal separation of joint surfaces. May occur in isolation or be associated with a fracture. The muscles involved then spasm causing the joint to lock. © Department of Clinical Education & Standards 17  Musculoskeletal Injuries – Component 8 Sprains and Strains Defined as damaged to the “soft tissues, ligaments and tendons around a joint without penetrating the joint capsule.” © Department of Clinical Education & Standards 18  Musculoskeletal Injuries – Component 8 Sprain Sprains are ligamental injuries that involve a partial or complete tear of a ligament. © Department of Clinical Education & Standards 19  Musculoskeletal Injuries – Component 8 A sprain in the pre hospital setting is difficult to differentiate from a fracture, therefore ASSUME there is a fracture and immobilise accordingly. © Department of Clinical Education & Standards 20  Musculoskeletal Injuries – Component 8 Strain A strain (or 'pull') is a stretch and/or tear of muscle fibers and/or tendon. © Department of Clinical Education & Standards 21  Musculoskeletal Injuries – Component 8 Management Assess ABCDE Are there any TIME CRITICAL FEATURES Correct C ABC If TIME CRITICAL refer to MAJOR TRUAMA TOOL and transfer to major trauma centre ( continue patient management on route ) Ascertain MOI Assess limbs for Motor Sensory Circulation MSC Remove jewellery or constrictive clothing Consider pain management Examination of Injury – Look/Feel/Move Immobilise fractures/Apply splintage For strains and sprains consider a cold compress and limb elevation. JRCALC PLUS – Guidelines – Limb Trauma © Department of Clinical Education & Standards 22  Musculoskeletal Injuries – Component 8 Basic principles of limb immobilisation: Assessment and reassessment of the neurovascular status before and after any manipulation or handling of the fracture using MSC - Motor: Ask the patient to move the limb. - Sensory: Apply light touch to evaluate sensation. - Circulation: Assess a distal pulse and skin temperature - Immobilisation of the joints above and below the fracture. © Department of Clinical Education & Standards 23 Musculoskeletal Injuries – Component 8 The six ‘P’s of ischaemia Sign Symptom Pain Out of proportion to the injury not eased by splinting or pain relief Pallor Compromised blood flow to limb Paralysis Loss of movement Paraesthesia Changes in sensation Pulselessness Loss of peripheral pulses which can lead to complete occlusion of circulation Perishing cold Limb is cold to touch © Department of Clinical Education & Standards 24  Musculoskeletal Injuries – Component 8 Splinting Reduces: Pain Haemorrhage and damage to blood vessels and nerves Further damage from bone fragments Provides support Risk of fat embolism Pressure on skin and adjacent neurovascular structures Muscle spasms © Department of Clinical Education & Standards 25  Musculoskeletal Injuries – Component 8 Injury Splintage type # Neck of Femur(NOF) Padding between legs. Figure of eight around ankles. Broad bandage 2 above 2 below knee # Shaft of Femur Kendrick Traction splint. Not be used if # to ankle,tibia,fibula, knee on the same side as femoral #,NOF # or # Dislocation Long Leg Box splint around the knee Vacuum splint Patella Dislocation Vacuum splint Long leg Box splint. Sometimes when splinting the leg the patella spontaneously relocates © Department of Clinical Education & Standards 26  Musculoskeletal Injuries – Component 8 Injury Splintage type Tibia/Fibula shaft # Long leg box splint Long leg vacuum splint Ankle # Short leg box splint Short leg vacuum splint Foot #’s Short box splint Short vacuum splint Clavicle Self splintage Humerus Triangular sling Radius Vacuum splint for forearm # Ulna Short box splint © Department of Clinical Education & Standards 27 Musculoskeletal Injuries – Component 8 The traction splint should be applied quickly if it does not delay transfer, otherwise apply manual traction, once applied this should not be released. © Department of Clinical Education & Standards 28  Musculoskeletal Injuries – Component 8 Mid shaft femoral fractures (#) are Time Critical as blood loss can be considerable (500- 2000mls) more if an open # 1000mls plus can be lost from a pelvic # © Department of Clinical Education & Standards 29  Musculoskeletal Injuries – Component 8 Complications of musculoskeletal injuries Bleeding Damage to blood vessels , nerves , muscles and arteries Infection Loss of tissue Long term disability Compartment syndrome © Department of Clinical Education & Standards 30  Musculoskeletal Injuries – Component 8 Summary Patients with musculoskeletal injuries/limb trauma may be in considerable pain and distress Splinting will contribute to “circulation” care by reducing further blood loss and pain, while on route to hospital Do not be distracted from assessing less visible but life threatening problems when dealing with a Musculoskeletal injuries Consider the need to request the appropriate clinician with regard to TIME CRITICAL Injuries and PAIN management. © Department of Clinical Education & Standards 31 Musculoskeletal Injuries – Component 8 Any Questions? © Department of Clinical Education & Standards 32