Orthopedic Trauma Emergencies 231121.pptx

Orthopedic Trauma Emergencies  Demonstrate knowledge of anatomy and physiology of the Objectiv skeletal system es Demonstrate knowledge, assessment and treatment of common...

Orthopedic Trauma Emergencies  Demonstrate knowledge of anatomy and physiology of the Objectiv skeletal system es Demonstrate knowledge, assessment and treatment of common orthopedic traumatic injuries  Musculoskeletal Anatomy System: Bones-206 bones and Joints Tendons Physiolog Ligaments Muscles y Vessels Nerves Anatomy and Physiolog y- Bones  Anatomy and Physiology - Tendons and Ligaments General BEWARE of the Assessment distracting injury ALWAYS secure ABC’s before moving on to the next step Then complete trauma assessment including: ABCDEFGHI  F- Focused Assessment General Mechanism of injury Assessm Onset ent Duration Blunt or penetrating Precipitating factors Preexisting injuries Associated symptoms Medical problems – seizure disorder? Syncope?  Focused neurovascular evaluation is integral in the General presence of trauma Pain Assessme Pulses Paralysis nt Paresthesia Pallor Polar (temperature) Compartment Syndrome  Pain – seemingly disproportionate to injury Decreased mobility of digits Compartm Paresthesia ent Polar- Cool to the touch, decreased Syndrome- cap refill Signs and Pallor- pale in relation to Symptoms surrounding skin Tenseness of overlying skin! The impacted area will feel tight! Pulses-can be palpable, absent or decreased Compartme nt Syndrome- Fasciotomy Compartment Syndrome Nursing Interventions Notify MD Position limb at level of the heart Assess neurovascular function hourly or more often Emergency Treatment is a Fasciotomy  A contusion is a closed wound in which a ruptured blood vessel has hemorrhaged into the surrounding tissues Contusio ns and Hematomas can form if there is sufficient bleeding Hemato that has been contained mas Swelling, discoloration and tenderness Contusions and Interventions Hematomas Pressure dressing Rest and elevation Cold pack 20 minutes at a time 4 times a day for the first 2-3 days Do not put ice directly on skin!!!!!  Contusions and Hematomas 24-48 hours: area tender and swollen. Ecchymosis may not appear- reddish, blue or purple color 5-7 days: color begins changing on periphery toward center with greenish tint 7-10 days: yellow tint 10-14 days: brown 2-4 weeks: clears  Strains and Sprains Strain Sprain Weakening or When a joint exceeds its overstretching of muscle normal limit and damages at attachment point to ligaments the tendon Hx of popping or snapping Hx of snapping noise sound at time of injury Local pain Pain Point tenderness Swelling Slight muscle spasms  Compression bandage Intermittent elevation of the limb above the heart Interventio level ns & Cold pack (no more than Treatment 15minutes at a time) Light to no weight bearing depending on severity of injury Tendo Quadriceps tear frequent with runners n and Intervention Muscl Incomplete – rest and e intermittent application of ice followed by heat for 24- 48 hours Ruptur Complete – surgery Achilles tendon rupture e Thompson Test Thompson Test Crush Injury Frequent in industrial settings Complications Tissue necrosis Myo-globinuria Acidosis Increased potassium Renal failure Shock  Stabilize the impaling object Impaling Injuries Do not remove immediately, may require surgical removal! Complications Infection Problems with the structures into which the object is impaled Bleeding  Must begin with stabilization of Traumatic Amputation ABCs! High-flow oxygen Large bore PIV x2 Control of bleeding Antibiotics Tetanus Preservation of amputated part Wrap in saline- moistened gauze and place in plastic bag or container Place sealed container on top of ice and water  ABCs Angulation Deformity Fractures- Pain General Regional and point Assessme tenderness Swelling nt Immobility Crepitus Impaired neurovascular status  Considered Open Fractures contaminated Greater potential for shock May be obvious or only involve a puncture wound Immobilization Control hemorrhage Elevation PIV Fluid/blood product replacement Antibiotics Analgesia Anesthesia  Reduces bleeding by reducing the Immobilization volume of muscle compartments Prevent additional soft tissue injury - closed to open fracture Patient comfort Neurovascular status should be assess prior to and after all procedures Splints initially placed in nondisplaced fractures and then changed to circumferential casts after swelling subsides. Immobilization Options- Casting  Immobilize Traction fractures or dislocations displaced by muscle forces that cannot be adequately controlled with simple splints Pelvic fractures Hip dislocations Femur fractures Fixation External fixation is used for the treatment of open fractures in unstable patients who cannot tolerate significant anesthesia times or blood loss – requiring stabilization and urgent vascular repair Pin care – clean with normal saline or half-strength peroxide solution Assess drainage Clavicular Fractures Usually seen in children and adolescents Can be a sports related injury Complications Pneumothorax Hemothorax Brachial Plexus injuries Interventions Cold pack intermittently for 12-24 hours Sling May require surgical pinning  Very uncommon- Scapular Fractures only 1% of all fractures Usually caused by violent direct trauma Interventions: Neurovascular status Compression bandage over scapula Sling Shoulder immobilizer Intermittent cold packs Upper Arm Fractures Children and older adults Can be in association with dislocated shoulder and trauma Complications Radial nerve damage Interventions Surgical closed reduction Sling Cast for midshaft fractures Forearm and Wrist Fractures Include radius and ulna Common across the lifespan Complications Neurovascular compromise Risk for contracture Interventions Splint Sling Closed reduction Pelvic Fracture Significant bone and tissue damage Complications Nerve injury and Artery damage Large volume of blood loss Complications Bladder trauma- do not insert foley catheter if blood is seen at the meatus Genital trauma Ruptured internal organs Sepsis Shock Death Pelvic Wrapping Pre and Post Pelvic Wrap Xray  Common in elderly Hip Fractures secondary to falls In younger patients usually caused by major trauma Complications Hypovolemia Shock Avascular Necrosis Interventions Minimize movement of leg- early application of traction Serial vitals – potential for blood loss Femur Fracture Usually secondary to major trauma Severe muscle spasms can cause limb to shorten Can be caused by GSW to thigh Complications Hypovolemic shock Further soft tissue damage from moving bone fragments Neurovascular compromise  All age groups Tibial/Fibular Fractures Complications Blood loss up to 2L Infection Soft-tissue damage Neurovascular Compromise Compartment Syndrome Interventions Should be splinted as found – only reduce in case of neurovascular compromise Ankle and Foot Occur in multiple injury patterns Fractures Can be open or closed fractures Complications - Neurovascular compromise, bleeding Interventions Reduction Closed Open with pinning Cast Progress to walking cast then splint Fat Embolism Syndrome Occurs in patients with multiple injuries – particularly orthopedic injuries Life threatening complication of fracture Signs can occur hours to days after injury Long bone and pelvic fractures Signs/symptoms Respiratory distress Altered mental status Skin Petechiae Chest pain Tachypnea Treatment Supportive Corticosteroids Early fixation can reduce incidence Dislocation s Occurs when joint exceeds its normal range of motion Partial (subluxation) Complete Soft tissue injuries can occur Complications Ischemia Aseptic necrosis Recurrent dislocations Assess neurovascular status! Dislocation s Intervention Splint joint as found Reduction after administration of analgesia/sedati on Immobilization after reduction  Shoulder Dislocations Elbow Radial head subluxation (nursemaid’s elbow) Does not require immobilization after reduction Wrist Hand/Finger Foot Toe –reduce immediately to avoid swelling Patellar – can spontaneously reduce  Hip Dislocation Dislocations Can be externally or internally rotated and shortened Complication Necrosis of femoral head if not relocated within 4-6 hours Artery and nerve damage Intervention Reduction! Bed rest with traction after relocation  Knee Dislocations Usually caused by severe trauma Complications Neurovascular compromise – high incidence of popliteal artery injury Nerve damage Interventions Splint in position of comfort Reduction Admission for elevation of knee with intermittent cold packs Cast placement  Ankle Dislocations Commonly associated with a fracture Complications Neurovascu lar compromis e Interventions Splint in position of comfort and apply ice pack Relocation