EMT CH 31

form, upright posture, movement, protects vital organs
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Terms in this set (152)
form, upright posture, movement, protects vital organs
the musculoskeletal system provides
Skeletal muscle (voluntary muscle)
attaches to the bones and usually crosses at least one joint (most abundant portion of body's muscle mass)
arteries, veins, nerves
all skeletal muscles are supplied with
tendons
skeletal muscle tissue is directly attached to the bone by
tendon
extension of the fascia that covers all skeletal muscle
smooth muscle
performs much of the anatomic work of the body, contracts and relaxes to control the movement of the contents within tubular structures
cardiac muscle
specially adapted involuntary muscle with its own regulatory system
bone marrow
the skeleton produces blood cells in
206
approximate number of bones in the skeletal system
protect the brain
function of the skull
heart, lungs, great vesselsthoracic cage protects thetwo scapulae and two claviclesthe pectoral girdle consists ofshoulder to the fingertips (composed of upper arm)upper extremity extends from thecarpals, metacarpals, phalangesbones of the handpelvissupports the body weight and protects structures within the pelvis ( bladder, rectum, female reproductive organs)thigh, leg, and footthe lower extremity consists ofto which the muscles and tendons are attachedthe bones of the skeleton provide a frameworkjointformed wherever two bones come togethertough fibrous capsulejoints are held together in asynovial fluidjoints are lubricated byallow motionfunction of jointssignificant forcegenerally required to cause fractures and dislocationsfracturea break in the continuity of a boneclosed/openfractures are classified as eitheropen fracturetreat any injury that breaks the skin as athe bone has been moved from a normal positionfractures are described by whethernondisplaced fractureA simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.displaced fractureproduce new and abnormal bone arrangementscommunited fracturebreak of bone into more than 2 fragmentsepiphyseala break at the location of the growth plate, which can affect growth of the bonegreenstick fracturebending and incomplete break of a bone; most often seen in childrenincomplete fracturebone is not broken all the way throughoblique fractureoccurs at an angle across the bonepathologic fractureoccurs when a weakened bone breaks under normal strainspiral fractureragged break occurs when excessive twisting forces are applied to a bonetransverse fractureoccurs straight across the bonesigns/symptoms of fracture- pain - deformity - decreased ability to move - swelling - hearing or feeling a snap -bruising -crepitus -false motion -exposed fragments -locked jointDislocationdisplacement of a bone from its jointa serious problema dislocation that does not reduce issigns/symptoms of dislocationdeformity, swelling, pain and tenderness that is aggravated by attempt at movement, loss of function numbness/impaired circulationsprainoccurs when a joint is twisted or stretched beyond its normal range of motionsigns/symptoms of sprainsguarding swelling + ecchymosis pain instability of the jointstrainstretching or tearing of muscle or tendonlikelihood of having a complication ( from orthopedic injury) is directly related to-strength of force causing injury -injury location -pt's overall healthpreventing contamination of an open fracture-brush away debris on the skin -do not enter/probe the fracture sitereducing the risk/duration of long term disability (from orthopedic injury)-prevent further injury -reduce risk of wound infection -minimize pain with use of cold and analgesia -transportation to an appropriate medical facilitygolden hourthe critical time between when an injury occurs and definitive care is initiatedcritical emergencyany suspected open fracture/vascular injury is aDCAP-BTLSdeformities, contusions, abrasions, punctures, burns, tenderness, lacerations, swellingDCAP-BTLSuse _____________ to assess the musculoskeletal systemsplintA flexible or rigid appliance used to protect and maintain the position of an injured extremity.moving the patient, unless immediate dangersplint all fractures, dislocations, and sprains beforesplintingReduces pain Prevents further damage to muscles, nerves, and blood vessels Prevents closed fracture from becoming open fracture Reduces bleeding and swellinggeneral principles of splinting-remove clothing from the area -note and record the pt's neurovascular status -cover open wounds with dry, sterile dressing -do not move the pt before splinting, unless there is danger -stabilize the joints -pad all rigid splints -maintain manual stabilization -if you encounter resistance, splint the limb in its deformed position -when in doubt, splintrigid splints are applied to thesides, front, and/or back of an injured extremityrigid splints prevent motion atthe site of injuryhow many emts do rigid splints take to apply2the two situations in which you must splint the limb in a position of deformity-when deformity is severe -when you encounter resistance or extreme pain when applying gentle traction to the fracture of a shaft of a long boneformable splints-comfortable -provides uniform contact -applies firm pressure to a bleeding wound -used to stabilize injuries below the elbow or kneedrawbacks of formable splints-zipper can stick/freeze -significant changes in the weather or altitude can affect pressure of the splintexamples of formable splints-vacuum splints -pillow splints -structural aluminum malleable (SAM) -sling and swathe -pelvic bindertractionthe act of pulling on a body structure in the direction of its normal alignmentTraction splints are used primarily to secure fractures of thefemurgoals of in line traction-stabilize the fracture fragments -align the limb sufficiently -avoid potential neurovascular compromisedo not use a traction splint for any of these conditions-injuries of the upper extremity -injuries close to/involving the knee -injuries of the pelvis -partial amputations/ avulsions with bone separation -lower foot, leg, ankle injurypelvic binderused to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption and painhazards of improper splinting-compression of nerves, tissues, and blood vessels -delay in transport of a pt with a life threatening injury -reduction of distal circulation -aggravation of injury -injury to the tissue, nerves, blood vessels, musclesvery few musculoskeletal injuries justify the use of ________ __________ during transportexcessive speedpts with a pulseless limb in regards to an orthopaedic injury should be given a _________ transport priorityhigherIf the treatment facility is more than __________ away transport by helicopter or immediate ground transport (orthopaedic injuries)an hourfractures of the clavicle-pt will report pain in the shoulder and hold the arm across the front of the body -swelling and point tenderness occur over the clavicle -occur commonly in childrenfractures of the scapula are almost always the result ofa forceful, direct blow to the backthe____________ __________ __________ pose the greatest threat to long term disability in regard to fractures of the scapulaassociated chest injuriesJoint frequently separated during sportsacromioclavicular jointthe humeral head most commonly dislocatesanteriorlyStabilization of shoulder dislocations may be difficult becauseany attempt to bring the arm toward the chest wall produces painSplint the joint (shoulder dislocation) inwhatever position is more comfortable for the ptfractures of the humerus occureither proximally, in the midshaft, or distally at the elbowin a fracture of the humerus consider applying ___________ to realign the fracture fragments before splintingtractionsplint the arm with a _________ __________ __________ in a fracture of the humerussling and swatheFracture of the distal humerus- Common in children - Fragments rotate significantly, producing deformity and causing injuries to nearby vessels and nerves - Swelling occurs rapidly and is often severedislocation of the elbow-typically occurs in athletes -ulna and radius are most often displaced posteriorlyelbow joint sprain-often mistakenly applied to an occult non displaced fracturefracture of the olecranon process of the ulna-can result from direct/indirect forces -often associated with lacerations/abrasions -pt will be unable to extend the elbowfractures of the radial head-often missed during diagnosis -generally occurs as a result of a fall on an outstretched arm/a direct blow to the lateral aspects of the elbow -attempts to rotate the elbow/wrist cause discomfortcare of elbow injuries-always assess distal neurovascular status functions periodically -provide prompt transport for all pts with impaired distal circulationall ___________ injuries are potentially serious and require careful managementelbowIn fractures of the forearm, usually the __________ and __________ break at the same timeradius, ulnacolles fracturesfractures of the distal radiusin injuries of the wrist and hand dislocations are usually associated witha fractureisolated nondisplaced fracture of a ________ bone is common (wrist and hand injury)carpalany questionable wrist injury should besplinted and evaluated in the EDFractures of the pelvis often result fromdirect compression in the form of a heavy blow ( can be caused by indirect forces, not all pelvis fractures result from trauma)Pelvis fractures may be accompanied bylife threatening loss of bloodsuspect a fracture of the pelvis in any patient whohas sustained a high velocity injury and complains of discomfort in the lower back/abdomeninjury to the bladder or to the urethra may causelower abdominal tenderness and evidence of hematuria or bloodthe hip dislocates usually only aftersignificant injurymost dislocations of the hip areposteriorsuspect a dislocation of the hip in any pt whohas been in an automobile crash and has a contusion, laceration, or obvious fracture in the knee regionposterior dislocation is frequently complicated by injuries to thesciatic nervedistinctive signs of hip dislocation-severe pain in the hip -strong resistance to movement of the joint -tenderness on palpationDo not attempt to _________ the hip dislocation in the fieldreducefield treatment for hip dislocation-splint the dislocation -place the pt supine on a backboard -support the affected limb with pillows -secure the entire limb to the backboard with long straps -prompt transportFractures of the proximal femur are the especially common inolder pts, pts with osteoporosisin a fracture of the proximal femur the break goes (3 ways)-through the neck of the femur -the interochanteric region -across the proximal shaft of the femurpts with a fracture of the proximal femur displaycharacteristic deformity -lie with the leg externally rotated, and injured limb is usually shorter than the opposite uninjured limbIn factures of the proximal femur, assess the pelvis for any __________ ____________ ____________ and bandage appropriatelysoft tissue injurytreatment for fractures of the proximal femursplint lower extremity and transport to the EDfemoral shaft fractures can occur inany part of the shaft from the hip region to the femoral condyles, just above the knee jointin femoral shaft fractures large muscles of the thighspasm in an attempt to "splint" the extremityfemoral shaft fractures produce-significant deformity -shortened limb -significant blood lossin femoral shaft fractures bone fragments maypenetrate or press on important nerves and vesselsit is important to carefully and periodically assess ____________ ____________________ ____________ in femoral shaft fracturesdistal neurovascular functioncover any wound withdry, sterile dressingfemoral shaft fractures are best stabilized using atraction splintwith ligament injuries you will generally find-swelling -occasional ecchymosis -point tenderness on injury site -joint effusion______________ all suspected knee ligament injuriessplintdislocations of the knee aretrue emergencies that may threaten the limbin dislocations of the knee the ligaments may bedamaged/torndirection of dislocation refers to the (knee dislocation)position of the tibia with respect to the femur -posterior dislocations -medial dislocationscomplications of dislocation of the knee include-limb threatening popliteal artery disruption -injuries to the nerves -joint instabilityif adequate distal pulses are present, (knee dislocation)splint the knee and transport to the EDfractures about the knee may occur (3 ways)-at the distal end of the femur -at the proximal end of the tibia -in the patellaif there is an adequate distal pulse and no significant deformity (knees)splint the limb with the knee straightif the pulse is absent below the level of injury (knee)contact medical controlnever use a _______________ ____________ on a knee injurytraction splintdislocation of the patella most commonly occurs inteenagers and young adults in athletic activitiesusually the dislocated patella displays to thelateral side and produces significant deformityfor dislocations of the patella, splint the knee in the positionyou find it infracture of the tibia/fibula may occur in any place between theknee joint and ankle joint (often bones fracture at the same time)stabilize injuries to the tibia/fibula with apadded, rigid long leg splint or an air splintin injuries to the tibia/fibula correct severe deformity withgentle longitudinal tractionany ankle injury that produces pain, swelling, localized tenderness, or the inability to bear weight must be evaluated bya physicianmanagement of ankle injuries-dress all open wounds -assess distal neurovascular function -correct any obvious deformity by applying traction -before releasing traction, apply a splintin foot injuries, frequently the force of the injury is transmittedup the legs to the spineif you suspect a foot dislocation assess for pulses andmotor and sensory functioninjuries of the foot are associated with significant swelling but rarelygross deformityto splint the footapply a rigid padded board splint, an air splint, or a pillow splint and leave the toes exposedthe general treatment of strains and sprains is similar to that offracturesrices mnemonicrest ice compression elevation splintingwith amputations, make sure to immobilize the part withbulky compression dressingsdo not ________________ any partially amputated partseverwith amputations, a priority should becontrolling external bleedingif bleeding is severe apply atourniquetwith a complete amputation, do this with the amputated partwrap the clean part in a sterile dressing and place it in a plastic bag. Put the bag in a container filled with icethe goal is to keep the amputated part ____________ without allowing _____________ or development of __________cool/freezing/frostbitecompartment syndrome most often occurs with a ____________ fracture or the ___________ of childrentibia/forearmcompartment syndrome usually develops within _______________ after injury6-12 hourscompartment syndrome develops as a result of-excessive bleeding -severely crushed extremity -rapid return of blood to an ischemic limbcompartment syndrome is characterized by-pain that is out of proportion to the injury -pain on passive stretching of muscles within the compartment -pallor -decreased sensation -decreased powerif you have a pediatric pt with a fracture below the elbow/knee, be on the lookout for these signs and symptoms-extreme pain -decreased pain sensation -pain on stretching of the muscles affected -decreased powerif you suspect a pt has compartment syndrome-splint the affected limbs, keeping at the level of the heart -transport immediately -reassess neurovascular status frequently during transport