4. TRAUMA EMERGENCIES
4.4 MUSCULOSKELETAL INJURIES
Musculoskeletal injuries can occur from both blunt and penetrating trauma. Injuries may include contusions, cramps, dislocations, fractures, spasm, sprains, strains and subluxations. Early proper treatment of these injuries may prevent long term morbidity and disability. Major injuries to the musculoskeletal system ( e.g., pelvic fractures and hip dislocations) may cause shock due to hemorrhage, injury to adjacent nerves and blood vessels and infection due to the presence of an open fracture. Fractures of the humerus, pelvis or femur take priority over other musculoskeletal injuries as do fractures or dislocations involving circulatory or neurologic deficits.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer oxygen by nasal cannula or mask as determined by patient's condition.
4. Determine patient's hemodynamic stability and symptoms. If indicated, continually assess Level of Consciousness, ABCs and Vital Signs.
5. Assess the neurovascular status (motor, sensory and circulation) distal to the injury before and after proper immobilization.
6. If no palpable, distal pulse apply gentle traction along the axis of the extremity distal to the injury until the distal pulse is palpable and immobilize in place. Note: This does not apply to dislocations.
7. Immobilize fractures and/or dislocations involving joints in the position found. Joints adjacent to each end of the injured bone must be fully immobilized as well as supporting and immobilizing the injured bone.
8. Immobilize all fractures not involving joints. Bones must be fully immobilized as well as supporting and immobilizing the adjacent joint(s).
9. All jewelry should be removed from an injured extremity.
10. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse or Trauma.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated.
3. Administer oxygen by nasal cannula or mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Assess the neurovascular status (motor, sensory and circulation) distal to the injury before and after proper immobilization.
6. If no palpable, distal pulse apply gentle traction along the axis of the extremity distal to the injury until the distal pulse is palpable and immobilize in place. Note: This does not apply to dislocations.
7. Immobilize fractures and/or dislocations involving joints in the position found. Joints adjacent to each end of the injured bone must be fully immobilized as well as supporting and immobilizing the injured bone.
8. Immobilize all fractures not involving joints. Bones must be fully immobilized as well as supporting and immobilizing the adjacent joint(s).
9. All jewelry should be removed from an injured extremity.
10. For hemodynamically unstable patients with suspected pelvic fracture(s), contact MEDICAL CONTROL for potential utilization of PASG/MAST.
11. Activate ALS intercept, if deemed necessary and if available.
12. Initiate transport as soon as possible with or without ALS.
13. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated.
3. Administer oxygen by nasal cannula or mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Assess the neurovascular status (motor, sensory and circulation) distal to the injury before and after proper immobilization.
6. If no palpable, distal pulse apply gentle traction along the axis of the extremity distal to the injury until the distal pulse is palpable and immobilize in place. Note: This does not apply to dislocations.
7. Immobilize fractures and/or dislocations involving joints in the position found. Joints adjacent to each end of the injured bone must be fully immobilized as well as supporting and immobilizing the injured bone.
8. Immobilize all fractures not involving joints. Bones must be fully immobilized as well as supporting and immobilizing the adjacent joint(s).
9. All jewelry should be removed from an injured extremity.
10. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline while in transport. (if indicated).
11. Contact MEDICAL CONTROL. Medical Control may order:
a. administration of additional fluid
b. application/inflation of PASG/MAST.
12. Activate Paramedic intercept, if deemed necessary and if available.
13. Initiate transport as soon as possible with or without Paramedics.
14. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization. Airway may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated.
3. Administer oxygen by nasal cannula or mask as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.)
5. Assess the neurovascular status (motor, sensory and circulation) distal to the injury before and after proper immobilization.
6. If no palpable, distal pulse apply gentle traction along the axis of the extremity distal to the injury until the distal pulse is palpable and immobilize in place. Note: This does not apply to dislocations.
7. Immobilize fractures and/or dislocations involving joints in the position found. Joints adjacent to each end of the injured bone must be fully immobilized as well as supporting and immobilizing the injured bone.
8. Immobilize all fractures not involving joints. Bones must be fully immobilized as well as supporting and immobilizing the adjacent joint(s).
9. All jewelry should be removed from an injured extremity.
10. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline, titrate IV infusion rate to patient's hemodynamic status.
c. Application/inflation of PASG/MAST (if indicated)
11. MEDICAL CONTROL may order:
a. Administration of additional IV Normal Saline.
b. Morphine Sulfate 2-5 mg IV Push for pain control related to an isolated long bone injury. May be repeated at discretion of Medical Control. Contraindicated in multisystems trauma.
12. Initiate transport as soon as possible.
13. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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