EMR ch20

Copyright ©2012 by Pearson Education, Inc.All rights reserved.

Emergency Care, Twelfth EditionDaniel J. Limmer • O’Keefe • Grant • Murray • Bergeron • Dickinson

Emergency Medical Responder: First on Scene, Ninth EditionLe Baudour • Bergeron • Wesley

CHAPTERCHAPTER

Caring for Muscle and Bone InjuriesCaring for Muscle and Bone Injuries

2020




Two major divisions of the skeletal system are the appendicular skeleton (shown in the first figure in yellow) and the axial skeleton

(shown in the second figure in yellow).




Select Mechanisms of Extremity Injury




Closed and open injuries.




Assessing capillary refill in the fingers. (©Dan Limmer)




Algorithm for emergency care of patients with musculoskeletal injuries.




SPLINTINGSPLINTING




Manual stabilization of an injured limb.




SplintingSplinting

• Managing Angulated Injuries– Do only what you have been trained to do

and what is allowed in your EMS system.– If no distal pulse, and skin in distal

extremity is pale or blue and cold, take action immediately to minimize potential permanent damage.

(continued)




SplintingSplinting

• Managing Angulated Injuries– Do not force limb if you meet resistance or

if patient complains of too much pain.– Apply soft splint and elevate limb by

propping it on blanket roll or pillow. – Provide oxygen (if allowed).




Place one end of the base of the triangular bandage over the uninjured shoulder. Ensure that the apex is pointed toward the

injured arm.




Bring the lower end of the bandage up and over the shoulder on the injured side. Tie a knot at the side of the neck.




Pin or tape the apex to form a pocket at the elbow.




Secure the arm to the body with a swathe.




Partially inflate the splint and slide it over the patient's extremity. Allow the fingers or toes to remain exposed at the end of the splint.

Warning: Air splints may leak. When applied in cold weather, an air splint will expand when the patient is moved to a warmer place. Pressure also will change at different altitudes. Monitor the pressure in the splint by pressing with your fingertip. These splints may stick to the patient's skin in hot weather.




Maintain manual stabilization of the extremity while your partner inflates the splint. Inflate so that you leave a slight dent when the

splint is pressed with one finger.




Reassess circulation, sensation, and motor function, and monitor the pressure of the splint. Add air if necessary.




MANAGEMENT OF SPECIFIC MANAGEMENT OF SPECIFIC EXTREMITY INJURIESEXTREMITY INJURIES




Shoulder. Apply a sling and swathe. Elevate the wrist above the elbow and support it with the swathe.




Upper arm. Immobilize with a rigid splint from the shoulder to the elbow. Apply a sling and swathe that will elevate and support the

limb.




Elbow (bent). Apply a sling and swathe to elevate and support the limb.




Elbow (straight). Pad the armpit. Splint should extend from the armpit beyond the fingertips. Use roller bandages to secure the splint to the arm starting at the distal end. Secure the arm to the body with

cravats.




Forearm, wrist, hand. The splint should extend from the elbow to beyond the fingertips. Use a sling and swathe for elevation and

support.




Finger. Use a tongue depressor as a splint or tape the finger to an uninjured finger.




Algorithm for the emergency care of patients with upper extremity injuries.




Deformity caused by dislocation of the shoulder joint.




Check circulation, sensation, and motor function (CSM) prior to splinting.




Secure a rigid splint to the arm.




Apply a sling and swathe.




Recheck circulation, sensation, and motor function (CSM).




Ensure the hand is in the position of function.




Splinting an injured elbow in a straight position.




Manually stabilize the limb prior to splinting.




Check circulation, sensation, and motor function (CSM).




Apply a rigid splint to the limb.




Place the limb in a sling and recheck circulation, sensation, and motor function (CSM).




Soft splint for wrist and hand injuries.




Management of SpecificManagement of SpecificExtremity InjuriesExtremity Injuries

• Injuries to the Fingers– Not all injuries to fingers require rigid

splinting. – Immobilize injured finger by taping finger

to adjacent, uninjured finger; tongue depressor; aluminum splint; pen or pencil.




One way to immobilize an injured finger is to tape it to an adjacent, uninjured finger.




Algorithm for emergency care of patients with lower extremities injuries.




Assess distal circulation, sensation, and motor function (CSM).




Place rigid splint below the limb.




Pad the voids.




Secure the splint to the limb and recheck circulation, sensation, and motor function (CSM).




Assess distal circulation, sensation, and motor function (CSM).




Stabilize the knee above and below the injury site.




Place the padded side of the splints next to the injured extremity. Note that they should be equal in length and extend 6–12 inches

beyond the midthigh and midcalf.




Secure splints at both ends, using cravats or similar material.




Using a figure-eight configuration, secure one cravat to the ankle and the boards and the second cravat to the thigh and the boards.

Reassess distal circulation, sensation, and motor function (CSM).




Access circulation, sensation, and motor function (CSM) prior to splinting the extremity.




Choose a splint that extends from the heel to well above the knee.




Secure the splint above and below the knee and at the ankle.




Reassess circulation, sensation, and motor function after the splint is secure.




Immobilization of the lower leg using a towel.

EMR ch20

Healthcare

Transcript of EMR ch20