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Chapter 22: Musculoskeletal Trauma

Types of Muscular Injuries Contusion- closed wound in which the skin is unbroken, although damage has occurred to the tissue immediately beneath. Compartment Syndrome- condition that occurs when circulation to a portion of the body is cut off; muscle ischemia that is caused by rising pressures within an anatomic fascial space. Penetrating Injury- injury caused by an object breaking the skin and entering the body. Muscle Fatigue- occurs as the muscle reaches its limit of performance. Muscle Cramp- muscle pain resulting from over activity, lack of O2, and accumulation of waste products. Muscle Spasm- intermittent or continuous contraction of a muscle. Muscle Strain- injury resulting from overstretching of muscle fibers. Types of Joint Injury- consider any injury within 3 inches of a joint to be a joint injury. Sprain- tearing of a joint capsules connective tissues. o Types of Sprains Grade 1- minor and incomplete capsule tear Grade 2- significant but incomplete tear Grade 3- complete tear Subluxation- partial displacement of a bone end from its position in a joint capsule. Dislocation- complete displacement of a bone end from its position in a joint capsule. Types of Bone Fractures (FX) Open- a broken bone in which the bone ends or the forces that caused it penetrate the surrounding skin. Closed- a broken bone in which the bone ends or the forces that caused it do not penetrate the skin. Hairline- small crack in a bone that does not disrupt its total structure. Impacted- break in a bone in which the bone is compressed on itself. Transverse- a break that runs across a bone perpendicular to the bones orientation. Oblique- break in a bone running across it at an angle other that 90 Comminuted- fracture in which a bone is broken into several pieces. Spiral- a curving break in a bone as may be caused by rotational forces. Greenstick- partial fracture of a childs bone. Epiphyseal- disruption in the epiphyseal plate of a childs bone Osteoporosis- weakening of bone tissue due to loss of essential minerals, especially calcium. Bone repair Cycle

1. Osteocytes- from the bone ends begin to multiply rapidly and produce osteoblasts. 2. Depostion of Salts3. Fiber matrix strengthen- the callus and stabilize the bone to near-normal strength. Callus- thickened area that forms at he site of a fracture as art of the repair process. Inflammatory & Degenerative Conditions Bursitis- acute or chronic inflammation of the small synovial sacs. Tendonitis- inflammation of a tendon and /or its protective sheath. Arthritis- inflammation of a joint. o Osteoarthritis- inflammation of a joint resulting from wearing of the articular cartilage. o Rheumatoid arthritis- chronic disease that causes deterioration of peripheral joint connective tissue. o Gout- inflammation of joints and connective tissue due to build-up of uric acid crystals. A pelvic fracture may account for hemorrhage of more than 2L. A femur fracture may account for as much as 1,500mL of blood loss. 500mL is a critical loss of blood. The 6 Ps in Evaluating Limb Injury Pain/tenderness- upon palpation/movement Pallor- skin may be pale or flushed, and capillary refill may be delayed. Paralysis- inability or difficulty moving Paresthesia- patient may report numbness or tingling Pressure- a feeling of tension within the extremity Pulses- may be diminished or absent Early Indicators of Compartment Syndrome Feelings of tension within limb Loss of distal sensation complaints of pain Condition more severe than MOI Pain on passive extension o extremity Pulse deficit (late sign) Basics of Musculoskeletal Injury Care Protecting open wounds Proper positioning- do not attempt alignment of dislocations and serious injuries within 3inches of a joint. o Reduction- returning of displaced bone ends to their proper anatomic orientation Immobilizing the injury- immobilize the joint above and the joint below the injury. Monitoring of neurovascular function- always check PMS in distal extremity before, during, and after splinting.

Medications Sedatives/Analgesics o Nitrous Oxide o Diazepam o Morphine o Meperdine o Nalbuphine RICE Procedure for Strains, Sprains, Soft Tissue Injuries Rest the extremity Ice for first 48 hours Compress w/elastic bandage Elevate extremity

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