Prehospital Trauma Life Support

Lesson

10

Musculoskeletal Trauma

PROVIDER COURSE
Copyright 2003, Elsevier Science (USA). All rights reserved.

Objectives
Discuss the pathophysiology of musculoskeletal trauma Discuss the management of musculoskeletal trauma in isolated trauma and multisystem trauma

10-2
Copyright 2003, Elsevier Science (USA). All rights reserved.

Musculoskeletal Trauma
Management depends on the situation
Multisystem Trauma Patient Simple Isolated Injury

vs

10-3
Copyright 2003, Elsevier Science (USA). All rights reserved.

You are called to the scene of an intoxicated male who stumbled and put his hand through a window. On your arrival you see a large amount of blood and broken glass by the front door. The police direct you to a 40-year-old male sitting in a chair, bleeding heavily from the upper arm. On examination you see a laceration to the antecubital fossa with copious bright red bleeding.

10-4
Copyright 2003, Elsevier Science (USA). All rights reserved.

What, if any, life-threatening injuries are present?

What are some examples of life-threatening musculoskeletal injuries? What ways exist to control the bleeding?
Does this injury require rapid packaging and transport?

10-5
Copyright 2003, Elsevier Science (USA). All rights reserved.

A 28-year-old female fell while skiing. Ski patrol has brought her to the lodge. She complains of severe right thigh pain.

10-6
Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Patent B - Normal C - No external hemorrhage, normal pulse rate, skin warm and dry D - GCS score 15 What are your conclusions based on these findings?

10-7
Copyright 2003, Elsevier Science (USA). All rights reserved.

Secondary Survey
You find a swollen angulated right thigh.
How much blood could a patient lose from this type of injury? Is this enough to cause shock?
How would you manage this injury?

10-8
Copyright 2003, Elsevier Science (USA). All rights reserved.

Your patient is a 45-year-old male pedestrian who was struck by an SUV. He smells of alcohol.

10-9
Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Patent B - VR rapid and shallow, clear BS C - Blood oozing from multiple soft tissue injuries, weak and rapid radial pulse D - GCS score 13 (E-3, V-4, M-5) When you gently stress his pelvis, crepitus is noted and the patient screams in pain.

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Copyright 2003, Elsevier Science (USA). All rights reserved.

What are your conclusions based on the primary survey? What are your management priorities for this patient?

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Copyright 2003, Elsevier Science (USA). All rights reserved.

A 22-year-old male crashed while riding a mountain bike. Because of the remote location, you reach the patient about 1 hours after the injury occurred.
A - Patent B - VR slightly increased C - No external hemorrhage, rapid and weak radial pulse D - GCS score 15 E - Deformities noted to left upper arm and to both lower legs

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Secondary Survey
VR 24; pulse, 122; BP 104/72 There is no abdominal or pelvic tenderness

How do you explain these findings?

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Table of Estimated Blood Loss

10-14
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A 70-year-old woman slipped on some ice and fell down a staircase. On your arrival she is complaining of pain in her left wrist and left ankle. On examination, deformities are found in both extremities.

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Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Patent B - VR slightly fast C - Moderate hemorrhage from oozing and open ankle, irregular pulse D - GCS score 15
VR, 22; pulse, 105; BP, 110/70

Complains of pain at fracture sites

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Copyright 2003, Elsevier Science (USA). All rights reserved.

Are life-threatening injuries present? How are you going to manage this patient?

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Summary
Although musculoskeletal injuries can be dramatic, always begin with the primary survey. Multisystem trauma patient
Focus on threats to life Most musculoskeletal trauma is splinted with spinal immobilization

Isolated musculoskeletal injury

Splint as appropriate Consider pain management
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Copyright 2003, Elsevier Science (USA). All rights reserved.

Prehospital Trauma Life Support

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