Beruflich Dokumente
Kultur Dokumente
Yokhanan Muryadi
SBY Yogyakarta
MUSCULOSKELETAL INJURIES
Sprains/Strains
Sprain
Injury to ligaments (bands of tissue that holds
bones in position in the joints)
Strain
Injury to muscles or tendons that attach muscles
to bones or to both
May be found on x-ray as avulsion fractures those
in which a small piece of bone is pulled away from
main shaft. Seen most commonly in ankles
Crush Injuries
Kerusakan jaringan
lunak yang hebat
Kerusakan seluler,
vaskuler dan saraf
Hancurnya tulang dan
otot
Syok hipovolemia
Trauma Muskuloskeletal
Sering terjadi, jarang
mengancam jiwa
Bisa merupakan
bagian dari multi
trauma
Ingat ABC
Perdarahan pada trauma
muskuloskeletal
Mekanisme fisiologis tubuh :
Mengaktifkan sistim pembekuan darah
untuk mengurangi perdarahan
Memperbaiki integritas membran sell dan
kapiler untuk meningkatkan reabsorbsi
cairan
Meningkatkan aliran darah kolateral untuk
merangsang penyembuhan
Cedera jaringan lunak
Terganggunya integritas kulit tempat
masuknya mikro organisme
Macam kerusakan jaringan lunak :
Abrasi
Avulsi
Kontusi
Laserasi
Puncture
Cedera Pada Sendi
Occult joint
instability
Subluksasi Dislokasi
Fraktur Femur
Trauma mayor
Pada orang tua : fraktur collum femur
Fraktur femur tertutup : 1 – 1,5 liter
Gambaran klinis :
Nyeri, tidak dapat menahan BB
Deformitas : pemendekan tungkai,
exo/endorotasi
Oedema
Syok
INJURY ASSESSMENT
Initial Assessment - ABC’s
History – SAMPLE
Chief Complaint
Mechanism of injury
Onset of symptoms
Focused Physical Assessment
Observation
Inspection
Palpation
5 P’s
9 Illinois EMSC
INTERVENTIONS
R - Rest/immobilize
I - Ice
C - Compression
E - Elevation
S - Support
10 Illinois EMSC
IMMOBILIZATION/SPLINTING
KEY POINTS
Immobilize joint above and Minimize movement
below injury
of extremity during
Assess neurovascular
status distal to injury prior splinting
to splint application and Secure splint to
again right after splint
application
provide support and
If angulation at fracture site
compression
without neurovascular Reassess/monitor
compromise, immobilize as neurovascular status
presented
every 5-10 minutes
11 Illinois EMSC
HIP DISLOCATION
- ORTHOPEDIC EMERGENCY!
- Biasanya disebabkan auto accident
- Paling sering bagian posterior
- HIP FLEXED AND LEG ROTATED
INTERNALLY
- Nyeri hebat TO STRAIGHTEN
… continued
Memerlukan intervensi bedah
Mismanagement can cause sprain to
become strain
MUSCULOSKELETAL INJURIES
Sprains/Strains
Knowledge Medical Management
• These injuries are painful with • X-Ray
swelling commonly present
• Usual mechanism of injury is • Splint - may be used if injury
hyperextension of joint:twist severe enough. Used more now in
ankle, bend wrist or fingers place of casting to allow swelling to
backward, twist knee go down & ROM exercises to be
• Most common sites of Injury done to avoid freezing of joint
Sprains/Strains : Ankle, • Elastic Wrap – most common
Elbow,Hand/fingers, Knees treatment
• Crutches used to prevent re-injury
& to take stress off joint
MUSCULOSKELETAL INJURIES
Sprains/Strains
Assesment Interventions
• Deformity, presence of swelling • Assess for Fx
• Sensory, motor, circulation Fx • Rest, ice, compression, elevation
• Pain
• Application of elastic wrap
• Mechanism of injury
• Depending on type of splint, may
• 1st aid given – is it splinted? Has apply or assist with application Any
area of injury been manipulated splint involving casting material
since injury? must be applied by MD
• Assume fracture until proven • Patient Education: splint
otherwise management, monitoring of
sensory, motor & circulation; crutch
walking, S/S to report.
DISLOCATION
Excessive stress in an abnormal direction
may produce a dislocation
Common sites for dislocations
Shoulder-may be a reoccurring problem,
(humeral head slips out of glenoid
cavity)
Usually treated with closed reduction
and external immobilization
Hip -femoral head forced from within the
acetabulum, orthopedic emergency !!
FRACTURES
Break in continuity of bone
No difference between broken vs. fracture
Always have injury to surrounding tissue
Classified as
Complete vs. incomplete
Closed (Simple) vs. Open (Compound)
Complex
Communited
Impacted
Stress/Pathological
SPLINTING INDICATIONS
Prevention of Stabilize fracture or
further injury dislocation
• Deformity RICE
• X-Ray –human eyes R = Rest area (Limit
can’t see fracture or movement)
extent of obvious
fracture I = Ice (Not directly on skin)
C = Compression, Contain
• Pain, swelling,bruising
(Splinting)
• Sensory, motor,
circulation Fx E = Elevate (above level of
• Presence of Crepidus heart to ↓ swelling)
Pengkajian Fracture
Look, Feel, Move
Radiologi
Pengkajian neuromuskuler P5
P ain
P ale
P uls
P araesthese
P aralise
Pengkajian
Look deformitas, luka, perdarahan
Feel Palpasi
Move don’t’n move if # sign
Pengukuran
Intervensi
Splinting + spalk
Traction manual, continous t (closed,
open/pembedahan)
Immobilisasi
Femur Fractures
DO NOT attempt to splint a fracture of femur
May assist with splinting but requires more than
one person to splint and can do more damage to
splint
Only splinted if failure to do so will interfere with
transport or compromise circulation distally
Remember, splint in position found on arrival
Get pain medicine on board fast!
Remember that patient can bleed to death from
fractured femur
Requires surgical intervention
Penatalaksanaan Fractur Femur
Casting
Splinting
Repositions traction, ORIF, closed
reductions
Komplikasi
Schock
Assesment Interventions