Refresher 2003

Common Outdoor Injury Management

Instructors
This PowerPoint was developed to be used as an instructor- aid for the 2003 OEC Fall Refresher. Please MODIFY its contents to meet your patrols needs. A mini-presentation is a good teaching style for this exercise. Your review should not take more than 30 minutes maximum!

Refresher 2003

Common Outdoor Injury Management

Common Outdoor Injury Management

Objectives

Review mechanisms and patterns of traumatic injury Illustrate the types of injury that occur to the skeleton, soft tissue, and skeletal support structures Explain the general principles of wound care and the emergency care for musculoskeletal injuries

Mechanism of Injury

Mechanism of Injury
Types of Trauma

Mechanism of Injury
Types of Trauma
Penetrating

Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension

Nail in Index Finger

Mechanism of Injury
Types of Trauma
Penetrating

Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension

Severe Contusion of Foot

Mechanism of Injury
Types of Trauma
Penetrating

Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension

Cervical (C5-C6) Fracture Dislocation

Mechanism of Injury
Types of Trauma
Penetrating

Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension

Dorsal Dislocation, Long Finger Middle Joint (PIP Joint)

Mechanism of Injury
Types of Trauma
Rotational

Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma

Normal Tibia Left

Spiral Fracture Tibia Right

Mechanism of Injury
Types of Trauma
Rotational

Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma

Dislocation of Right Shoulder

Mechanism of Injury
Types of Trauma
Rotational

Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma

Train Crush Injury, Leg

Mechanism of Injury
Types of Trauma
Rotational

Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma

Deceleration Trauma

Mechanism of Injury
Types of Trauma
Rotational

Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma

Car struck from behind accelerates passengers, producing an extension injury to the neck!
Acceleration Trauma

Mechanism of Injury
Types of Force

Mechanism of Injury
Types of Force
Direct

Force Indirect Force Twisting Force High Energy Force

Direct Mid-Shaft Fracture, Femur

Mechanism of Injury
Types of Force
Direct

Force Indirect Force Twisting Force High Energy Force

Indirect Posterior Dislocation, Elbow

Mechanism of Injury
Types of Force
Direct

Force Indirect Force Twisting Force High Energy Force

Twisting Subtalar Dislocation, Ankle

Mechanism of Injury
Types of Force
Direct

Force Indirect Force Twisting Force High Energy Force

High Energy Fractured Pelvis

Types of Injury

Types of Injury
Fracture

Any break in the continuity of a bone

May vary from a simple crack to a completely shattered bone

Fracture Classification
Closed/Open Incomplete/Complete Non-Displaced/Displaced

Closed Fracture, Base of Thumb

Closed Dorsally Angulated Forearm Fracture

n Fracture, Tibia

Fracture, Forearm

Open Fractures Are More Serious!

Blood

loss

Potential

contamination with risk of infection

Fracture Classification
Closed/Open
Incomplete/Complete Displaced/Displaced

Incomplete Fracture, Distal Radius

Complete Fracture, Femur

Fracture Classification
Closed/Open Incomplete/Complete
Non-Displaced/Displaced

Non-Displaced Fracture, Distal Tibia and Fibula

Displaced Forearm Fractures

Other Types of Fracture

Comminuted fractured into more than two segments Pathologic fracture through diseased bone Epiphyseal fracture passes through the growth plate

Comminuted Femur Fracture

Other Types of Fracture

Comminuted fractured into more than two segments Pathologic fracture through diseased bone Epiphyseal fracture passes through the growth plate

Lytic lesion (darker = tumor) in proximal phalanx of finger, with associated transverse fracture

Pathologic

Other Types of Fracture

Comminuted fractured into many pieces Pathologic fracture through diseased bone Epiphyseal fracture through the growth plate

Epiphyseal (growth-line) Fracture, Distal Femur

Signs of a Fracture
Tenderness

Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

Seven Signs of Fracture

Tenderness

Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

Fractured Patella

Seven Signs of Fracture

Tenderness

Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

Angulated Fracture, Radius and Ulna

Seven Signs of Fracture

Tenderness

Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

Crepitus In a complete fracture, the sounds of bone ends clicking or rubbing against each other; denotes an unstable fracture!

Seven Signs of Fracture

Tenderness

Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

Open Ankle Fracture

Seven Signs of Fracture

Tenderness Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

False Motion The unusual visual sensation of observing motion at a long bone fracture site where there is no joint!

Seven Signs of Fracture

Tenderness

Swelling

and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb

Fracture, Right Clavicle Right Arm Protected

Seven Signs of Fracture

The presence of any one of the seven fracture signs just listed is sufficient to assess this injury!

Types of Injury
Dislocation
Disruption of a joint such that the bone ends are no longer in normal contact Must have torn ligaments and joint capsule

Signs of Dislocation
Tenderness Deformity

(usually marked) Swelling and Ecchymosis Loss of normal joint motion

Common Dislocations
Shoulder

Finger
Hip Elbow

Anterior Dislocation, Right Shoulder

Common Dislocations
Shoulder

Finger
Hip Elbow

Dislocation, Middle Joint (PIP Joint), Ring Finger

Common Dislocations
Shoulder

Finger
Hip Elbow

Posterior Hip Dislocation

Common Dislocations
Shoulder

Finger
Hip

Elbow

Posterior Elbow Dislocation

Types of Injury
Fracture-Dislocation
A combined injury with joint dislocation and an adjacent bone fracture

FractureDislocation, Ankle

Types of Injury
Sprain
or complete temporary joint dislocation Ligaments are torn partially or completely May produce as much structural damage as a dislocation
Partial

Sprain, Left Ankle

Types of Injury
Muscle Pull Stretching or tearing of muscle, or muscle fascia (covering) Occurs frequently in the lower back secondary to poor posture and poor abdominal muscle control

Strain

Assessing Musculoskeletal Injuries

MOI on Approach ABCs Injury History (What happened?) Palpation of injury site -

Take one finger and show me where it hurts!

DCAP-BTLS
Deformities Contusions Abrasions Puncture Burns Tenderness Lacerations Swelling

Wounds

Evaluation of Distal Neurovascular Function

(CMS)

Pulse

(circulation) Motor Function Sensation

Radial Pulse

Posterior Tibial Pulse

Evaluation of Distal Neurovascular Function

(CMS)

Pulse

(circulation) Motor Function Sensation

Extension

Flexion

Ankle Dorsiflexion

Ankle Plantar Flexion

Evaluation of Distal Neurovascular Function

(CMS)

Pulse

(circulation) Motor Function Sensation

Medial and Lateral Hand

Medial Foot

Lateral Foot

 ABCs

Principles of Musculoskeletal Injury Management

Evaluate

distal neurovascular function Dress all wounds Splint all suspected injuries Prepare patient for transport

Injury Management All open wounds should be covered with a dry sterile compression dressing

Splinting Immobilizes the Injury and:

Reduces

Injury Management

Pain Facilitates Transport Prevents further damage to blood vessels, nerves and skin adjacent to the injury Decreases Bleeding

Principles of Splinting
Check and record CMS Dress all wounds Immobilize the joints above and below a suspected fracture With injuries at or near joints, immobilize the bones above and below the injury Stabilize the injury site during splint application

Principles of Splinting
Use gentle in-line manual traction to realign displaced long bone fractures Expect to encounter increased pain and some resistance when attempting to realign a deformed limb Immobilize all suspected spinal injuries in a neutral in-line position on a spineboard

Principles of Splinting

If the patient demonstrates major signs of shock, align the limb as close to its normal anatomic alignment as possible on a spineboard (immobilization of total body), and provide rapid transport

Total Body Immobilization

When in doubt: SPLINT!

Rigid Splints
Quick Splint Cardboard Splint

Ladder Splint

SAM Splint

Soft Splints
Air Splint Vacuum Splint

Sling and Swathe

Blanket Roll

Traction Splint

When standard splints are unavailable,

improvisation
is better than doing nothing!

UPPER EXTREMITY
All fractures can be immobilized by securing the extremity to the chest!

LOWER EXTREMITY All fractures can be immobilized by securing the injured extremity to the opposite lower extremity!

The End