EMT Lecture - Musculoskeletal & Head Injuries

Musculoskeletal Injuries Overview

Introduction to the Skeletal System

• The presentation begins with a visual representation of bones, including radius, ulna, femur, and tibia/fibula.

• The skeletal system serves multiple functions: providing shape, serving as muscle attachment points, and producing red blood cells through its extensive blood supply.

Key Components of the Skeleton

• There are 33 vertebrae divided into five regions: cervical (7), thoracic (12), lumbar (5), sacral (4).

• Arm structure includes one humerus and two smaller bones: radius (lateral) and ulna (medial).

• The leg consists of the femur from pelvis to knee, patella as kneecap, tibia (medial), and fibula (lateral).

Muscle Types Recap

• Three types of muscles in the body:

• Skeletal Muscle: Voluntary control.

• Smooth Muscle: Involuntary; operates without conscious thought.

• Cardiac Muscle: Found only in the heart; known as myocardium.

Understanding Tendons and Ligaments

Tendons Explained

• A tendon is an extension of a muscle that connects it to bone. It is crucial for EMS studies.

• Remembering "EMT" can help recall that tendons connect muscle to bone.

Ligaments Overview

• Ligaments connect bone to bone at joints. They play a vital role in joint stability.

Fractures Defined

Understanding Fractures

• A fracture is defined as a break in the structure of a bone. Both terms—break and fracture—are interchangeable.

• Regardless of severity or type, all breaks are considered fractures. This understanding is essential for communicating with patients about injuries.

Common Fracture Types

Understanding Fractures and Injuries

Types of Fractures

• The speaker emphasizes that individuals are not responsible for knowing all types of fractures, but understanding the basics is important.

• There are two main types of fractures: closed (or simple) and open (or compound). Each type has two names that should be familiar to medical personnel.

• A closed fracture does not break the skin, yet can be severe and painful. Treatment often involves surgery with pins or plates, referred to as "open reduction internal fixation" (ORIF).

• An open or compound fracture is characterized by the bone protruding through the skin. It's crucial to recognize that these terms are often used interchangeably in practice.

• Most cases encountered will likely involve closed fractures; however, recognizing an open fracture is critical when visible.

Understanding Dislocations

• Dislocations occur at joints where bones move beyond their normal range. This results in a joint being unable to function properly.

• The speaker clarifies that a joint is defined as the articulation between two bones, emphasizing its importance in understanding dislocation injuries.

Sprains vs. Strains

• The distinction between sprains and strains is often misunderstood. EMTs must know these definitions clearly.

• A strain refers specifically to an injury involving muscles or tendons due to overstretching.

• Conversely, a sprain occurs only in ligaments at joints; one cannot sprain a muscle or tendon directly.

Key Takeaways on Body Parts and Injuries

• Four primary body parts relevant to injuries include bones, joints, muscles/tendons, and ligaments—each associated with specific types of injuries: fractures for bones, dislocations for joints, strains for muscles/tendons, and sprains for ligaments.

Diagnosis Challenges

• Diagnosing orthopedic injuries without imaging technology can be challenging; assumptions about injuries may lead to incorrect conclusions.

• In most cases without clear visual evidence (like a bone protruding), it’s difficult to definitively diagnose fractures or other issues without further imaging like X-rays or MRIs.

Understanding Musculoskeletal Injuries and Assessment

The Importance of Accurate Terminology in EMS

• In New York State, EMS personnel are prohibited from using terms like "fracture" or "break," as these are considered diagnoses. Instead, they must describe injuries as “painful swollen deformed extremities” to maintain legal compliance.

• This terminology emphasizes the need for careful assessment without making definitive medical diagnoses on-site, which can lead to liability issues.

Key Observations in Injury Assessment

• Pain: Recognizing pain is crucial; it’s a subjective experience that varies among individuals but is essential for diagnosis. Pain indicates an injury's severity and location.

• Swelling: Swelling is visually identifiable and often signifies inflammation or injury severity, such as a grapefruit-sized bulge indicating significant trauma. Understanding this helps in assessing the extent of the injury.

• Deformity: Assessing deformity requires comparing both extremities; what may appear abnormal could be normal for some individuals due to congenital differences. Thus, practitioners should avoid jumping to conclusions based solely on appearance.

Signs and Symptoms of Musculoskeletal Injuries

• Common signs include bruising, deformity, angulation (where limbs are stuck at an angle), and exposed bone ends which indicate severe fractures requiring immediate attention. All orthopedic injuries should be treated with caution as potential fractures until proven otherwise.

• Tenderness is defined as pain upon palpation; recognizing this distinction between general pain and tenderness is vital for accurate assessments during examinations by EMTs or other practitioners.

Circulation Assessment Techniques

• EMTs must assess circulation by checking distal pulses—specifically radial pulses in arms—and noting any loss of circulation if pulses cannot be felt despite visible deformities or swelling. This step is critical in determining the urgency of treatment needed for limb injuries.

• The three key assessments include:

• Pulse: Checking for blood flow distal to the injury.

• Motion: Evaluating if patients can move their fingers or toes.

• Sensation: Testing sensory response by blocking vision and asking patients to identify touched areas on their body (e.g., fingers). These collectively form the PMS (Pulse, Motor function, Sensory function) assessment protocol used frequently in emergency situations involving orthopedic injuries.

Clarifying PMS Assessment

Understanding Splinting Techniques

Importance of Splinting

• The instructor emphasizes the significance of mastering splinting as it will be a recurring skill throughout the course, with assessments by New York State.

• Splinting is crucial for closed fractures to prevent potential internal damage and complications from movement.

• Proper splinting can significantly reduce pain associated with orthopedic injuries, highlighting its effectiveness.

Types of Splints

• The discussion includes various types of splints: anatomical, soft, rigid fixation, and traction splints.

• Emphasis on learning how to use different types of splints effectively during practical sessions.

General Rules for Splinting

• Key rules include identifying the affected extremity and understanding which bones are involved in the injury (e.g., radius and ulna).

• Before applying a splint, it's essential to perform PMS (Pulse, Motor function, Sensation checks) to monitor changes post-splint application.

Application Process

• The rule for applying a splint involves covering the affected area and including proximal and distal joints.

• For wrist injuries, both elbow (proximal joint) and wrist (distal joint) must be immobilized; shoulder mobilization may not be necessary.

Handling Joint Injuries

• If an injury is suspected at a joint without visible swelling but with tenderness or pain, similar rules apply but focus on the specific bone involved.

• In cases of joint injuries like dislocations, it's important to immobilize both proximal (humerus) and distal bones (radius/ulna).

Understanding the Nervous System and Its Functions

Anatomy Review for EMTs

• The speaker emphasizes the importance of anatomy knowledge for EMTs, specifically mentioning the mandible (lower jaw) and maxilla (upper jaw).

• Key bones discussed include the occipital bone and mastoid process, highlighting their significance in medical contexts.

• The cervical and lumbar regions are identified as the most commonly injured areas of the spine, a critical point for EMT training.

Overview of the Nervous System

• The nervous system is divided into two main sections: Central Nervous System (CNS), which includes only the brain and spinal cord, and Peripheral Nervous System (PNS), encompassing all other nervous system components.

• Understanding voluntary versus involuntary muscle control is crucial; voluntary actions require messages from the brain while involuntary actions occur automatically.

Functional Aspects of the Nervous System

• The somatic nervous system controls voluntary movements, such as picking up an object, while autonomic functions are managed by the autonomic nervous system.

• Autonomic processes like digestion happen without conscious effort; this system is further divided into sympathetic (fight or flight response) and parasympathetic (rest and digest).

Sympathetic vs. Parasympathetic Systems

• The sympathetic nervous system accelerates bodily processes during stress or danger, whereas the parasympathetic promotes relaxation and recovery.

• Medications can influence these systems by either increasing or decreasing their activity to achieve desired physiological effects.

Medication Effects on Nervous System Functionality

• Many medications work by altering sympathetic or parasympathetic tone to restore balance in bodily functions.

• An example provided involves treating asthma with medications that increase sympathetic tone while decreasing parasympathetic tone to enhance respiratory function.

Understanding the Role of the Vertebrae and Meninges

Purpose of the Vertebrae

• The primary function of the vertebrae is to protect the spinal cord, which serves as a critical communication pathway between the brain and body.

• Similar to how ribcages protect lungs and major vessels, vertebrae are essential for safeguarding vital neural structures.

Neurological Functionality

• Neurological deficits are assessed by checking if messages from the brain travel down the spinal cord to peripheral nerves effectively. This includes signals reaching extremities like toes.

• Understanding this communication is crucial in diagnosing neurological issues. The integrity of this pathway directly impacts bodily functions.

Meninges: Protective Layers

• The meninges consist of three protective layers surrounding both the spinal cord and brain: Pia mater (innermost), Arachnoid (middle), and Dura mater (outermost). This can be remembered with "PAD."

• Meningitis refers to inflammation of these membranes, often tested through a lumbar puncture procedure rather than an injection. This highlights its clinical significance in diagnosing infections.

Lumbar Puncture Procedure

• A lumbar puncture involves extracting cerebrospinal fluid (CSF) for analysis, helping determine conditions like meningitis or encephalitis based on fluid characteristics. It’s performed in hospitals, not ambulances.

• CSF is crucial for understanding various neurological conditions; it should only be found around the brain and spinal cord, indicating potential issues if detected elsewhere.

Spinal Cord Injuries and Their Implications

• Injuries at different levels of the spinal cord lead to varying degrees of paralysis; higher injuries may result in quadriplegia while lower injuries could cause paraplegia affecting leg function but sparing arm movement. Understanding this helps predict patient outcomes post-injury.

Neurological and Head Injuries Overview

CSF Leaks and Major Head Injuries

• Cerebrospinal fluid (CSF) may leak from the nose or ears in cases of severe head injuries, often associated with basal skull fractures.

• A CSF leak is typically accompanied by blood; gauze can be used to identify this, showing a yellow (CSF) and red (blood) separation.

• If CSF is detected in a patient with a major head injury, immediate medical attention is crucial.

Signs of Basal Skull Fractures

• Battle signs indicate bleeding behind the ear due to a basal skull fracture; this requires urgent care if linked to trauma.

• Raccoon eyes are bruising around both eyes that can occur from significant trauma, often seen in unconscious patients.

Neurological Posturing

• Severe head injuries may lead to neurological posturing, which can manifest as either decerebrate or decorticate posturing.

• The Glasgow Coma Scale classifies trauma severity based on responses and posturing; it remains relevant for assessing unconscious patients.

Cushing's Reflex

• Cushing's reflex occurs after major head injuries and includes three critical signs: hypertension, bradycardia, and irregular respiration patterns.

• Increased blood pressure results from intracranial bleeding leading to elevated pressure within the skull.

• Bradycardia is an unusual response during head injury scenarios where heart rate decreases instead of increasing as seen in shock conditions.

Understanding Neurological Injuries and Assessment

Mechanism of Injury and Initial Assessment

• A good EMT assesses the scene for major mechanisms of injury, noting vital signs such as respiration rate and heart rate.

• In cases of unresponsiveness, high blood pressure, and erratic respirations, rapid transport to a trauma center is crucial.

• Seizures and nausea are common after head injuries; neurogenic shock can occur due to central nervous system damage.

Understanding Neurogenic Shock

• Neurogenic shock results from significant head injuries affecting the central nervous system.

• Priapism, an uncontrolled erection following a head injury, is highlighted as a serious condition requiring attention.

Pupil Examination in Head Injuries

• Unequal pupils can indicate a head injury; one pupil may be dilated while the other is constricted (myosis).

• The presence of unequal pupils necessitates further investigation into potential drug use or trauma history.

Treatment Protocol for Neurological Injuries

• Focus on airway management and breathing support when treating neurological injuries in the field.

• Recognize that neurological deficits can manifest in extremities; stabilization protocols have evolved recently.

Pediatric Considerations in Emergency Care

• For children, achieving the sniffing position during CPR may require using a folded towel or sheet for proper alignment.

• Current practices regarding immobilization devices like backboards are changing; understanding new protocols is essential.

Glasgow Coma Scale Overview

• The Glasgow Coma Scale (GCS), used to assess consciousness levels, ranges from 3 (lowest possible score even if deceased) to 15 (fully alert).

Understanding GCS and Ventilation Decisions

Overview of GCS (Glasgow Coma Scale) and Ventilation

• The discussion begins with the importance of recognizing a GCS score of 8 or less, indicating that ventilation is necessary for the patient.

• It is noted that electronic PCR tablets can assist in calculating GCS scores by answering specific questions related to the patient's condition.

Components of GCS Assessment

• The assessment includes evaluating eye response; spontaneous eye opening indicates a better score.

• Verbal responses are assessed by asking questions like "What day is it today?" Responses indicate orientation, confusion, or appropriateness. For example, saying "banana" would be inappropriate.

• Motor responses are evaluated by commands such as raising a hand. A score of six is given if the patient obeys commands.

Pain Response Evaluation

• If a patient withdraws from pain or shows flexion/extension movements in response to pain stimuli, these actions contribute to their motor scoring on the GCS.

Importance of Monitoring Patients