TRAUMA SISTEM MUSKULOSKELETAL

How do musculoskeletal injuries impact on the primary survey?

External bleeding

Occult blood loss

Pelvic fractures

Long bone fractures

During the Primary Survey The 3 Ss

Stop the bleeding! (pressure / tourniquet)

Splint the extremity

Stabilize the pelvis

Secondary survey
Look

Deformity

Pain

Tenderness

Wound(s)

Listen

Doppler signals

Bruit

Feel

Crepitus

Skin flaps

Neurologic deficit

Pulses

Management open fracture

Apply appropriate splint

Cleanse / debride

(now or later)

Consider time factor

Obtain orthopedic consult

Antibiotic / tetanus status

What injuries can cause compartment syndrome?

Tibia and forearm fractures

Vascular and bony injuries

Injuries immobilized in tight dressings or casts

Severe crush injuries to muscle

Burns

How do I recognize compartment syndrome?

Pain

Disproportionate

Passive stretch

Tense compartments

Asymmetry

Paresthesia

Tissue pressures > 35 to 45 mm Hg

SPINE AND SPINAL CORD TRAUMA

When should you suspect a spine injury?

Mechanism of injury

Unconscious patient

Neurologic deficit

Spine pain / tenderness

How do I protect the spine during evaluation and transport?

Immobilize entire patient on long spine board with proper padding.

Apply semirigid collar.

Clinical

Normal neurologic exam and

Absence of spinal pain and tenderness

If patient is

Conscious

Cooperative

Able to concentrate on c-spine

If no neck or spine pain or tenderness

If still no pain or tenderness with voluntary movement

No further evaluation or x-ray necessary

How do I assess the patients neurologic status?

Neurologic level

Most caudal level of motor / sensory function

Motor and sensory may not be the same

Sensory can vary on each side

Site of vertebral column damage

Bony level

Neurogenic Shock Direct Effects

Cardiovascular phenomenon due to loss of sympathetic tone

Associated with cervical / high thoracic spine injury

Hypotension and slow heart rate

Treatment includes fluid resuscitation and occasional atropine and vasopressors

Spinal Shock Direct Effects

Neurologic, not hemodynamic phenomenon

Occurs shortly after cord injury

Variable duration

Flaccidity and loss of reflexes

How do I manage patients with spinal cord injury and limit secondary injury?

Ensure adequate ventilation and oxygenation

Maintain blood pressure

Maintain perfusion of spinal cord

Management of Patients Requiring Transfer

Provide respiratory support as needed

Exclude other life- threatening injury

Properly immobilize entire patient

Avoid hypothermia