EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 60 of 71

ORTHOPEDIC TRAUMA STANDARD Trauma COMPETENCY Applies fundamental knowledge to provide basic emergency care and transportation based on assessment fi ndings for an acutely injured patient. • Brief description of the frequency of traumatic injuries and deaths, and the personal ramifi cations of these types of injuries. • Pathophysiology of injury to the skeletal bones, and how some can be either life threatening or limb threatening. • Assessment steps and clinical fi ndings consistent with orthopedic trauma is presented. • Current treatment parameters and key elements of splinting specifi c types of injuries: Pelvis fracture; Femur fracture: Eff ect of orthopedic trauma as it pertains to pediatric and geriatric patients. These bones are connected to each other by ligaments and articulated with muscles and tendons. Together these bones and connective tissues form the musculosk- eletal system. Before we consider what can go wrong, we should fi rst consider the basic functions of the musculoskel- etal system. Bone, muscle, and connective tissue work together to provide the body with fi ve basic functions: • Giving the body shape • Protection of important structures • Movement • Creation of red blood cells • Storage of key minerals the body uses for metabolism. When we consider orthopedic injuries, we need to think about how injuries affect these basic functions. In addition, when considering injuries, we should examine how the musculoskel- etal system works in concert with other body systems. For example, most long bones are anatomically located next to very large blood vessels (arteries and veins) and nerves. Therefore, an injury to such a bone may, in fact, have an impact on the circulation of blood as well. With those factors in mind, let us now consider damage to the musculoskeletal system. The most obvious injury to the musculoskeletal system is the fracture. In this case, bone is actually broken. A fracture can physically displace bones, as in an angulated fracture, or simply crack the bone, as in a greenstick frac- ture. Major concerns regarding fractures fall back to the musculoskeletal system function. Examples of this include loss of mobility (did the fracture hinder move- ment associated with a particular bone, as it usually does?), loss of protection (did the force that broke the bone also damage underlying organs?), and impact on associated systems (did the fracture damage proximal blood vessels and or nerve tissue?). In addition to fractures, connective tissue can be damaged in the form of strains and sprains. Generally, these injuries occur when movement of a joint exceeds the normal range of motion. Excessive motion can stretch and tear tendons and ligaments. Again, assess- ment of the injury must consider func- tion. Sprains and strains are typically limited to disruption of movement and structure but can also have an impact on other systems, such as circulation and nervous function. A joint can be dislocated when the junction of two or more bones is disrupted. These types of injuries can have a serious impact on structure and movement and can seriously impair blood flow and nervous function. LIFE-THREATENING ORTHOPEDIC INJURIES Most orthopedic injuries are not life threatening. However, certain injuries present an immediate lethal potential. For the most part, these injuries are the ones that directly affect the circulatory system. Fractures of the pelvis—a basin- shaped structure composed of large irregular bones that require tremendous force to fracture—are among the most dangerous orthopedic injuries. Because large blood vessels, such as the iliac arteries, pass through the pelvis, frac- tures (and the force required to fracture) can result in massive hemorrhage and blood loss. In addition to adjacent blood vessels, Compact bone Marrow cavity Arteries large bones also have their own network of internal circulation that is vulnerable when the bone is fractured (see Figure 1). Along with the pelvis, the femurs are very susceptible to severe bleeding associated with a fracture. A loss of up to 1.5 liters of blood can be associated with a single fractured femur. This blood loss can be serious in itself, but it would be even more dangerous when it contrib- utes to blood loss from other injuries. If a force is great enough to break a large bone such as the femur, we must always be concerned with potential injuries to other parts of the body. Always remember that the total blood loss may be made up of a variety of different sources of bleeding. We must consider (and treat) all the causes of blood loss. A fractured femur alone is serious; a fractured femur plus a lacer- ated liver is deadly. LIMB-THREATENING INJURIES Some injuries may not be imme- diately life threatening, yet they may still be considered critical. Although an Spongy bone Spongy bone Figure 1: Bones have both arteries and veins, although only arteries are shown here. Because they are so richly supplied with blood vessels, bones can bleed profusely when fractured. EMSWORLD.com | AUGUST 2011 57

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