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83 Cards in this Set
- Front
- Back
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15.9.1 Clavicle Fracture s/sx
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- Shoulder Pain or difficulty using arm secondary to pain
- Tenderness of clavicle - swelling around Fx site - Ecchymosis - Acromium pulls in and forward due to muscle spasm - grinding sensation felt with movement |
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15.9.1 Clavicle Fracture Tx
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- Figure 8 Splint 4-6 weeks
- Sling PRN for pain - Neuro Checks first 72 hrs - NSAIDS - Ice- q2h for 20min (x24hr then tid) - Medadvice message |
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15.9.1 Clavicle Fracture Labs
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-
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15.9.1 Clavicle Fracture Complications
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- Generally rare
- non-union - excessive callus formation at Fx site causing TOS - Truama to pluera and lung |
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15.9.1 Clavicle Fracture Disposition
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- MEDADVICE
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15.9.1 Compartment Syndrome s/sx
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- Pain- Extreme in Ischemis Muscle
- Paresis - Partial Paralysis - Decreased or loss of function from neuro ischemia - Swelling - Tenderness over affected compartment - Pain with use - diminished or absent sensory function at and distal to area involved |
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15.9.1 Compartment Syndrome Tx
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- immobilize and elevate
- do not use ice - monitor neuro status - analgesics - elevate extremity - no duty - if significant nuero compromise and inability to medevac soon, fasciotomy |
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15.9.1 Compartment Syndrome Complications
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- Permanent nuerovasicular compromise
- Muscle necrosis - Infection |
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15.9.1 Compartment Syndrome Disposition
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Nuero compromise; medevac request
no nuero compromise; medadvice |
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15.9.1 Tendon Laceration S/Sx
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- Pain
- Loss of motion - Lacerations or puncture wounds - Contusion - Muscle in a ball - loss of AROM distal to injury |
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15.9.1 Tendon Laceration Tx
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- Wound care
- Consider wound closure if definitive care is greater than 24 hrs - Immobilized - Antibiotics - Surgical referral upon RTP |
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15.9.1 Tendon Laceration Complications
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- Permanent disability
- Infection- greater significance if flexor tendon |
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15.9.1 Tendon Laceration Disposition
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- Medadvice on all suspected
- May be able to retain partial extensor tendon lacerations |
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15.9.1 Contusion S/Sx
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- Pain/Swelling/Decreased ROM
- Erythema/Eccymosis/Tenderness/ Hematoma, Signs of Shock |
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15.9.1 Contusion Tx
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- Minor - Symptomatic, Avoidance or further truama
- Major - RICE/ ANALGESICS/ Monitor for signs of shock |
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15.9.1 Contusion Complications
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- Internal bleeding
- Shock - Myosistis Ossificans - Nuerovascular compromise |
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15.9.1 Contusions Disposition
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- Retain on board unless complications occure
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15.9.1 Sprain s/sx
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- pain/Loss of function secondary to pain
- Tenderness over involved ligaments - Edema - Ecchymosis - Efusions - Joint Deformity (dislocation) |
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15.9.1 Sprain Grading Scale
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Grade 1 - Partial Tear, no instability of joint
Grade 2 - Partial Tear w/ instability of joint Grade 3 - Total Disruption |
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15.9.1 Sprain Tx
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- RICE
- Grade 1 - RICE/Progressive ROM and strengthening exercises - Grade 2 - RICE/Aircast split/ Progressive ROM and strengthening exercises - Grade 3 - Rice/Immobilize(bulky jones)/cast after swelling subsides/treat as a fracture/ORTHO Eval |
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15.9.1 Sprain Complications
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- Permenant loss of ROM
- Chronic Sprains |
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15.9.1 Sprain Disposition
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- Grades 1/2 - Retain on board as long as ambulatory
- Grade 3 - MEDEVAC |
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15.9.1 Joint Dislocations S/Sx
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- Defomity/Edema/Ecchymosis/ loss of ROM
- Pain/Paresthesias |
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15.9.1 Joint Dislocations Tx
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Acute - Nureo Checks/Prompt Reduction/ ICE/ NARCS/Splint/Sling
Chronic - usually self reduces/ Immobilize/ice/nsaids/ortho referral |
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15.9.1 Joint Dislocations Complications
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- Neuro Compromise
- Fx - recurrence - arthritis - avascular necrosis |
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15.9.1 Joint Dislocations Disposition
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- retain on board
- Medadvice - Medevac - unable to reduce/ neurovascular compromise/ can not move safely around boat |
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15.9.1 Extremity Fx S/Sx
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- Tenderness
- Swelling - ecchymosis - deformity/angulation - unnatural motion - open wound with bone protruding - neuro compromise -Pain/Limited Use |
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15.9.1 Extremity Fx Tx
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Non-Displaced
- Splilnt/ICE/ELEVATE/NSAIDS/PAIN MEDS Open/Displaced - Reduce/Splint/Wound care/tetanus/IV Antibiotics/ IV fluids for blood loss/ Pain Med/ Muscle relaxants to reduce |
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15.9.1 Extremity Fx Complications
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- Nero Comp
- Infection- Oxacillin/clindamycin - Shock - Fat Embolism - Permanent Deformity |
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15.9.1 Extremity Fx Disposition
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- Minor Fx with no Neuro involvement can be retained onboard and referred inport
- Medadvice - Medevac- Open Fx/Displaced Fx/Neuro Comp/Shock/Non-ambulatory/ unable to safely climb ladders |
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15.9.1 Rib Fx s/sx
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- Point Tenderness/Swelling/ Crepitus/Subcutaneous emphysema/ Decreased breath sounds
(hemothorax/Pneumothorax) Flail chest - 2 or more Fx in 2 or more ribs - Pain w/ breathing or motion - SOB - 2nd to pain/pneumo/hemo - pain may increase for a week before improvement occurs |
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15.9.1 Rib Fx Tx
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- Analgesics
- Light Duty to limit motion - Splint flail Segment |
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15.9.1 Rib Fx Complications
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- Pneumothorax, Hemothorax
- Pericardial tamponade - Splenic or hepatic laceration |
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15.9.1 Rib Fx Disposition
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Retain on board if no neuro or respiratory complications, otherwise medevac
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15.9.1 Vertebral Fracture s/sx
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- Localized pain
- muscle spasm - Neuro (Hypereflxia/sensory loss/ loss of sphincter control/ weakness/ paralysis/ progressive nuero signs secondary to hematoma formation. - Back Pain - Neuro (paresthesias to loss of sensation/weakness) |
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15.9.1 Vertebral Fracture Tx
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- ABC's
- Immobilize - Pain meds as indicated - monitor neuro status closely |
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15.9.1 Vertebral Fracture Complications
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Neuro
- Transient (spinal cord concussion) - Permanent (Spinal cord contusion or lacreration) |
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15.9.1 Vertebral Fracture Disposition
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- A severity dependant but at a minimum send medadvice msg
- Medevac any neuro compromise or suspected Fx |
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15.9.4 Rheumatoid Arthritis s/sx
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S- Arthralgia, Usually multiple joints
- Swollen, Erythematous joints - Limited, Painful ROM - Fever/Malaise/ Weight loss/ Splenomegaly Sx- Onset can be insidious - Polyarticular joint pain - Pain is worse in the A.M. initial period or stiffness - Small joints usually affected first(hands/feet) - Early PM malaise and fatigue |
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15.9.4 Rheumatoid Arthritis Tx
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- Local Joint Rest
- Moist Heat - NSAIDS - Corticosteroids |
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15.9.4 Rheumatoid Arthritis Complications
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- Deformity
- Permanent loss of ROM - Vasculitis - Synovial Cysts |
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15.9.4 Rheumatoid Arthritis Disposition
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- Retain and treat onboard
- Medadvice - Refer upon RTP |
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15.9.6 Osteoarthritis S/Sx
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- Crepitus/Enlarged Joint/ Deformity/ Changes on x-ray (spur/angulation)
- Pain/Stiffness/Decreased ROM/ Gradual onset/ Worse after increased activity(exercise) |
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15.9.6 Osteoarthritis Tx
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- NSAIDS
- Rest - Moist Heat - ROM Exercises |
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15.9.6 Osteoarthritis Complications
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- Permanent loss of ROM
- Neuro Deficits |
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15.9.6 Osteoarthritis Disposition
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Retain and treat onboard
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15.9.4 Costochondritis s/sx
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- point tenderness in costal cartilage, normally costochondral junction
- CV and respiratory exams normal sx- Localized pain with movement, respiration or palpation - pain is sharp and stabbing - Associated chest tightness |
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15.9.4 Costochondritis Tx
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- Moist Heat
- NSAIDS - Rest and reassurance |
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15.9.4 Costochondritis Complications
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Chronic Pain
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15.9.4 Costochondritis Disposition
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Retain and treat onboard
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15.9.6 Tendonitis/tenosynovitis s/sx
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s- Tenderness/swelling/erythema/crepitus w/motion(tenosynovitis)/ limited ROM 2nd to pain/ friction rub on auscultation (tenosynovitis)
sx- pain at rest/pain with resisted motion |
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15.9.6 Tendonitis/tenosynovitis Tx
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- Rest - for achilles tendonitis/tenosynovitis non-weight bearing
- ICE -NSAIDS |
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15.9.6 Tendonitis/tenosynovitis Complications
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- Chronic pain
- Tendon Rupture |
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15.9.6 Tendonitis/tenosynovitis Disposition
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Retain and treat onboard and refer if SX's progress/persist
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15.9.6 Bursitis s/sx
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s-Swelling/tenderness / erythema/ decreased ROM/ Large cystic mass(elbow, patella)
Sx- Pain that increases w/ movement/ decreases ROM 2nd to pain or swelling |
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15.9.6 Bursitis Tx
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- NSAIDS
- ICE - Compression - Change shoes or training program - avoid aspiration or injection - IV antibiotics if suspected septic bursitis |
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15.9.6 Bursitis Complications
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- Bacterial Infection
- Muscle Atrophy |
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15.9.6 Bursitis Disposition
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- Retain and treat onboard
- Refer upon RTP if swelling/effusion persists - Medadvice message if suspected septic bursitis |
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15.9.6 Chondromalacia Patella S/Sx
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S- Tenderness under borders of patella,Tenderness with patellar compression, quadriceps atrophy - especially VMO
Sx- Pain that increases significantly with ascending or descending stairs, pain may radiate to back of knee, weakness or quads, pain with resisted extension |
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15.9.6 Chondromalacia Patella Tx
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- NSAIDS
- Rest - Moist heat or ice - SLR's, Quad Sets(isometric) |
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15.9.6 Chondromalacia Patella Complications
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- Chronic Pain
- Difficulty with activities or Daily Living |
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15.9.6 Chondromalacia Patella Disposition
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- Retain and treat onboard
- Refer in port(true Dx is Surgery) - May be Disqual |
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15.9.5 Special Infection S/Sx
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S-swelling, erythema, purulence, tenderness
sx- pain, decreased ROM, loss of function/use, fever, malaise, tenosynovitis |
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15.9.5 Special infection tx
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Mild-Afebrile
-I&D - Oral Antibiotics - Heat - Limit use - Elevate Severe-Febrile -IV Antibiotics -Wound care -rest -moist heat -elevation |
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15.9.5 Special Infection Complications
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- sepsis-Death
- Compartment syndrome - gangrene/necrosis - flexor tendon adhesions |
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15.9.5 Special Infection Disposition
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- Mild Infections - Retain and treat onboard
- Severe infections - medevac if unable to achieve afebrile state or any complications |
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15.9.5 Septic Joint S/Sx
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s-tenderness, erythema, limited ROM, fever
sx-pain even at rest increases with use, malaise, sweats, chillls |
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15.9.5 Septic Joint Tx
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iv antibiotics, moist heat, rest, elevations
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15.9.5 Septic joint Complications
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-deformity
-permanent loss of function -Systemic infection |
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15.9.5 Septic Joint Dispostion
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Medadvice msg
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15.9.6 Back Pain S/Sx
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S-Altered posture/gait, decreased trunk ROM, Palpable muscle spasms, tenderness, Sensory or motor changes, pelvic misalignment, lateral curvature of the spine
sx- Pain/Decreased or loss of sensation, decreased strength |
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15.9.6 Back Pain Tx
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Rest,NSAIDS, Stretching exercises, ice, moist heat, strengthening exercises
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15.9.6 Back Pain Complications
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- Nerve root compression
- Chronic pain/loss of function - Chronic pain syndrome - major psychogenic syndrome |
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15.9.2 Ganglion Cyst S/Sx
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s- Well localized swelling on dorsum of wrist, tenderness, cystic feeling on palpation, may be slightly moveable
sx- Pain with flexion/extension, pain may be intermittent or only occur at end ranges or motion |
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15.9.2 Ganglion Cyst Tx
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NSAIDS, Reassurance, Ice, Refer for surgical removal
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15.9.3 Gout s/sx
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s- Swelling, erthema, tenderness, warm to touch, tense, skinny skin, fever
sx- Pain, Malaise, Nocturnal onset |
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15.9.3 gout tx
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acute attack-
-indocin 50mgQID -DC penicillin admin -rest -elevation -ice prn -tylenol -maintain adequate fluids -avoid foods that increase urate metabolism -refer in port |
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15.9.6 back pain Disposition
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- Retain on board
- MEDADVICE msg if neuro symptoms present - Refer in port if no change in sx's |
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15.9.1 Strain s/sx
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- Pain, Limited use, loss ROM
- Tenderness over muscle, edema, ecchymosis, guarding |
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15.9.1 Strain Grading scale
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Grade 1 - Minimal damage to muscle/tendon
Grade 2 - Partial tear to muscle/tendon Grade 3 - Complete disruption/rupture |
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15.9.1 Strain Tx
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Grade 1- RICE, ROM, NSAIDS
Grade 2- RICE, Splint in position 48hrs, ROM post 48hrs, NSAIDS Grade 3- Immobilize, NSAIDS, PRN meds as needed. |
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15.9.1 Strain Complications
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- Compartment syndrome
- Partial rupture becomes complete |
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15.9.1 Strain Disposition
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Grade 1/2- treat on board as long as patient is able to move about boat safely
Grade 3- Medevac |
