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122 Cards in this Set

  • Front
  • Back
8 Musculoskeletal Conditions (8)
Traumatic
- fracture
- sprain
- strain
- dislocation
- compartment syndrome

Non Traumatic
- scoliosis
- osteoporosis
- arthritis
Fracture: pathophysiology (1)
- force applied to bone tissue beyond its tolerance levels usually via direct, indirect, twisting or high energy injuries
Fracture Classifications (4)
- closed fracture
- open fracture
- non-displaced fracture
- displaced fracture
Closed Fracture (1)
a fracture that does not break the skin
Open Fracture (1)
external wound associated with a fracture
Non-displaced Fracture (1)
simple crack of the bone with no deformity
Displaced Fracture (1)
fracture in which there is an actually deformity of the bone
Fracture: signs / symptoms (10)
- deformity
- tenderness
- guarding
- swelling
- ecchymosis
- crepitus
- false motion (appearance of a joint where there should not be one)
- exposed fragments
- pain
- locked joint
Fracture: treatment (6)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport
- immobilize the injury
Greenstick Fracture (1)
an incomplete fracture that passes only partway through the shaft of the bone, may still cause angulations, often occurs in children
Comminuted Fracture (1)
when the bone is broken into more than two fragments
Pathological Fracture (1)
a fracture of weakened or diseased none; osteoporosis, osteogenesis imperfecta
Epiphyseal Fracture (1)
a fracture that occurs in the growth section of a child's bone which may prematurely stung growth if not properly treated, occurs in fractures of bone ends
Dislocation: pathophysiology (2)
- a disruption of a joint in which the bones ends are no longer in contact
- supporting ligaments are stretched or torn allowing the bone ends to separate completely from each other
Dislocation: signs / symptoms (6)
- marked deformity
- swelling
- pain aggravated by movement
- tenderness on palpation
- complete loss of normal joint motion
- numbness or impaired circulation distal to the injury
Dislocation: treatment (6)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport
- immobilize the injury (do not manipulate it at all)
Are EMR's allowed to put dislocations? (1)
no, only allowed to immobilize in the position found
Sprain: pathophysiology (2)
- the stretching or tearing of ligaments
- occurs at a joint, most commonly the knee and ankle
Sprain: signs / symptoms (6)
- point tenderness
- swelling
- ecchymosis
- pain
- increased range of motion - due to ligaments being damaged, the joint can move more then it is supposed to
- guarding
Ecchymosis
bruise
Sprain: treatment (6)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport
- immobilize the injury
Strain: pathophysiology (5)
- the stretching of tearing of tendons or muscles
- AKA "muscle pull"
- commonly the result of quick sprints while running
- there is localized tenderness or a "bulge" more commonly at the inner region of the back of the leg
- pain is aggravated by walking, descending stairs, or raising heel of the affected leg off the ground
Strain: treatment (6)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport
- immobilize the injury
Possible complications of Musculoskeletal Injuries (7)
- hemorrhage
- instability
- loss of tissue
- simple laceration and contamination
- interruption of blood supply
- nerve damage
- long term disability
Compartment Syndrome: pathophysiology (3)
- elevated pressure within the fascial compartment (fibrous tissue that surrounds muscles and neuromuscular structures)
- occurs up to 12 hours after injury, usually as a result of excessive bleeding, a severely crushed extremity, or a rapid return of blood to an ischemic limb
- lack of blood flow to an area results in toxic build ip of metabolites at site, followed by necrosis
Compartment Syndrom: signs / symptoms (4)
- pain that is disproportionate to the injury
- pallor
- decreased sensation
- decreased power
Compartment Syndrom: treatment (6)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport
- immobilize the injury
What is the definitive treatment for compartment syndrome in a hospital setting? (1)
surgical intervention
Scoliosis: pathophysiology (1)
- an abnormal curvature of the spine, results in S-curving of the spin laterally
Scoliosis: signs / symptoms (6)
- uneven waist and shoulders
- prominent shoulder blade(s)
- elevated hips
- leaning to one side
- pain from disc degeneration
- possibility of pinching a nerve or slipping a disc
Scoliosis: treatment (5)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport (commonly for pain management)
Another possible effect of scoliosis on respiration is.. (1)
respiration dysfunction due to severe curvature
Osteoporosis: pathophysiology (3)
- is a disease characterized by low bone mass and deterioration of bone tissue
- this leads to increased bone fragility and risk of fracture, particularly of the hip, spine and wrist
- is often known as "the silent thief" because bone loss occurs without symptoms
Osteoporosis: signs / symptoms (1)
kyphosis (unusual curvature of upper spine)
Osteoporosis: Risk Factors (4)
- age >65
- family history
- post menopausal
- low dietary calcium intake
Osteoporosis: treatment (6)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport
- immobilize any musculoskeletal injury appropriately as you find it
Arthritis: pathophysiology (2)
- an inflammation of a joint
- this disease has many forms and varies widely in its effects, two common ones are (osteoarthritis Arthritis, rheumatoid arthritis)
Osteoarthritis Arthritis (1)
- results from cartilage loss and ware and tear of the joints (common in the elderly)
Rheumatoid Arthritis (1)
- an autoimmune disorder that damages joints and surrounding tissues
Arthritis: signs / symptoms (4)
- pain in joints
- pain can be increased with barometric pressure changes
- stiffness of joints
- swelling of joints
Arthritis: treatment (8)
- may have to modify exam due to decreased range of motion
- equipment must be made to "fit the patient" (think backboard)
- high flow O2
- AMPLE
- OPQRSTA
- vital signs
- transport

* these patients are commonly on Analgesics, ensure to BRING them!
Generalized Musculoskeletal Assessment & Treatment (5)
- rapid respirations and pulse accompany pain, may not be signs of shock
- if patient critically injured, transport immediately (DO NOT SPLINT ON SCENE- if the patient is a load and go)
- be alert for compartment syndrome
- splint injury after assessing it in the secondary
- check CMS status before and after splinting and after palpating in the primary survey
Generalized Musculoskeletal Assessment & Treatment: Evaluating CMS Function (3)
- examination of the injured limb should include assessment of the following: circulation, motor function, sensation
Generalized Musculoskeletal Assessment & Treatment: Capillary Refill (relevant in children and infants) (2)
- should be less than 2 seconds
- should be the same as the uninjured limb
Generalized Musculoskeletal Assessment & Treatment: Critical Musculoskeletal injuries (3)
- multiple open fractures of limbs
- pelvic fractures with hemodynamic instability
- bilateral femur fractures
Splinting (4)
- flexible or rigide device used to protect extremity
- injuries should be splinted prior to moving patient, unless the patient is critical (we manually mobilize on scene only)
- splinting helps prevent further injury to muscles, nerves, blood vessels and bid and decrease pain
Types of splints (8)
- Traction splints
- KED
- Sling & Swathe
- Wood splints
- Vacuum splints
- Air splints
- Wire splints
- Speed splints
Rigid Splints (3)
- cannot change shape
- required body part to be positioned to fit splint (board splints, some cardboard splints)
- pad before use
Soft or Formable Splints (1)
- mild into various shapes to accommodate injured body part
Examples of Soft or Formable Splints (8)
- pillows
- blankets
- slings & swathes
- vacuum splints
- some cardboard splints
- wire ladder splints
- padded, flexible aluminum splints
- inflatable splints (not used for injuries close to knee or below)
Traction Splints (2)
- mid-shaft femur fractures only
- provide traction to stabilize and align the femur or femurs
RICE
R - rest
I - immobilize
C - cold
E - elevate
Splinting Fractures / Splints: RICE (9)
Immobilize
- assess pulse, motor & sensory function
- prepare equipment prior to patient movement
- 1 move allowed to position patient for splinting
- generously pad the splint
- splint above & below injury site
- immobilize the joint above and below
- cover the minimum amount of anatomy requires, ensure visibility of deformity site
- reassess pulse, motor & sensory function
- requires one EMS practitioner to maintain stabilization as the other applies splinting materials
Splinting Joints / Dislocations / Sprains: RICE (8)
Immobilize
- assess pulse, motor & sensory function
- prepare equipment prior to patient movement
- 1 move allowed to position patient for splinting
- generously pad the splint
- immobilize in position found
- cover the minimum amount of anatomy requires, ensure visibility of deformity site
- reassess pulse, motor & sensory function
- requires one EMS practitioner to maintain stabilization as the other applies splinting materials
Hazardous of Improper Splinting (5)
- compression and/or injury to nerves, tissues, and blood vessels
- delay in transport of a patient with a life-threatening condition ("splinting a patient to death")
- reduction of distal circulation
- aggravation of the injury
- splinting should be done en route for Load & Go patients, NEVER on scene. However, manual immobilization needs to occur during movement on scene
In-Line Traction Splinting of a Femur Only (6)
- act of exerting a pulling force on a bony structure in the direction of it's normal alignment
- realigns fracture of the shaft of a long bone and decreases leg muscle spasm lending itself to decreasing pain
- use the least amount of force necessary (max 10% of the pt's body weight, max 15lbs of traction for any sized patient
- if resistance is met or pain increases, splint in deformed position
- only a traction splint can apply traction, the EMR should manually immobilize the leg until a traction splint is available (usually done en-route)
- used only for mid-shaft femur fracture, single or bilateral if you have a bilateral sager splint (injury must be located one hand width distal to hip joint and one hand width proximal to the knee
Contraindications to an in- line traction splinting of a femur (3)
- hip, knee, lower leg or ankle are injured on affected side
- inability to properly size the device (really tall pt)
- ensure the rear ambulance doors to not impact the traction splint as it sticks out about 12" pas patients heel
Applying an Air Splint (6)
- hold the injured limb, apply gentle traction and support the injury site
- partner should place splint around extremity
- if splint has a zipper, zip the splint up
- inflate by pump or by mouth, to the point where complete compression is still possible
- check and record distal neurovascular function
- consider changes in altitude and temperature changes and their effects on the air pressure inside the splint
Applying a Vacuum Splint (5)
- stabilize and support the injury
- place the splint and wrap it around the limb
- draw the air out of the splint with the supplied vacuum device and seal the valve
- check and record distal neurovascular function
- rare on ambulances due to exceptional cost
Why would you realign a fracture? (1)
if circulation is impaired
Realignment (1)
attempt to reposition to anatomical position, any grossly deformed mid-shaft fractures of extremities
Rules of Realignment of a grossly deformed mid-shaft fracture (3)
- never realign if it COULD be a joint
- only 1 attempt can be made
- mid-shaft is defined as "more than 1 hand width away from the joint"
Realignment Technique & guideline (8)
- handle injury carefully
- gentle manipulation to anatomical position or until circulation returns
- if obvious resistance to alignment, splint extremity without repositioning
- one attempt at realignment is made in prehospital setting
- only if there is a circulation compromise
- consult with medical direction (if unsure)
- perform manipulation as soon as possible after injury
- assess and document circulation, motor function and sensation before and after manipulating injured extremity
Perfusion (1)
the circulation of blood within an organ or tissue in adequate amounts to meet the cells current needs for oxygen, nutrients and waste removal
Hemorrhage (1)
to bleed
Coagulation (1)
the contracting of a blood vessel and formation of a clot plugging a hole in a injured blood vessel
Closed Injuries (1)
soft tissue damage beneath the skin
Open injuries (1)
break in the surface of the skin
Burns (1)
soft tissue receives more energy than it can absorb
Which tissues/organs require a constant supply of blood? (4)
- brain
- heart
- lungs
- kidneys
Which tissues/organs only require blood when active? (2)
- muscles
- GI tract
When the cardiovascular system fails to provide sufficient circulation for every body part to perform its function, it is called …. or …… (2)
- shock
- hypoperfusion
The body can tolerate …….% loss of blood rapidly or a …..% loss of blood over a period of time. (2)
10 %
20%
Arterial Bleeding: pathophysiology (1)
some form of trauma has broken through the skin and cut a blood vessel leading away from the heart
Arterial Bleeding: signs / symptoms (6)
- spurting, bright red blood
- a lot of blood around the patient
- tachycardia
- tachypnea
- hypotension
- altered LOC
Arterial Bleeding: treatment (6)
- control the bleeding
- high O2
- AMPLE
- OPQRSTA
- vital signs
- transport
When dealing with Arterial Bleeding, what must you ensure for your own safety? (1)
BSI, wear appropriate PPE
Venous Bleeding: pathophysiology (1)
some form of trauma has broken through the skin and cut a blood vessel leading towards the heart
Venous Bleeding: signs / symptoms (2)
- oozing or flowing, dark red blood
- anxious patient
Venous Bleeding: treatment (6)
- control the bleeding
- high row O2
- AMPLE
- OPQRSTA
- vital signs
- transport (consider for stitches)
Capillary Bleeding: pathophysiology (1)
nasty encounter with pavement of the edges of a piece of paper or envelope
Capillary Bleeding: signs / symptoms (2)
- oozing small quantity of blood
- unusual amounts of pain relative to the injury
Capillary Bleeding: treatment (7)
- control the bleeding
- consider high O2
- AMPLE
- OPQRSTA
- vital signs
- consider transport
- inquire about hemophilia (high O2 & transport in this case)
Generalized External Hemorrhaging Assessment & Treatment (4)
- ensure BSI, including eye protection and the possibility of a gown
- treat deadly (arterial) bleeding as soon as possible (delegate)
- bleeding should stop within 10 minutes
- all bleeding will stop eventually
Methods to Control External Hemorrhaging (7)
- direct pressure
- pressure point
- pressure dressing
- elevation
- cryogenic therapy
- tourniquet
- patient position
Direct Pressure (2)
- assists clotting by decreasing blood flow through vessels and stimulated clotting factor
- may be easily delegated
Pressure Point (3)
- assists clotting by decreasing blood flow through the vessel NOT stopping it
- may be delegated
- often used in conjunction with pressure dressing
Pressure Dressing (4)
- assists clotting by decreasing blood flow
- stimulating clotting factor
- providing stopping point for blood exiting the body (dressing)
- are designed to be snug, but not restrict blood flow distal to where they are applied
Elevation (3)
- this assists clotting by decreasing blood flow through the vessel
- may be delegated
- direct pressure and elevation go hand in hand
Cryogenic Therapy / Cold Therapy (
- assists clotting by causing vasoconstriction at the site, thereby reducing blood flow through the affected area
- area should be cold, NOT frozen
- this is used in conjunction with pressure dressing and possibly pressure point
Tourniquet (1)
- assists clotting by completely cutting off ALL blood flow distal to where the tourniquet is applied
- consult with on line medical direction first
- DO NOT loosen the tourniquet once applied
Applying a Tourniquet (10)
- fold a triangular bandage into 4" wide cravat
- wrap the bandage around the extremity (as close to injury as possible, but not over a joint)
- use a stick as a handle to twist and secure the stick as tight as needed/tolerated
- write "TK" and time and place on patient's forehead
Patient Position assisting in Blood Clotting (2)
- assists blood clotting by reducing the force that is required by the heart to adequately perfuse all tissues
- place the patient in Supine (and elevating the part that's bleeding) reduces workload on the heart, thereby the force of blood traveling past an injured site is slowed
List of Dressing and Bandage Materials (13)
- field dressing
- bandage
- sterile and Non sterile Dressings
- Occlusive/ Non occlusive dressings
- adherent/ Non adherent dressings
- absorbent/ Non absorbent
- wet / dry dressings
- self adherent roller bandages
- gauze bandages
- adhesive bandages
- elastic (tensor) bandages
- triangular bandages
- steril strips
Field Dressing (1)
material placed directly on the wound to control bleeding and maintain would cleanliness
Bandagen (1)
material used to hold a dressing in place and to apply pressure to control hemorrhaging
Sterile and Non-sterile Dressings (2)
- sterile: direct wound contact like a abdominal pad
- non sterile: bulk dressing above sterile layer to add bulk or absorptive power
Occlusive / Non-occlusive Dressings (1)
sterilized plastic wrap and petroleum impregnated gauze are designed to prevent the movement of fluid and air through them
Adherent / Non adherent Dressings (2)
- adherent: stick to drying blood and fluid, they promote clot formation and reduce hemorrhage
- non adherent: specially treated with chemicals to prevent the wound fluids and clotting materials from adhering to the dressings - preferred for most uncomplicated wounds
Wet / Dry Dressings (2)
- wet: sometimes applied to special types of wounds (burns), sterile saline is the usual fluid used to wet dressings, they provide a medium for the movement of infectious mater into wounds
- dry: most often employed for wounds in prehospital care
Self adherent Roller Bandages (2)
- have limited stretch and resist unraveling, conforms well to body contours and is quick to apply
- this bandage is appropriate for injuries which require circumferential wrapping
Gauze Bandages (2)
- convenient for securing dressings, they do not stretch and thus do not conform to body contours
- because they do not stretch, they may increase the pressure associated with tissues swelling at injury sites
Adhesive Bandages (3)
- this is a strong plastic, paper or fabric material with adhesive applied to one side
- it can effectively secure a small dressing where circumferential wrapping is impractical
- if used circumferentially they DO NOT stretch to allow for tissue swelling
Elastic (Tensor) bandages (2)
- stretch easily to conform to body contours, provide stability and support for minor musculoskeletal injuries
* it is very easy to apply too much pressure with them effectively causing compartment syndrome - like effect
Triangular bandages (3)
- AKA cravats
- are strong, non-elastic bandages commonly used to make slings, swathes and to affix splints
- they do not maintain pressure or immobilize wound dressings very well
Steri Strip (5)
- also known as temporary stitch
- surgical strips of adhesive backed paper tape that are places across an incision or minor cut
- they keep the wound sterilized, however they are not used to keep the wound together
- they may be taken off 2-3 days after having stitches
- these are sometimes used instead of sutures because they lessen scarring and are easier to care for
Internal Bleeding: pathophysiology (1)
some form of trauma has caused internal structures to be compressed, torn or lacerated by other internal (or occasionally external) structures
Internal Bleeding: Signs and symptoms (14)
- *main* signs of hypovolemic shock without obvious cause (likely bleeding or blood around the patient)
- low volume shock
- tachycardia
- tachypnea
- hypotension
- LOC
- discolouration (usually in abdomen or femoral areas)
- hematoma
- hematemesis
- melena
- hematochezia
- hemoptysis
- pain, tenderness, brushing, guarding, or swelling
- broken ribs, bruises over the lower chest, or rigid, distended abdomen
Hematoma (1)
bleeding beneath the skin, the EMR may see the formation of the hematoma
Hematemesis (1)
blood in vomit
Melena (1)
black, tarry stool
Hematochezia (1)
red runny stool
Hemoptysis (1)
coughing up blood
Internal Bleeding: treatment (4)
- high flow O2
- AMPLE/OPQRSTA
- vital signs
- transport
Internal Bleeding: Other notes (2)
- definitive (corrective) care for this patient is the OR
- always suspect internal bleeding when high velocity trauma has been sustained
4 Specific bleeding conditions (4)
- skull fractures
- facial injuries
- sinusitis
- digital trauma / epistaxis
Skull Fractures: pathophysiology (1)
a large amount of force has been applied to the cranium possibly resulting in internal bleeding and/or spinal injury
Skull Fractures: signs & symptoms (7)
- blood or CSF from ears
- ecchymosis behind ears (battle signs)
- ecchymosis around eyes (raccoon eyes)
- altered LOC
- possibly Cushing's Triad
- nausea & vomiting
- seizures
Skull Fractures: Treatment (3)
- high flow O2, AMPLE/OPQRSTA, vitals signs, transport
- full spinal motion restriction protocols
- loosely cover ear to allow for drainage
Skull Fractures: (1)
the fluid the is escaping the cranium (usually the ears) may be acting as a "pressure reliever" therefore we never try to stop any fluids coming from the head
Facial Injuries: pathophysiology (1)
a large amount of force has been applied to the face possibly resulting in bleeding and / or spinal injury
Facial Injuries: Signs & symptoms (
.