United States
Department of Transportation
National Highway
Traffic Safety Administration
Paramedic: National Standard Curriculum
(Reprinted with
permission)
http://www.nhtsa.dot.gov/people/injury/ems/
Musculoskeletal
Trauma: 9
UNIT TERMINAL
OBJECTIVE
4-9 At the completion of this unit, the
paramedic student will be able to integrate pathophysiological principles and
the assessment findings to formulate a field impression and implement the
treatment plan for the patient with a musculoskeletal injury.
COGNITIVE
OBJECTIVE
At the completion
of this unit, the paramedic student will be able to:
4-9.1 Describe the incidence, morbidity, and
mortality of musculoskeletal injuries. (C-1)
4-9.2 Discuss the anatomy and physiology of the
musculoskeletal system. (C-1)
4-9.3 Predict injuries based on the mechanism of
injury, including: (C-3)
1.
Direct
2.
Indirect
3.
Pathologic
4-9.4 Discuss
the types of musculoskeletal injuries: (C-1)
a. Fracture (open and closed)
4.
Dislocation/ fracture
5.
Sprain
6.
Strain
4-9.5 Discuss
the pathophysiology of musculoskeletal injuries. (C-1)
4-9.6 Discuss the assessment findings associated
with musculoskeletal injuries. (C-1)
4-9.7 List the six "P"s of musculoskeletal
injury assessment. (C-1)
4-9.8 List the primary signs and symptoms of
extremity trauma. (C-1)
4-9.9 List other signs and symptoms that can
indicate less obvious extremity injury. (C-1)
4-9.10 Discuss the need for assessment of pulses,
motor and sensation before and after splinting. (C-1)
4-9.11 Identify the need for rapid intervention and
transport when dealing with musculoskeletal injuries. (C-1)
4-9.12 Discuss the management of musculoskeletal
injuries. (C-1)
4-9.13 Discuss the general guidelines for splinting.
(C-1)
4-9.14 Explain the benefits of cold application for
musculoskeletal injury. (C-1)
4-9.15 Explain the benefits of heat application for
musculoskeletal injury. (C-1)
4-9.16 Describe age associated changes in the bones.
(C-1)
4-9.17 Discuss the pathophysiology of open and
closed fractures. (C-1)
4-9.18 Discuss the relationship between volume of
hemorrhage and open or closed fractures. (C-3)
4-9.19 Discuss the assessment findings associated
with fractures. (C-1)
4-9.20 Discuss the management of fractures. (C-1)
4-9.21 Discuss the usefulness of the pneumatic
anti-shock garment (PASG) in the management of fractures. (C-1)
4-9.22 Describe the special considerations involved
in femur fracture management. (C-1)
4-9.23 Discuss the pathophysiology of dislocations.
(C-1)
4-9.24 Discuss the assessment findings of
dislocations. (C-1)
4-9.25 Discuss the out-of-hospital management of
dislocation/ fractures, including splinting and realignment. (C-1)
4-9.26 Explain the importance of manipulating a knee
dislocation/ fracture with an absent distal pulse. (C-1)
4-9.27 Describe the procedure for reduction of a
shoulder, finger or ankle dislocation/ fracture. (C-1)
4-9.28 Discuss the pathophysiology of sprains. (C-1)
4-9.29 Discuss the assessment findings of sprains.
(C-1)
4-9.30 Discuss the management of sprains. (C-1)
4-9.31 Discuss the pathophysiology of strains. (C-1)
4-9.32 Discuss the assessment findings of strains.
(C-1)
4-9.33 Discuss the management of strains. (C-1)
4-9.34 Discuss the pathophysiology of a tendon
injury. (C-1)
4-9.35 Discuss the assessment findings of tendon
injury. (C-1)
4-9.36 Discuss the management of a tendon injury.
(C-1)
4-9.37 Integrate the pathophysiological principles to
the assessment of a patient with a musculoskeletal injury. (C-3)
4-9.38 Differentiate between musculoskeletal
injuries based on the assessment findings and history. (C-3)
4-9.39 Formulate a field impression of a
musculoskeletal injury based on the assessment findings. (C-3)
4-9.40 Develop a patient management plan for the
musculoskeletal injury based on the field impression. (C-3)
AFFECTIVE
OBJECTIVES
At the completion
of this unit, the paramedic student will be able to:
4-9.41 Advocate the use of a thorough assessment to
determine a working diagnosis and treatment plan for musculoskeletal injuries.
(A-3)
4-9.42 Advocate for the use of pain management in
the treatment of musculoskeletal injuries. (A-3)
PSYCHOMOTOR
OBJECTIVES
At the completion
of this unit, the paramedic student will be able to:
4-9.43 Demonstrate a clinical assessment to
determine the proper treatment plan for a patient with a suspected
musculoskeletal injury. (P-1)
4-9.44 Demonstrate the proper use of fixation, soft
and traction splints for a patient with a suspected fracture. (P-1)
DECLARATIVE
I. Introduction
A. Epidemiology
1. Incidence
a. 70-80% of polytrauma patients suffer
musculoskeletal injuries
b. Blunt trauma
c. Penetrating trauma
2. Mortality/ morbidity
a. Upper extremity injury
(1) Contribute to long-term impairment
(2) Rarely life-threatening
b. Lower extremity injury
(1) Associated with higher magnitudes of
injury
(2) More significant blood loss
(3) More difficult to manage in polytrauma
patient
(4) Femur and pelvic injuries may constitute
life threats
3. Risk factors
4. Prevention strategies
a. Proper sports training
b. Wearing seat belts
c. Child safety seats
d. Airbags
e. Gun safety and education
f. Motorcycle driver education
g. Fall prevention
h. Highrise window guards
i. Other means of preventing
musculoskeletal trauma
5. Review of musculoskeletal anatomy
a. Skin
(1) Layer
(2) Thickness
b. Subcutaneous
(1) Fat
(2) Fascia
c. General breakdown of the skeletal
system
(1) Axial skeleton
(a) Forms the central (longitudinal) axis of
the body, includes the following bones
i) Skull
ii) Vertebral column
iii) Bony thorax
(b) Appendicular skeleton
(c) Pectoral girdle - bones that attach the
upper limbs to the axial skeleton
i) Clavicle
ii) Scapula
(d) Pelvic girdle - consists of the paired
bones of the pelvis that attach the lower limbs to the axial skeleton, and the
sacrum
(2) Vessels
(a) Arteries
i) Axillary
ii) Brachial
iii) Radial
iv) Ulnar
v) Hand arcade
vi) Digital
vii) Femoral
viii) Popliteal
ix) Dorsalis pedis
x) Posterior tibial
xi) Anterior tibial
xii) Foot arcade
xiii) Digital
(3) Muscles
(a) Latissimus dorsae
(b) Trapezius
(c) Rhomboids
(d) Deltoid
(e) Triceps
(f) Biceps
(g) Forearm extensors
(h) Intrinsic muscles of hand
(i) Hamstring group
(j) Quadriceps group
(k) Adductor group
(l) Gastrocenemius solius
(m) Intraosseos
(4) Tendons
(a) Extensors
(b) Flexors
(5) Bones
(a) Components of a longbone
i) Diaphysis
a) Long, narrow shaft
b) Very dense, compact bone
c) Yellow bone marrow that stores fat
ii) Periosteum
a) Outer covering for long bones
b) Vascular and full of nerves
c) Haversian canals allow circulation of
blood
iii) Epiphysis
a) Articulated, widened end
b) Cancellous bone filled with red blood
marrow
c) Responsible for growth in the infant
and child
d) Weakest point in a child’s bone and
weaker than a child’s ligaments
iv) Metaphysis
a) Area between the epiphysis and
diaphysis
(6) Scapulae
(a) Upper division
(b) Lower division
(c) Glenoid fossa
(7) Clavicle
(a) Claviclulo-sternal joint
(b) Acromio-clavicular joint
(8) Humerus
(a) Head
i) Anatomical neck
ii) Surgical neck
(b) Tuberosities
(c) Shoulder joint
(d) Neck
(e) Shaft
(f) Medial condyle
(g) Lateral condyle
(h) Elbow
(9) Radius
(a) Elbow
(b) Head
(c) Shaft
(d) Wrist
(10) Ulna