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/

Trauma: 4

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

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

(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

(7) Clavicle

(a) Claviclulo-sternal joint

(b) Acromio-clavicular joint

(8) Humerus

(a) Head

i) Anatomical neck

ii) Surgical neck

(b) Tuberosities

(d) Neck

(e) Shaft

(f) Medial condyle

(g) Lateral condyle

(h) Elbow

(9) Radius

(a) Elbow

(b) Head

(d) Wrist

(10) Ulna