First Aid-Nursing

Chapter 14 Bone, Joint, and Muscle Injuries

Bone Injuries

• Associated with a forceful cause of injury • May present with obvious disfigurement • The real problems associated with

fractures are the potential injury to the vital organs next to them.

Fractures

• Fracture and broken bone both mean a break or crack in a bone.

• Two categories − Closed—skin is intact. − Open—skin has been

broken.

© Jones & Bartlett Learning.

Types of Fractures

• Greenstick—incomplete fracture • Traverse—cut across bone at right angles • Oblique—cross bone in a slanting direction

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Types of Fractures

• Comminuted—bone is fragmented into more than two pieces

• Impacted—broken ends are jammed together

• Spiral—results from a twisting injury

Fractures: What to Look For

• Use DOTS to assess for injury: − Deformity − Open wounds − Tenderness − Swelling

© E. M. Singletary, M.D. Used with permission.

Fractures: What to Look For

• Loss of function • Guarding • Crepitus—grating sensation • History of injury that includes a serious

incident

Fractures: What to Do

• Check for life-threatening conditions first. • Gently remove clothing covering the area. • Look and feel for DOTS.

Fractures: What to Do

• Check pulse and nerves using the mnemonic CSM. − C—Circulation

• For arm injury, feel for radial pulse.

• For leg injury, feel for posterior tibial pulse.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Fractures: What to Do

• Use CSM (cont’d) − Sensation

• Lightly touch or squeeze one of the person’s toes or fingers while his or her eyes are closed.

• Ask which finger or toe he or she feels.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Fractures: What to Do

• Use CSM (cont’d) − M—Movement

• Have the person wiggle his or her toes and fingers. © Jones & Bartlett Learning. Courtesy of MIEMSS.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Fractures: What to Do

• Stabilize part. • For open fracture:

− Do not push on protruding bones.

− Cover wound with a dressing.

• Seek medical care. © American Academy of Orthopaedic Surgeons.

Joint Injuries

• A joint is where two or more bones come together.

Dislocations

• A dislocation occurs when a joint comes apart and stays apart with the bone ends no longer in contact.

© American Academy of Orthopaedic Surgeons.

Dislocations: What to Look For

• Deformity (main sign) • Tenderness, severe pain • Swelling • Inability to move injured part • Numbness or impaired circulation of

extremity

Dislocations: What to Do

• Call 9-1-1 if: − Extremity looks blue or extremely pale − Transport of the person would be difficult or

might aggravate the injury • Check the CSM.

Dislocations: What to Do

• If EMS will arrive soon, hold injured part to stabilize until they arrive.

• If EMS will be delayed or you are transporting to distant medical care, use the RICE procedure.

• Do not try to reduce a dislocation.

Sprains

• Occurs when a joint is twisted or stretched beyond its normal range of motion − Results in partially

or completely torn ligaments

© Sean Gladwell/Dreamstime.com.

Sprains: What to Look For

• Similar signs and symptoms to a fracture − Severe pain − Swelling − Discolored skin around the joint

Sprains: What to Do

• Use the RICE procedure. − Rest. − Ice. Apply for 20 minutes. − Compression. Apply for 3 to 4 hours.

• Repeat the cycle of ice and compression. − Elevate. Raise the injured part.

Muscle Injuries

• Muscle injuries pose no real emergency.

Strains

• Occurs when a muscle is stretched beyond its normal range of motion

• Inflammation begins immediately. − Can take 24 to 72 hours for pain and stiffness

to begin

Strains: What to Look For

• Occurs during physical activity • Sharp pain • Extreme tenderness • Inability to use injured part • Stiffness and pain when muscle is used

Strains: What to Do

• Use the RICE procedure.

Cramps

• Occurs when a muscle goes into an uncontrolled spasm and contraction

• Associated with diabetes, atherosclerosis, and physical activity

• Two categories − Night cramps − Heat cramps

Cramps: What to Look For

• Sudden, severe muscle pain • A muscle, often calf muscle, that feels

hard because of muscle contraction • Residual discomfort, may last for a few

hours

Cramps: What to Do

• Gently stretch the muscle. • Relax the muscle. • Apply an ice pack. • For heat cramps:

− Drink lightly salted cool water. − Drink a commercial sports drink.

Muscle Contusion

• A muscle contusion or bruise results from a blow to the muscle.

Contusions: What to Look For

• Person reports blow to a muscle • Swelling • Pain and tenderness • Black and blue mark appearing hours later

Contusions: What to Do

• Use the RICE procedure. • Seek medical care for any contusion larger

than the person’s palm.