Musculoskeletal Injuries - NREMT

Region: Shoulder / AC separation. What is the key care & notes?

Sling & swathe, fingers exposed for CSM checks.

Common in sports; clavicle driven away from scapula.

Region: Humerus, Distal = supracondylar or intercondylar

What is the key care & notes?

Rigid splint or sling & swathe; cravat for support.

Traction only if distal circulation is compromised.

Region: Elbow. What is the key care & notes?

Rigid/soft splint; gentle traction if distal pulse absent.

High swelling risk.

Region: Pelvis (GREATEST threat w/ HYPOTENSION). What is the key care & notes?

Pelvic sling/binder, monitor for shock (1500–3000 mL loss).

Check stability by gentle compression if not painful.

Region: Hip (proximal femur). What is the key care & notes?

Shortened & externally rotated leg; no traction splint; pad & scoop stretcher.

Elderly common; massive bleeding risk.

Region: Femur shaft. What is the key care & notes?

Traction splint (if isolated).

Blood loss 500–1500 mL; reduces pain & bleeding.

Region: Knee dislocation. What is the key care & notes?

If no distal pulse, gentle traction; if pulse returns → splint; otherwise immobilize as found.

Region: Tibia/Fibula. What is the key care & notes?

Often open; cover bone ends moist sterile, rigid/air/pillow splint.

Region: Foot/Hand. What is the key care & notes?

Splint foot in pillow, hand in position of function (slight flexion).

What’s the difference between tendons vs. ligaments (and fascia)

Structure	Connects	Common Injury
Tendon	Muscle → bone	Strain
Ligament	Bone → bone	Sprain
Fascia	Surrounds muscle/organ	Compartment syndrome if inflamed

What are the descriptions of these by displacement? Displaced, Nondisplaced.

By displacement	Description
Displaced	Bone ends out of alignment; limb appears shortened/angulated/rotated.
Nondisplaced	Hairline crack; alignment intact.

What are the descriptions of these by skin integrity? Closed Fracture, Open Fracture.

By skin integrity	Description
Closed Fracture	Skin intact.
Open Fracture	Skin broken—bone or trauma breached skin → infection/bleeding risk. Always treat any open wound over a fracture as open.

What are key signs someones going through it fracture wise?

• Deformity (compare opposite limb)

• Point tenderness (most reliable)

• Guarding (protective muscle spasm)

• Swelling, bruising, crepitus (grating bone ends), false motion, locked joint, possible exposed bone.

Management of Musculoskeletal Injuries

Purpose:

• Prevent further soft-tissue, nerve, or vessel injury.

• Prevent closed → open conversion.

• Reduce pain and bleeding.

• See if there’s crepitus & false motion

Steps:

1. Expose injury (remove clothing).

2. Check distal pulse (pulses felt beyond the injury site, such as the dorsalis pedis or posterior tibial pulse in the foot after an ankle injury. They’re checked before and after splinting because a weak or absent distal pulse can indicate impaired blood flow caused by the injury or by a splint that is too tight), motor function, sensation (circulation, sensation, movement) before & after splinting.

3. Cover open wounds with sterile dressing.

4. Immobilize joints above & below fracture (or bones above/below for joint injuries).

5. Pad rigid splints to prevent pressure sores.

6. Splint in position found unless distal pulses are absent or paresthesia present—then gentle traction to restore perfusion. Stop if pain or resistance increases.

Ex: A five-year-old female patient is complaining of pain in her right arm after falling off a slide at the school playground. The school nurse states she has spoken with the girl’s parents, and they will meet the ambulance at the emergency department. The patient has marked gross angulation and crepitus noted in the right upper arm. 

How will you stabilize this injury?

Stabalize with a sling and awathe, secure to the chest wall, and place a padded board splint on the lateral side and under the arm.

For a suspected mid-shaft humerus fracture with gross angulation and crepitus, the correct immobilization method combines a sling, swathe, and padded board splint. The sling supports the weight of the forearm and hand, reducing downward traction on the fracture site. The swathe secures the arm against the chest wall to prevent any movement. A padded board placed on the lateral side and under teh arm provides structural support while protecting the radial nerve, which runs along the posterior aspect of the humerus and is vulnerable in mid-shaft fractures.

Crush Syndrome. prolonged pressure on tissues. E.g. earthquakes

Entrapment >4 hours → tissue death → toxic release (K⁺, myoglobin).

Weak/absent distal pulses, cardiac dysrhythmias post-release.

ALS for fluids before extrication, O₂, monitor ECG.

Compartment Syndrome

Pressure buildup inside fascia → ischemia, nerve death.

Gradual Paresthesia (numbness/tingling), pain out of proportion, pallor, pulselessness, paralysis. Only certain limb

Immobilize, elevate (not above heart), monitor CSM; rapid transport.