eleven

The speaker discusses dislocations, sprains, and amputations. Dislocations can cause serious damage to arteries, veins, and nerves, and should not be popped back into place. Sprains occur when a joint is twisted or stretched beyond its normal range of motion and can take several weeks to heal. Amputations are severe injuries where a body part is completely severed, causing damage to the musculoskeletal system. Plastic and orthopedic surgeons can sometimes reattach amputated limbs, but there are limitations. You see in the movies, they go up and they go like this, boom, and they pop it back in place. So the arm dislocates forward, and the pelvis dislocates rearward, or the humerus dislocates rearward. Confirm the dislocation with the patient's history, they probably had a history of doing it before. If it's reduced, they've probably done it before. The dislocation does not reduce the serious problem. So if you have a dislocation that doesn't spontaneously reduce, that's a problem. Blood travels through a joint, an artery, a vein, and a nerve. So when I dislocate a joint, I put pressure on that artery, vein, and nerve. It can cause limb-threatening conditions. I can lose circulation, I can lose nerve function, I can have permanent deficits and damage. So it's a limb-threatening condition. Joints you do not move. Joints you leave in the position found. Bones, if you have a bone injury, remember we talked about that, I can reduce it once, I can pull traction, try and get a pulse back if I have a fracture. But if I have a joint injury, we immobilize it in the position found. Pulse or no pulse. Would this be dislocating? Yeah, you have a tripped joint. I don't know if that's dislocating, or it just has a lot of movement. I don't think that's dislocating. I used to think you have a lot of movement. I used to think you do that, too. Yeah, that's what I was thinking. Yeah, but it's dislocating. Yeah. No. It's a special way that they pop it in. You do not pop it back in place. Because if you pop it back in place, you can do permanent damage to the nerve. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. So dislocation is a marked lie, marked deformity. Uncertainty is a palpation, loss of normal joint motion, and numbness or impaired circulation. Check to make sure you've got a pulse and you've got sensation. CSMs. If you don't have CSMs, report that to the hospital, and that is a lights and sirens response, because they need corrective surgery right away. Sprains are different. Occur when a joint is twisted or outstretched beyond its normal range of motion. It can be mild to severe. If you've ever gone to see somebody who they sprained their ankle, they're unconscious, and three days later they're out playing basketball again, that's not a sprain. That's a strain. Sprains are like three to four to six weeks where you're going to have problems walking and moving and manipulating that joint. Most common joint to sprain is the ankle. Most common joint to dislocate is the shoulder. Severe deformity usually doesn't occur. You have a lot of swelling. Dislocations, you will lose that weight bearing with a sprain. You might have some weight bearing if it's mild, but if it's a severe sprain, you're not going to have any weight bearing on that at all. Who has weak ankles? Anybody have weak ankles where they roll a lot? Whenever you're sitting down watching TV or doing anything, put your legs out and roll your foot. Roll it forward ten times, then roll it back. Then do the other one forward. And just keep doing that. My son played basketball. He played for the AAU, which is the National League, when he was like 12, 14. He used to play with Crew Ainge, Danny Ainge's son. Danny Ainge is the president of Celtics. As a matter of fact, when they would play, they would practice where the Celtics would practice. So he'd tell me, they'd go and play practice, and then they'd be in the locker room, and he'd be in the locker room with Paul Peterson, and they'd all have locker rooms, and it was really cool. And he was friendly with Crew Ainge. His coach, I know I'm going off on a tangent, his coach was the head coach of the AAU for years. And his coach, when my son had bad ankles, he told him that's what you do, you roll your ankles, and you do that every time you're sitting down. And he said, after a few months. And my son, since he started doing that, never rolled his ankle again. Ever. He's like, fix it. Strengthens up the muscles around the ankle. You should try walking in heels. What's that? You should try walking in heels. I'll tell him to do that. Maybe he does. I don't know. So this is the sprain. You can see the swelling. And this is all due to blood from the injury, damaged blood vessels, and that bruising that happens. So you'll have guarding, swelling, and ectomotor pain, and instability of the joint. So a sprain is different from a strain. A sprain is actually damaging of the joint. Maybe temporary, but for damaging. A sprain is a muscle injury. The muscle's poor, basically. Whenever you work out, you're doing microscopic strength of the muscle, and then they heal, bigger and stronger. But this is a massive muscle tear, that we call muscle sprain. And sometimes, a bad muscle sprain and a mild sprain can look very common, very similar. You don't know. So what the doctors will usually say is they'll tell you, they'll tell you to rush, ice, heat, ice, rest. So ice, rest, heat. Ice, rest, heat. And elevate the knee. Right. So what they do is elevate your leg, but they want to put 30 minutes of ice, cool it, reduce the swelling. 30 minutes of heat, to bring blood flow to the area, to heal the muscle, and then rest it for 30 minutes, to let it calm down. So rest, ice, heat, ice, rest. Heat, ice, rest. And you do that for like a week, or a few days, and that usually helps. Amputation. An amputation is an injury in which the extremity is completely severed from the body. It can damage every aspect of the musculoskeletal system. Obviously, it causes complete damage. Plastic and orthopedic surgeons are miracle workers. I've seen them, I've seen them reattach some of the most nasty amputations, but sometimes there's only so much you can do. So amputation can lead to systemic changes in the body. Likelihood of having complications is related to the force of the impact, the injury location, and the patient's overall health. You've all heard the story about, you know, how patients, 80-year-old patients, especially in nursing homes, they break a hip and they're dead within six months. You know, hip fracture, surgery, pneumonia, death. Because what happens is with the hip injury, they become incapacitated, and they don't get the exercise, they don't move around, and so they develop complications, which can lead to pneumonia and death. To prevent contamination of an open fracture, brush away any debris. Don't irrigate. If you have an open fracture, don't irrigate, because that moisture will drag that dirt into the bone fracture itself. So if you have an open fracture, do not irrigate. Do not probe the fracture site. Don't go poking at it. Long-term disability is one of the most devastating consequences of orthopedic injuries, right? It can take a lot of therapy and a lot of rehab. You can help reduce the risk of duration of long-term disability by preventing further injury. How do we prevent further injury? What do we do? Splint. Splint. Immobilize. Splint. Immobilize. Splint. Reduce the risk of wound infection by bandaging. Do we splint and then bandage, or bandage and splint? Bandage. Bandage first, because you can't get the bandage around once you splint. Minimize pain by the use of cold and analgesics, and transport patients to the appropriate medical facility. Most of your ER, most of your ER is to handle minor fractures, but if you have a child with a long bone fracture, I highly recommend a pediatric trauma center like you have. The golden hour is critical for life and limb viability. Prolonged hyperperfusion. Yes, my arm can last for two hours without blood flow, but there is damage that begins after an hour. If I want full viability and use of that limb, I want to get it reperfused as quickly as possible. Any suspected open fracture or vascular injury is a critical emergency because of infection and damage. Most injuries are not critical. Always look at the big picture. Distinguish between mild and severe injuries. When in doubt, trauma center. Severe injuries may compromise neurovascular function, which could cause limb-threatening conditions. Make sure the scene is safe and assess the mechanism of injury. Use standard precautions. Consider that there may be bleeding, occult bleeding, bleeding internally. Evaluate the need for additional support. Make sure that you immobilize, splint, sling, and swap. Be alert for primary and secondary injuries, usually associated with swelling or loss of circulation. Focus on identifying life threats. Treat the patients according to bleeding, airway, breathing, circulation. Talk to the patient. Assess the chief complaint. Most of your patients are going to be walkie-talkie, talkie-talkie anyway. Administer high-flow oxygen to those patients. Don't be afraid. Bone injuries, put oxygen on the patient. If nothing else, it helps to reduce nausea, keeps the patient calm. Ask about the mechanism of injury. If there's significant trauma, musculoskeletal injuries may be of a lower priority. I can put them on a backboard and fully immobilize them. I don't necessarily have to split each individual brain. Fractures and sprains do not usually create airway or breathing problems. If you've got an airway or breathing problem, you've got a multi-system injury, and that's going to be a bigger problem. Evaluate the chief complaint. Determine whether the patient has a pulse, adequate perfusion and bleeding, are they in shock, treat for shock, maintain body temperature. Provide rapid transport to any patient with airway or breathing problems not corrected by oxygen or significant bleeding, or loss of circulation in a limb, right? Maybe the presence of a potential compartmental syndrome. A pain in medical history, look for your sample and your OPTRST. You might not have time to do OPTRST if the patient is critical. Use DCAP ETLS. Start at the head, wrist and feet if you're going to do an entire bodily assessment. Most of your musculoskeletal injuries, you can do a focused assessment. If it's multi-system, then it's not a focused assessment. When lacerations are present, consider an open fracture, bandage and then immobilize. Injury of the formular bone may be associated with vessel nerve damage, so you want to assess your neurovascular function. Do your CSMs. Get your vitals. Repeat vitals every five minutes. Can't go wrong. You're only going to have the patient for 20 minutes, two vitals every five minutes. Assess the overall condition and critically injure patient, secure the patient on a longboard. That's a complete body split. I don't have to do traction splits or individual splits. I can put them all just like that and that's it. Boom, done. If the patient has no life-threatening injuries, I can take the extra time to immobilize them. If I have a patient that's not life-threatening, like I did in Gardner a few years ago, I did a call for a girl. She was the 1776, what do they call that? Was it the hotel? No, no, no, this was a gym. What do they call that? CrossFit. 1776 CrossFit, something, 58. We got there and what happened was she was doing inverted pull-ups, you know how they go up, and she came down and she landed on her arms on the bar that goes across, bilateral femoral fractures, like deformity. Right, you can see the deformity in there. And she's just sitting there like this. She's in a lot of pain. So the first thing we did, checked the SMs, we gave her a fentanyl, and then we immobilized them before we moved her. Because if I tried to pick her up and put her on the stretcher before immobilizing those, that would have hurt my health. Imagine how unstable that is. So we immobilized before, unless it's life-threatening, we immobilized first. Sling and swap, split before you move the patient. If you can, get pain meds in first. The goal is stabilization in the most comfortable position that allows maintenance of good circulation. Next slide. Include a description of the problems found. Report the problems of ABCs, open fractures, and compromised circulation. These are all kidney-like and limb-threatening. And document the mechanism of injury. Emergency medical care, perform your primary assessment, stabilize. Perform your secondary survey, standard precautions, be alert for internal bleeding. Splits. The rest of this is just talking about splits, which we've already talked about. So the rest of it is just going to talk about splits. So I'm going to end it here.