Musculoskeletal Injuries
“Wait until you see this,” was the first thing a first responder said to me when we stepped out of the ambulance. Our patient was seated near a fallen ladder and another first responder was applying direct pressure to a distal leg wound.
We were told the patient missed the final step on the ladder, landed awkwardly on his foot, and had no other injuries. Before assessing the lower leg injury I wanted to be clear the patient had no additional injuries so I asked him several questions about the mechanism, his chief complaint, and SAMPLE history. It turns out he also had wrist pain and deformity that was not previously reported or found during the rapid trauma exam. Reassured that he did not have an MOI for spine injury or other more severe complaints I focused my attention on his injured lower leg.
Pulling away the dressing revealed a gaping wound with the distal end of the tibia jutting through the skin. The bone end appeared to be intact and there was no bleeding from the wound site. The patient’s foot was turned outward, but circulation and sensation was intact in his toes.
A combination of splints, non-pharmacological pain management, and pharmacological pain management and the patient was ready for transport. Because circulation and sensation were intact we did not reposition his deformity, but splinted in the position found. We followed general splinting principles to protect and stabilize the injured area, as well as the long bone above and below.
Gravity knows no season, but it seems to me that extremity musculoskeletal injuries are more common in the summer time. Kids and adults are more active in sports, outdoor work, and recreation. As we head into the latter half of the summer this may be a good time to brush up your knowledge about the assessment and treatment of musculoskeletal injuries. To learn more, browse to the RapidCE.com course library and select from one of these courses:
- Musculoskeletal Injuries Part 1: Anatomy, Physiology, and Injury Types
- Musculoskeletal Injuries Part 2: Assessment and Treatment
- Assessment and Treatment of Ankle Injuries
- Recognition and Treatment of Foot Injuries
- Unstable Pelvic Fractures and Emergency Stabilization
- Hip Fracture Assessment and Treatment
- Kinematics of Trauma
- Detailed Physical Exam
- Pain Management
Tags: musculoskeletal, Patient Assessment, RapidCE, trauma