CBT302-EMT11 – Orthopedic
Emergencies
© 2010 Seattle / King County EMS
Introduction
• Skeletal system - complex structure of bones
and connective tissue
• Provides shape & form for our bodies
• Protects internal organs
• Allows bodily movement
• Produces blood & stores minerals
© 2011 Seattle / King County EMS
Course Objectives
1.
2.
3.
4.
5.
6.
7.
8.
Identify the structures of the skeletal system.
Identify the definition of perfusion.
Identify signs and symptoms of shock.
Identify the four components required for adequate
perfusion.
Demonstrate an understanding of the physiology of
shock.
Identify prehospital treatment for shock.
Identify the characteristic injuries of specific bones.
Identify proper application of the principles of
splinting.
© 2011 Seattle / King County EMS
Terms
amputation - removal of a body extremity by trauma or surgery.
As a surgical measure, it is used to control pain or a disease
process in the affected limb, such as malignancy or gangrene
compartment syndrome — Elevation of pressure within fibrous
tissue that surrounds & supports muscles and neurovascular
structures, characterized by extreme pain, pain on movement,
pulselessness, and pallor. It is most frequently seen in fractures
below the elbow or knee.
compensated shock — early stages of shock in which the body
is able to compensate for blood loss or injury
crepitus — Grating or grinding sensation caused by fractured
bone ends or joints rubbing together. It also can be caused by
rubbing of irregular cartilage tissue or scar tissue.
dislocation — Disruption of a joint in which ligaments are
damaged & the bone ends are completely displaced.
© 2011 Seattle / King County EMS
Terms, continued
distal — The more distant of two or more structures.
fascia — Sheets or bands of fibrous connective tissue that lie
deep under the skin forming the outer layer of a muscle.
hypotension — Blood pressure that is lower than the normal
range — generally a systolic blood pressure less than 90 mmHg in
an appropriate clinical setting.
hypoxia — Condition in which the body tissues and cells do not
have enough oxygen.
ligament — A band of fibrous tissue joining two bones together
in a joint.
osteoporosis — Generalized degenerative bone disease common
among postmenopausal women in which there is a reduction of
bone mass making the bones fragile and susceptible to injury.
perfusion — Circulation of blood within an organ or tissue in
adequate amounts to meet cellular needs.
© 2011 Seattle / King County EMS
Terms, continued
point tenderness — Tenderness sharply localized at the site of
the injury. Found by gently palpating along the bone with the tip
of one finger.
proximal — Nearer to a point of reference such as a point of
attachment or the midline of the body.
sprain — Joint injury in which there is some partial or temporary
dislocation of the bone ends and partial stretching or tearing of
the supporting ligaments.
strain — A stretching or tearing of the muscle, causing pain,
swelling, and bruising of the soft tissue in the area. Also called a
“pulled muscle.”
tendon — Extension of a skeletal muscle that connects the
muscle to bone.
© 2011 Seattle / King County EMS
New Terms
crush syndrome - Serious medical condition characterized by
major shock and renal failure following a crushing injury to
skeletal muscle. Cases commonly occur in catastrophes such as
earthquakes or war, where victims have been trapped under fallen
masonry.
impaled objects - The driving of objects through the body,
causing deep stabbing wounds.
© 2011 Seattle / King County EMS
Bones
• Specialized form of connective tissue –
very strong & yet resilient
• Produce blood cells
• Store important minerals and
electrolytes
• Human skeleton – made up of 206
bones
• Supports the body & protects internal
organs
© 2011 Seattle / King County EMS
Related Structures
• Bones & muscles work together to create
movement
• Muscles – attached to bones by tendons
• Tendons – extension of fascia that cover all
skeletal muscles
• Fascia – sheets or bands of tough, fibrous
connective tissue that lie deep under skin
form an outer layer of the muscles
• Supplied with arteries, veins & nerves.
© 2011 Seattle / King County EMS
Joint
Joint – location where two bones come
together
Immovable joints – those between the bones of
the skull
Slightly movable joints – those in the front of
the pelvis
Movable joints – for example, elbow & knee
© 2011 Seattle / King County EMS
Types of Cartilage
• Immovable joints – held together by strong,
fibrous cartilage
• Slightly movable joints – held together by
elastic cartilage
• Movable joints – consist of layer of fibrous
cartilage connected to ligaments that support
bones
• Bones of movable joints – covered with
smooth cartilage & lubricated by synovial
fluid
© 2011 Seattle / King County EMS
Perfusion
• Cells of the body require constant supply of
oxygen & nutrients
• Cells also eliminate waste products such as
carbon dioxide & metabolic acids
• Provided by the circulatory, respiratory &
gastrointestinal systems.
© 2011 Seattle / King County EMS
Perfusion
Body depends on four things to
maintain adequate perfusion:
• Pump (heart) to move blood
throughout the tissues
• Pipes (which are the blood
vessels) to transport materials
to the cells
• Fluids (adequate blood
volume)
• Oxygen (adequate
oxygenation).
© 2011 Seattle / King County EMS
Shock
• Life-threatening condition develops when
circulatory system cannot deliver sufficient blood
to body’s tissues
• Many causes:
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•
•
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Blood loss
Cardiac failure
Respiratory failure
Spinal cord injury
• Inadequate tissue perfusion
• Common factor in all types of shock is
© 2011 Seattle / King County EMS
Shock
Characterized by:
• Reduced cardiac output
• Rapid heart rate
• Circulatory insufficiency
© 2011 Seattle / King County EMS
Signs & Symptoms
• Anxiety
• Altered LOC
• Delayed capillary refill
• Weak, thready/absent
peripheral pulses
• Pale, cool, clammy skin
• Increased pulse rate
• Decreased blood
pressure
UPPER BODY
© 2011 Seattle / King County EMS
Clavicle
• Someone with fractured
clavicle complains of shoulder
pain
• Attempt to guard injured
shoulder by holding affected
arm across chest
• Pain, swelling & point
tenderness over clavicle signs
of fracture
• Difficult to determine if a
clavicle is fractured without an
x-ray
• Separation at the acromioclavicular joint can resemble a
clavicle fracture.
© 2011 Seattle / King County EMS
Clavicle injuries
Clavicle
• Fractured – serious injury
• Bone positioned over major arteries, veins &
nerves
• When fractured…cause nerve & muscular damage
• Treatment includes
• Application of a sling & swathe
• Evaluation by a physician.
© 2011 Seattle / King County EMS
Scapula
• Scapula, also called
shoulder blade, less often
injured due to location &
protection by large
muscles
• Fan-shaped bone hard to
crack
• Fractures usually occur
from direct blow
• For example, baseball bat
striking the back
© 2011 Seattle / King County EMS
Blunt trauma to scapula
Scapula
• Fractures usually are result of significant
trauma to back
• Injury to chest cavity & its components (e.g.,
the heart and lungs) can accompany injured
scapula
• Examine chest for evidence of other injuries
• Assess patient's ability to breathe &
auscultate breath sounds
© 2011 Seattle / King County EMS
Shoulder
• Shoulder joint – junction between humerus &
scapula
• Remarkably complex joint
• Allows us to do many things
• Throw a ball
• Cradle a baby
• Scratch your back
• Because of its complexity shoulder easily
injured
© 2011 Seattle / King County EMS
Shoulder
• Most commonly dislocated
joint
• Usually, the humeral head
will dislocate anteriorly
• Posterior dislocations can
happen but are much less
common
• Very painful & patient will
exhibit aggressive guarding by
holding affected extremity
away from the body
• Observe injury by deformity
of shoulder & mechanism of
injury
© 2011 Seattle / King County EMS
Dislocated shoulder
Shoulder
Treatment
• Application of a sling & swathe
• Evaluation by a physician.
© 2011 Seattle / King County EMS
Humerus
• Can be fractured at
midshaft, elbow or
shoulder
• Midshaft fractures seen
more often in young
• Result of direct trauma
• Fractures of proximal
humerus common in
elderly patients who have
fallen
© 2011 Seattle / King County EMS
Fractures of the humerus
Compartment Syndrome
• Elevation of pressure within fibrous tissue
that surrounds & supports muscles &
neurovascular structures
• Characterized by extreme pain, pain on
movement, pulselessness & pallor
• Fractures of the forearm or lower leg are the
most common injuries that cause
compartment syndrome
© 2011 Seattle / King County EMS
Elbow
• Result of a direct force or twisting of arm
• Elbow dislocations rare—but very serious injuries
• Often lead to nerve & vascular damage
• Makes olecranon process of ulna much more
prominent
• Joint usually locked with forearm moderately
flexed on arm
• This position makes any movement
extremely painful
© 2011 Seattle / King County EMS
Elbow
• Often swelling,
significant pain &
potential for vessel &
nerve damage
• Treatment includes
either sling & swathe
or splinting in place
depending on situation
© 2011 Seattle / King County EMS
Dislocated elbow
Radius/Ulna
• Fractures of radius &
ulna are common
• Occur as a result of a fall
on an outstretched arm,
excessive twisting, or from
direct blow
• Fracture of distal radius
sometimes called Colles or
"silver fork" fracture
• Can occur in the growth
plate & cause future
complications in children
© 2011 Seattle / King County EMS
Ulna & radius fracture
Wrist and Hand
• Hand & wrist fractures
common & usually result of fall
or direct blow
• Falls on outstretched hand
can crack scaphoid bone (at the
base of the thumb)
• Fistfight can fracture fourth or
fifth metacarpal
• Excessive force can dislocate
fingers or thumb
© 2011 Seattle / King County EMS
• Immobilize hand & wrist
injuries with rigid splint
• Wrist & hand contain
many small bones &
ligaments
• Most injuries will require
examination by physician
LOWER BODY
© 2011 Seattle / King County EMS
Pelvis
• Often result from motor
vehicle, pedestrian accidents or
falling from a height
• In elderly can occur
simply by falling
• Vital blood vessels & nerves
passing near pelvis & femur
• Vital organs in pelvic area
• Bowel, bladder & Uterus)
• Injuries to this region can be
very serious
© 2011 Seattle / King County EMS
Pelvis
• Sometimes an indirect force may be
transferred through the femur & hip, causing
a pelvic fracture
• Because major blood vessels located in pelvic
cavity susceptible to further injury
• Splint & immobilize all suspected pelvic
fractures as quickly as possible to prevent
further blood loss
• Stabilize patient on a backboard
• Anticipate development of shock.
© 2011 Seattle / King County EMS
Hip Dislocation
• Head & neck of femur, along with the greater
trochanter, meet pelvis to form hip
• Hip joint ball-and-socket joint that is quite
strong
• Hip dislocations rare – extremely serious
injury
© 2011 Seattle / King County EMS
Hip Dislocation
• Hip dislocations can damage
large vessels & nerves
• Most common cause – motor
vehicle accidents
• Knee strikes dashboard femur
can dislocate backwards
• Posterior hip dislocations: leg
shortened & rotated internally
• Anterior dislocations: leg
lengthened & externally rotated
© 2011 Seattle / King County EMS
• Treatment includes
splinting extremity in the
position it is found
• Do not attempt to
reduce a hip dislocation
Femur (Hip Fractures)
• Fractures of the proximal
femur, also called "hip"
fractures, most common
femoral fractures
• Especially in geriatric
population
• Osteoporosis & reduced
muscle mass contribute to high
incidence of this type of
fracture
• Break usually occurs at neck
or across proximal shaft
© 2011 Seattle / King County EMS
• Hip fractures typically cause
patient's leg to rotate externally
• Leg is also shortened
• Falls most common reason for
this type of fracture
Femur (Hip Fracture)
• Lead to loss of moderate
amount of blood
• Monitor for signs of
shock
• Follow these steps when
caring for suspected hip
fracture:
© 2011 Seattle / King County EMS
• Check for other injuries (e.g., cspine or head injury)
• Use scoop stretcher to move
patient to padded backboard or
stretcher
• Keep patient warm
• Treat patient gently & minimize
movement
• Immobilize injured leg in place, if
possible
• Pad generously to immobilize
femur (including between legs)
• Carefully move patient to
stretcher or backboard (with scoop
stretcher, if available)
Treatment of Hip Fracture
• First, assess patient & immobilize spine, if
mechanism of injury indicates
• No reason to suspect cervical spine injury, ccollar is not necessary
• For example, fall from standing position onto hip
with no trauma to head
© 2011 Seattle / King County EMS
Treatment of Hip Fracture
Key points for treating fractured hip:
Minimize movement of injured limb
Immobilize injured leg in place, if possible
Pad generously to immobilize femur including between legs
Pad generously under leg if femur elevated
Secure legs together
Consider using scoop stretcher to lift to backboard (padded
with blanket)
• Pad well for comfort
• Keep patient warm
• Treat patient gently & minimize movement
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•
© 2011 Seattle / King County EMS
Treatment of Hip Fracture
• Scoop stretcher or clamshell stretcher –
excellent choice for moving someone with hip
fracture
• Movement minimized with scoop stretcher
when compared with using backboard where
you must log roll the patient
• Place patient directly on padded backboard
from scoop stretcher
Note: Use traction splint for mid-shaft femur
fractures only
© 2011 Seattle / King County EMS
Femur (Shaft)
• Fractures of femur also
occur in shaft & femoral
condyles just above the
knee joint
• When femur fractured,
large muscles of thigh can
go into spasms
• Can cause shortening &
deformity of limb with
severe angulation or
external rotation at fracture
site
© 2011 Seattle / King County EMS
Femur fracture
Femur (Shaft)
• Broken ends of femur can pierce skin &
cause open fracture
• Blood loss can be significant
• Lead to hypovolemic shock
• Bone fragments & deformity can damage
important nerves & vessels
• Long lasting effects
• Delay recovery
© 2011 Seattle / King County EMS
Femur (Shaft) Treatment
• Reduce angulation of open femur fracture
after removing foreign matter as well as
possible
• Apply manual traction & gently attempt to
move limb to achieve normal alignment
• Use sterile dressings to cover open wounds
at fracture site
• Anticipate signs of shock
• Check distal CMS at regular intervals
• Provide rapid transport
© 2011 Seattle / King County EMS
Knee
• Knee joint, like the
shoulder joint, extremely
complex & easily injured
• Ligament or cartilage
damage commonly seen
with twisting injuries
• Injuries to ligaments of
knee range from mild
sprains to complete
dislocation of bone ends
© 2011 Seattle / King County EMS
Knee injuries
Knee
• Patella (kneecap) susceptible to injury such
as fracture or dislocation
• Pulseless knee dislocation true medical
emergency
• Requires emergent transport to facility
• Vascular surgery on hand
© 2011 Seattle / King County EMS
Tibia and Fibula
• Two bones of the lower
leg
• Fibula smaller of the two
• Located near surface of
skin
• Open fractures are common
• Mid-shaft fractures of tibia
& fibula usually result in
gross deformity with
significant angulation &
rotation
© 2011 Seattle / King County EMS
Tibia-fibula fracture
Tibia and Fibula
• Often accompanied by vascular injury
• Realigning & splinting limb may restore
adequate blood flow to foot
• Need to realign an angulated tib/fib fracture
• Check distal CMS before & after realignment
• Rapid transport
• Physician evaluation
© 2011 Seattle / King County EMS
Ankle
• Twisting – most common
mechanism of injury to ankle
• Often impossible to
distinguish fractured bone from
severe ankle sprain
• Both will lead to swelling &
pain
• Typically, fractures cause
more pain & often limits ability
to walk
• Lateral & medial malleolus are
distal ends of fibula & tibia
respectively
• Often crack if twisting force
applied to ankle is sufficient
© 2011 Seattle / King County EMS
Ankle fractures
Ankle
• As with all joint injuries, difficult to tell a nondisplaced ankle fracture from a simple sprain
without an x-ray
• Ankle injuries that produce pain, swelling,
localized tenderness, or inability to bear
weight
• Need physician evaluation
• Immobilize ankle by securing foot & lower
leg
• Pillow splint one technique effective in
immobilizing ankle
© 2011 Seattle / King County EMS
Foot
• Foot injuries common
• Falls from heights
• Excessive twisting motions
• Calcaneus bone (heel bone) may be
fractured if patient falls from sufficient height
& lands on heels
• If calcaneus fractured may be enough force to
have other associated fractures such as vertebral
fractures
• Pain, swelling & ecchymosis may be seen
with fractures of foot
© 2011 Seattle / King County EMS
Amputation
• Rare occurrences but life
altering events
• In 1999, an estimated
19,700 occupational
amputation cases were
treated in a hospital
emergency department
• About 0.5% of all injuries
and illnesses treated in
hospital emergency
departments among workers
aged 15 and older
© 2011 Seattle / King County EMS
Finger amputation in factory
Mechanism of Injury
• Significant force is usually required to fracture
a bone or dislocate a joint
• Many types of forces can cause these injuries
• Direct
• Fall on the tail bone that cracks coccyx
• Indirect
• Person falling & landing on feet causing vertebral fracture
• Twisting
• Skiing causes twisting injuries – can crack ankle or tibia
• High-energy forces
• Car striking another car
© 2011 Seattle / King County EMS
Mechanism of Injury
• An important aspect of patient care: assess
mechanism of injury & determine which
forces have been applied to patient's body
• Consider signs of blunt or penetrating trauma
• Consider which underlying structures may
have been impacted by force
© 2011 Seattle / King County EMS
Trauma and the Elderly
• Risk of fatality from
multi-system trauma is
three times greater at age
70 than age 20
• Happens because elderly
body does not
compensate effectively
from trauma
• Most trauma deaths in
seniors caused by falls &
motor vehicle accidents
© 2011 Seattle / King County EMS
• Consider following
factors:
• Elderly patients often lie in
extreme environments for
long periods of time before
help arrives leading to
hypothermia or hyperthermia
• Elderly patients more often
dehydrated & malnourished
• Chest trauma more likely to
cause lung damage because
chest wall is less flexible
Osteoporosis
• Extreme force or transfer of energy is not
always necessary to fracture a bone
• Osteoporosis – loss of bone density
• Usually caused by calcium loss
• Common in women who have gone through
menopause
• Insignificant force can easily fracture a bone
weakened by a tumor or osteoporosis
• Geriatric patients with osteoporosis
• Minor fall, simple twisting injury or even a violent
muscle contraction may cause a fracture
© 2011 Seattle / King County EMS
Assessment
• Start assessment by assessing mechanism of
injury
• Try to determine which forces acted on the body
& to what degree
• Patient SICK, care of orthopedic injuries is
not the highest priority
• Must assure ABCs
• Patient NOT SICK, you have a little more
time to investigate MOI
• Perform physical exam & focused history
© 2011 Seattle / King County EMS
Assessment
Signs of orthopedic injury
include:
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•
•
•
•
•
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Deformity or angulation
Pain and tenderness
Grating (crepitus)
Swelling
Bruising (discoloration)
Exposed bone ends
Joint locked into position
© 2011 Seattle / King County EMS
Don’t focus solely on
obvious injuries – may
overlook other
potential injuries:
• Spinal trauma
• Damage to
internal organs
• Pre-existing
medical conditions
CMS
• Mnemonic: circulation, motor, & sensory function
• Indicators of proper vessel & nerve function
• Any extremity with injury or deformity may have
underlying damage to important blood vessels &
nerves.
• Always check CMS of an extremity before & after
splinting
• Note any changes
© 2011 Seattle / King County EMS
CMS – Circulation
• Upper extremity injuries check
radial pulse & capillary refill
• Check capillary refill by gently
squeezing & releasing nail bed of a
finger
• Full color should return within
two seconds
• These tell you state of perfusion
to tissues in extremity
• Poor circulation may be
caused by shock or damaged
blood vessels
© 2011 Seattle / King County EMS
• Lower extremity injury using
posterior tibial or dorsalis pedis
pulse
• Check capillary refill by
blanching nail bed of a toe
CMS – Motor Function
• Ask patient to wiggle his or her fingers (or
toes) to check for proper motor function
• Lack of movement may reveal tissue or nerve
damage
© 2011 Seattle / King County EMS
CMS – Sensory Function
• Lightly touch fingers or toes (remembering
that the bottom of the patient's foot belong
to them)
• Ask patient to distinguish exact location of
sensation
• Numbness or tingling distal to injury may
indicate nerve damage
© 2011 Seattle / King County EMS
Treatment of Shock
Prehospital treatment for
hypovolemic shock includes
following steps:
• Evaluate mechanism of injury
• Determine SICK or NOT SICK
• Maintain airway, assist
ventilations if needed
• Control bleeding
• Administer high flow oxygen
• Place in Trendelenburg position
• Splint fractures
• Consider use of Pneumatic AntiShock Garment (PASG) for
stabilization
• Maintain body temperature
• Monitor vital signs
• Rapid transport
© 2011 Seattle / King County EMS
Video demonstration available at
EMS Online:
http://www.emsonline.net/ortho2011
/treatment.asp
Splinting Procedures
• Primary reason for applying a
splint is to prevent
movement of a fractured
bone
• Proper splinting in field can
decrease pain & bleeding which
in turn can reduce patient's
hospital stay & speed recovery
© 2011 Seattle / King County EMS
• There are six principles
for applying a splint:
• Support the fracture site
• Bone fracture: Immobilize
the joint above and below the
fracture site
• Joint injury: Immobilize the
bones above and below the
dislocation
• Check CMS before and after
splinting
• Pad the splint well
• Elevate the extremity after
splinting, if possible
Benefits of Splinting
• Splint will provide many benefits when
properly applied – immobilize fractured bone
ends
• Loose bones ends can cause the following
problems:
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Damage to muscles, nerves, and blood vessels
Lacerations to the skin
Impeded blood flow
Increased bleeding
Increased pain
© 2011 Seattle / King County EMS
Treatment of Hip Fracture
• First, assess patient & immobilize spine if mechanism of injury
indicates
• No reason to suspect a cervical spine injury, c-collar not
necessary
•
For example, fall from standing position onto hip with no trauma to head
• In most cases, splint fracture without repositioning the leg:
•
•
•
•
•
Place a pillow or rolled blanket between patient's legs to prevent hip from
moving laterally
Pad under leg generously if femur is elevated
Secure legs together
Use scoop stretcher to lift patient onto a backboard (padded with a
blanket)
Pad well for comfort & secure patient
© 2011 Seattle / King County EMS
Realigning Joint Injuries & Dislocations
• Splint dislocations or other joint injuries in position
found
• Exceptions include:
• Loss of a distal pulse and neurological function where definitive
care is delayed
• In these cases:
• Attempt to straighten into anatomical position until pulse returns,
excessive pain felt, or resistance encountered
• Support with blanket, pillow, or well-padded splint
• Elevate the limb
• Pack injured area in ice or use ice pack
• Document attempts to re-align injury
© 2011 Seattle / King County EMS
Realignment of Long Bone Fractures
• You can attempt to realign fractures of long
bones that occur in the middle 1/3 of the
bone only
• Long bone fractures, which occur in the
proximal or distal 1/3, may be realigned only
if compromise of distal circulation or nerve
function is detected and definitive care is
delayed
© 2011 Seattle / King County EMS
Traction Splinting
• Use traction splint for mid-shaft femur
fractures only
• They stabilize bone ends & help reduce
muscle spasms in large thigh muscles
• Helps prevent further injury to vessels,
nerves & tissues
• Reduces pain
© 2011 Seattle / King County EMS
Traction Splinting
Contraindications for the use of a traction
splint include:
• Injury close to or involving the knee
• Hip injury
• Pelvis injury
• Partial amputation or avulsion with bone
separation
• Lower leg or ankle injury
© 2011 Seattle / King County EMS
Traction Splinting
The key points for applying a
traction splint are:
• Do not apply if there is a
destabilizing injury to hip, knee
or ankle
• Support fracture site when
limb is lifted
• Apply manual traction & hold
until splint is secured
• Check CMS before & after
apply splint
© 2011 Seattle / King County EMS
Video demonstration available at
EMS Online:
http://www.emsonline.net/ortho2011
/traction.asp
Treating Pelvic Injuries
Immobilization of pelvic fractures can be accomplished by use of a bed
sheet or an approved, commercially-available splinting device.
Instructions for splinting with a bed sheet are as follows:
• Fold the sheet lengthwise into an 8" to 14" width.
• Place the sheet beneath the patient. Wrap the ends around the patient
and twist while crossing over the pelvic area.
• Tie the sheet with square knot or plastic ties to apply moderate
pressure around the circumference of the pelvis.
• Secure the ends of the sheet to the backboard, if possible.
Pelvic sheeting technique
© 2011 Seattle / King County EMS
Case Studies
Video Case Study #1
http://www.emsonline.net/ortho2011/case1.asp
Video Case Study #2
http://www.emsonline.net/ortho2011/case2.asp
© 2011 Seattle / King County EMS
Summary
• Muscles are attached to bones by tendons
• Fascia are sheets or bands of fibrous
connective tissue that cover muscles
• Joint is a location where two bones come
together
• Bones of movable joints are covered with
cartilage
© 2011 Seattle / King County EMS
Summary
• Common factor in all types of shock is inadequate
tissue perfusion
• Perfusion is circulation of blood within an organ or
tissue
• To maintain adequate perfusion the body requires
four intact components:
•
•
•
•
Pump (heart)
Pipes (blood vessels)
Fluids (adequate blood volume)
Oxygen (adequate oxygenation
© 2011 Seattle / King County EMS
Summary
Signs and symptoms of shock include:
• Anxiety
• Altered LOC
• Delayed capillary refill
• Weak, thready or absent peripheral pulses
• Pale, cool, clammy skin
• Increased pulse rate (an early sign)
• Decreased blood pressure (a late sign)
© 2011 Seattle / King County EMS
Summary
Treatment of hypovolemic shock includes:
• Assess the MOI
• Determine SICK or NOT SICK
• Maintain airway, assist ventilations if needed
• Control bleeding
• Administer high flow oxygen
• Place in shock position
• Splint fractures
• Maintain body temperature
• Monitor vital signs
• Rapid transport
© 2011 Seattle / King County EMS
Summary
Principles of splinting are:
• Support the fracture site
• Bone fracture - immobilize the joint above and
below the fracture site
• Joint injury - immobilize the bones above and below
the dislocation
• Check CMS before and after splinting
• Pad the splint well
• Elevate extremity after splinting, if possible
© 2011 Seattle / King County EMS
Summary
• You can attempt to realign fractures of long bones that occur in
the middle 1/3 of the bone only
• Splint dislocations or other joint injuries in position found
except in cases of loss of a distal pulse & neurological function
where definitive care is delayed
• Outcome of most traumatic injuries does not rest with us but in
our ability to transport to a Trauma Center in an expeditious
fashion
• The old adage still applies:
We don't save trauma victims the operating room does!
© 2011 Seattle / King County EMS
Questions
EMS Online
Guidelines and Standing Orders
http://www.emsonline.net/downloads.asp
Susan Kolwitz
Program Manager
Email support: help@emsonline.net
Dr. Mickey Eisenberg
Medical Director
Ask the Doc: http://www.emsonline.net/doc.asp
© 2011 Seattle / King County EMS