Advanced Trauma Life Support ATLS Student Course Manual 2018

164
CHAPTER 8 n Musculoskeletal Trauma
A
B
n FIGURE 8-10 Splinting of an ankle fracture. Note extensive use of padding with posterior and sugartong splints. A. Posterior and sugartong
plaster splints being secured in place with an elastic bandage wrap. B. Completed splint.
or discomfort from a major fracture may have other
associated injuries which interfere with sensory
perception (e.g., intracranial or spinal cord lesions)
or be under the influence of alcohol and/or drugs.
Effective pain relief usually requires the administration
of narcotics, which should be given in
small doses intravenously and repeated as needed.
Administer sedatives cautiously in patients with
isolated extremity injuries, such as when reducing
a dislocation. Whenever analgesics or sedatives are
administered to an injured patient, the potential exists
for respiratory arrest. Consequently, appropriate
resuscitative equipment and naloxone (Narcan) must
be immediately available.
Regional nerve blocks play a role in pain relief and
the reduction of appropriate fractures. It is essential to
assess and document any peripheral nerve injury before
administering a nerve block. Always keep the risk of
compartment syndrome in mind, as this condition
may be masked in a patient who has undergone a
nerve block.
Associated Injuries
Because of their common mechanism, certain
musculoskeletal injuries are often associated with
other injuries that are not immediately apparent or
may be missed (n TABLE 8-5).
Steps to ensure recognition and management of these
injuries include:
1. Review the injury history, especially the
mechanism of injury, to determine whether
another injury is present.
table 8-5 musculoskeletal injuries:
common missed or associated injuries
INJURY
• Clavicular fracture
• Scapular fracture
• Fracture and/or
dislocation of shoulder
• Fracture/dislocation
of elbow
• Femur fracture
• Posterior knee
dislocation
• Knee dislocation
• Displaced tibial plateau
• Calcaneal fracture
• Open fracture
MISSED/ASSOCIATED
INJURY
• Major thoracic injury,
especially pulmonary
contusion and rib
fractures
• Scapulothoracic
dissociation
• Brachial artery injury
• Median, ulnar, and radial
nerve injury
• Femoral neck fracture
• Ligamentous knee injury
• Posterior hip dislocation
• Femoral fracture
• Posterior hip dislocation
• Popliteal artery and
nerve injuries
• Spine injury or fracture
• Fracture-dislocation of
talus and calcaneus
• Tibial plateau fracture
• 70% incidence of
associated nonskeletal
injury
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