Archive for March, 2007

MUSCULOSKELETAL TRAUMA

March 28, 2007

The next series of blogs will be an in-depth review of the recognition and management of musculoskeletal trauma in the wilderness, marine, disaster, and military environments.  This body of knowledge is the best example of the difference between urban, or street medicine, and the extended care environment. 

In the urban realm, typically, the ER is just minutes away and the primary concern is to stabilize the fracture or dislocation in the position found, and transport. Once outside the golden hour, the primary concern becomes circulation distal to the site of the injury. This may require straightening out angulated fractures, reducing dislocations, proper long-term splinting with big, ugly, fat, fluffy splints, and monitoring the circulation every 15 minutes for the duration of the evacuation.

ANATOMY AND PHYSIOLOGY OF THE MUSCULOSKELETAL SYSTEM

ANATOMY:

Bones:
Consist of a dense cortex surrounding an inner, soft marrow and they provide the rigid framework to which everything attaches. Bones also store calcium, an essential electrolyte, and produce the blood cells in the bone marrow.
Cartilage:
Acts as a lubricated durable cap on the ends of the bones so that your joints can
flex and rotate smoothly and without friction. Cartilage also provides support for muscle in areas where more flexibility than bone offers is needed.
Periosteum:
Is the tough fibrous layer that covers the bones and which contains the nerves that produce the pain associated with injuries.
Synovial fluid:
Is the lubricant in the joint space produced by the synovial lining of the joint capsule that surrounds the joint, allowing for friction-free movement.
Muscles:
Are like bundles of bungee cords. In response to signals sent from your brain through your central nervous system, they contract and relax, which flexes your joints and allows you to move. All muscles work by contracting, 
Tendons:
Are the ties connecting muscles to bone. They span joints and allow for movement.
Ligaments:
Are like nylon cords and attach bones to other bones. They span joints, maintaining proper alignment and setting the limits of range of motion.

PHYSIOLOGY:  Musculoskeletal system functions:

Movement: 
The contraction of muscles provides us with purposeful movement.
Heat Production:
The contraction of muscles produces heat.
Protection: 
The strength and flexibility of  muscle protects many internal structures including the bundles of nerves, arteries, and veins beneath the muscles.
Calcium storage: 
The bones act as a large calcium store.  Calcium is an electrolyte that allows for the contraction of muscle, including the heart muscle, and the conduction of nerves impulses.
Hematopoiesis: 
The process by which the various blood cells (red blood cell, white blood cell, and platelets), are produced in the bone marrow.
Cosmesis: 
The muscular and skeletal structures contribute greatly to how we look.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Book Review:

March 22, 2007

Hypothermia, Frostbite, and other Cold Injuries
Prevention, Survival, Rescue, and Treatment

By Gordon Giesbrecth, Ph.D., and James A. Wilkerson, M.D.

The book is published by The Mountaineers Books
They describe themselves as “Outdoor books by the experts” and in this case it is certainly true. The authors of this text are recognized experts in the field of cold-related injuries.

The authors have done an excellent job of describing and reviewing the various cold-related injuries. The text is up-to-date, comprehensive, well written, and applicable. This is a very useful body of knowledge for both the outdoor enthusiast as well as mountain rescue personnel. The authors have taken the time to provide information on the fundamentals of thermoregulation and clothing design as well as the recognition and management of cold-related injuries. I had the opportunity and honor of writing the chapter on non-freezing cold injuries.

If you enjoy the outdoors, or if you are a provider wilderness emergency medicine and rescue, this is a must read book. I think you will enjoy it.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Free Sample Issue of the Wilderness Medicine Newsletter

March 12, 2007

Due to the popularity of the Frozen Mythbusters series on this site, we have decided to make the entire original article by Gordon Giesbrecht, PhD; Murray Hamlet, DVM; and Frank Hubbell, DO,from the Wilderness Medicine Newsletter available as a free pdf file.

Click here to download Volume 15, Number 6, of the Wilderness Medicine Newsletter; “Frozen Mythbusters”.

Please note this is a large file and, depending on your computer, may take several minutes to download.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

March 7, 2007

Lightning # 8 – Emergency Care – Hospital

Further Office Evaluation:  If seen in the ER or by FP after the event:

Continue O2 & IV
EKG & continuous monitoring
Labs:   
electrolytes & calcium, magnesium
CBC
CK & CKMB & myoglobin
BUN & Cr
Coagulation profile
ABG
U/A for urinary myoglobin
Consider CXR, CT head, C-spine series or CT of the cervical spine
Consider EEG (long-term)

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

March 3, 2007

Lightning # 7 – Emergency Care – Prehospital

Emergency Care for a Lightning Strike Victim – At the scene:

Survey the scene:

For immediate danger to you, others, and the victim.

Primary Survey:

Are they CONSCIOUS?
Are they BREATHING?  —>  If not, give ARTIFICIAL RESPIRATION!
Do they have a PULSE?  —>  If not, begin CPR!

Secondary Survey:

Vital Signs:

Paying particular attention to level of consciousness.
Monitor every 5 minutes until conscious and coherent.

Physical Exam – needs to be detailed:

Skin – check for burns.
Check ears for blood in the canal, and look for Battle’s sign.
Evaluate for spinal injuries.
Evaluate for sprains/strains and fractures.
Monitor peripheral pulses.

Evacuate– force fluids to help prevent late complications.
   
Treat Injuries & Transport:

Protect Airway
Protect Spine
O2 – NC at 6lpm
IV – NS at 500 – 1000cc/hr

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.


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