Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 1984
ReviewExamination and assessment of injuries and problems affecting the elbow, wrist, and hand.
In summary, injuries to the elbow, wrist, and hand are common complaints in emergency department practice. A systematic, thorough examination should be carried out meticulously on each injured patient. Routine radiographs should be taken and any additional views that are needed should be ordered. Most of the commonly missed injuries are due to an inadequate physical examination and inadequate x-ray films of the injured part.
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Emerg. Med. Clin. North Am. · May 1984
ReviewPrinciples of prehospital care of musculoskeletal injuries.
Prehospital management of musculoskeletal injuries in the traumatized patient is based on the application of a few basic principles in an orderly but expeditious manner. The patient must be assessed for immediate life-threatening conditions involving airway, respiratory, and circulatory functions while the cervical spine is protected. Resuscitative efforts to reestablish and preserve an adequate circulating volume of oxygenated blood must follow, using airways, oxygen therapy, and fluid replacement through MAST trousers and intravenous fluids. ⋯ In the multiply traumatized patient with severe injuries to several organ systems, prehospital care may need to be expedited to provide this patient the in-hospital care required to save his or her life. Appropriate treatment in such life-threatening trauma situations will consist of a rapid primary assessment, airway and cervical spine control, appropriate respiratory and cardiovascular assistance, gross whole body fracture immobilization using a backboard, and immediate transport. For less severely injured patients, primary assessment, resuscitation, stabilization, full secondary assessment, initial definitive care, and immobilization should be completed before transport begins.
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A systematic approach to the injured shoulder includes careful history taking and sequential examination of all anatomic components of the shoulder girdle in each and every patient. High quality radiographs, with two views at 90 degrees to one another, are essential. A specific diagnosis can and must be made on every patient with an injured shoulder to enable referral for proper care and follow-up.
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Emerg. Med. Clin. North Am. · May 1984
ReviewClues to the initial radiographic evaluation of skeletal trauma.
Significant injuries to the musculoskeletal system usually result in a radiographic abnormality. The physician is faced with the problem of recognizing and correctly interpreting these abnormalities. The best way to recognize an abnormality is to thoroughly understand what is normal. Knowledge of normal appearances and relationships will allow identification of even subtle fractures and dislocations.
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Pelvic, acetabular, and hip fractures have a very high incidence of catastrophic early and late complications. In the emergency department, attention should be focused on the prompt and judicious management of concurrent local visceral and systemic problems. The eventual outcome of any pelvic or hip injury reflects the adequacy of the emergency treatment.