Articles: emergency-medical-services.
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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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At the scene of an accident with possible injury to the cervical spine, management should focus on life support and prevention of further injury. On arrival of the patient in the emergency department, three standard x-ray films should be obtained in search of the abnormalities in soft tissues, alignment, and joints that indicate cervical spine injury and a thorough neurologic assessment should be performed. The potential of cord injuries to deteriorate makes careful monitoring of blood gases, urine output, and blood pressure imperative during this period. Early therapy with steroids and mannitol seems to minimize neurologic deterioration.