Muscle Skeletal Trauma for EMS
-
Upload
paulhotvw67 -
Category
Documents
-
view
2.152 -
download
3
description
Transcript of Muscle Skeletal Trauma for EMS
Musculoskeletal InjuriesMusculoskeletal Injuries
ScenarioScenario
You respond to a soccer field for an You respond to a soccer field for an “accidental injury.” Your patient is a “accidental injury.” Your patient is a 33-year old male who is complaining 33-year old male who is complaining of severe right ankle pain. You note of severe right ankle pain. You note gross angulation and deformity of gross angulation and deformity of the ankle and carefully remove his the ankle and carefully remove his shoe to assess his distal circulation. shoe to assess his distal circulation. Your examination reveals that there Your examination reveals that there is almost no perfusion to his foot. is almost no perfusion to his foot.
DiscussionDiscussionDiscussionDiscussion
What exam findings would lead you to believe What exam findings would lead you to believe that perfusion to the extremity is poor?that perfusion to the extremity is poor?
Describe actions that should be taken Describe actions that should be taken immediately to improve blood flow to the immediately to improve blood flow to the foot.foot.
How will you determine if your actions are How will you determine if your actions are successful?successful?
What anatomical structures are likely What anatomical structures are likely involved in this injury?involved in this injury?
What exam findings would lead you to believe What exam findings would lead you to believe that perfusion to the extremity is poor?that perfusion to the extremity is poor?
Describe actions that should be taken Describe actions that should be taken immediately to improve blood flow to the immediately to improve blood flow to the foot.foot.
How will you determine if your actions are How will you determine if your actions are successful?successful?
What anatomical structures are likely What anatomical structures are likely involved in this injury?involved in this injury?
Introduction to Musculoskeletal InjuriesIntroduction to Musculoskeletal Injuries
Millions of Americans experience Millions of Americans experience annually.annually.
Multiple MOIMultiple MOI Falls, Crashes, Violence, etcFalls, Crashes, Violence, etc Multi-system traumaMulti-system trauma
Anatomy & Physiology of the Anatomy & Physiology of the Musculoskeletal SystemMusculoskeletal System
Skeletal Tissue & StructureSkeletal Tissue & Structure Protections organsProtections organs Allows for efficient movementAllows for efficient movement Stores salts and other materials needed Stores salts and other materials needed
for metabolismfor metabolism Produces RBC’sProduces RBC’s
Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System
Muscular InjuryMuscular Injury ContusionContusion Compartment SyndromeCompartment Syndrome Penetrating InjuryPenetrating Injury FatigueFatigue Muscle CrampMuscle Cramp Muscle SpasmMuscle Spasm StrainStrain
Anatomy & Physiology of the Anatomy & Physiology of the Musculoskeletal SystemMusculoskeletal System
Appendicular skeleton (126 bones)Appendicular skeleton (126 bones) Pectoral girdle (4)Pectoral girdle (4)
ClavicleClavicle ScapulaScapula
Upper limbs (60)Upper limbs (60) Pelvic girdle (2)Pelvic girdle (2) Lower limbs (60)Lower limbs (60)
Anatomy — Skeletal SystemAnatomy — Skeletal System
Bone ClassificationsBone Classifications
Long bonesLong bones
Short bonesShort bones
Flat bonesFlat bones
Irregular bonesIrregular bones
Anatomy — Skeletal SystemAnatomy — Skeletal System
Posterior viewPosterior view
Anatomy & Physiology of the Anatomy & Physiology of the Musculoskeletal SystemMusculoskeletal System
Bone AgingBone Aging Birth to Adult (18-20)Birth to Adult (18-20)
Transition from flexible to firm boneTransition from flexible to firm bone Adult to elderly (40+)Adult to elderly (40+)
Reduction in collagen matrix and calcium Reduction in collagen matrix and calcium saltssalts
Diminution of bone strengthDiminution of bone strength Spinal curvatureSpinal curvature
Anatomy & Physiology of the Anatomy & Physiology of the Musculoskeletal SystemMusculoskeletal System
Muscular Tissue Muscular Tissue & Structure& Structure
600 muscle 600 muscle groupsgroups
Types of Types of musclesmuscles
SmoothSmooth StriatedStriated CardiacCardiac
Skeletal MusclesSkeletal Muscles
Have striationsHave striations
Greater strengthGreater strength
Referred to as striated muscleReferred to as striated muscle
Are under voluntary controlAre under voluntary control
Also called voluntary musclesAlso called voluntary muscles
Skeletal MusclesSkeletal Muscles
Conscious controlConscious control 40% of total body mass40% of total body mass Two attachmentsTwo attachments
Origin: More fixed and proximal Origin: More fixed and proximal attachmentattachment
Insertion: More movable and distal Insertion: More movable and distal attachmentattachment
Contractions are rapid and forcefulContractions are rapid and forceful
Smooth MusclesSmooth Muscles
Walls of hollow organs (e.g., urinary Walls of hollow organs (e.g., urinary bladder and uterus) bladder and uterus)
Walls of tubes (e.g., respiratory, Walls of tubes (e.g., respiratory, digestive, reproductive, urinary, and digestive, reproductive, urinary, and circulatory systems)circulatory systems)
Innervated by autonomic nervous Innervated by autonomic nervous systemsystem Regulates size of lumen of tubular structuresRegulates size of lumen of tubular structures
Contractions strong and slowContractions strong and slow
Cardiac MusclesCardiac Muscles
Cardiac MusclesCardiac Muscles
Have strength of skeletal muscle and endurance Have strength of skeletal muscle and endurance of smooth muscleof smooth muscle
Provide for movement of blood through the body Provide for movement of blood through the body on a continuous basison a continuous basis
Respond to stimulation from the nervous systemRespond to stimulation from the nervous system
Highly sensitive to lack of oxygenHighly sensitive to lack of oxygen
Respond to lack of oxygen with pain in that area Respond to lack of oxygen with pain in that area (angina)(angina)
Cardiac MusclesCardiac Muscles
MyocardiumMyocardium Forms middle layer of Forms middle layer of
heartheart
Innervated by Innervated by autonomic nervous autonomic nervous system but contracts system but contracts spontaneously without spontaneously without any nerve supplyany nerve supply
Contractions are Contractions are strong and rhythmicstrong and rhythmic
TendonsTendons
Bands of connective tissue Bands of connective tissue Bind muscles to bonesBind muscles to bones
Allow for power of movement across Allow for power of movement across jointsjoints
Supplied by sensory fibers that Supplied by sensory fibers that extend from muscle nervesextend from muscle nerves
BursaeBursae Flattened, closed sacs of synovial fluidFlattened, closed sacs of synovial fluid
Where tendon rubs against bone, Where tendon rubs against bone, ligament, or other tendonligament, or other tendon
Reduce friction Reduce friction
Act as shock absorberAct as shock absorber
Fill with fluid when infected or injuredFill with fluid when infected or injured
CartilageCartilage
Connective tissue covering epiphysisConnective tissue covering epiphysis
Surface for articulationSurface for articulation
Allows for smooth movement at Allows for smooth movement at jointsjoints
LigamentsLigaments
Connective tissue that crosses jointsConnective tissue that crosses joints
Attaches bone to boneAttaches bone to bone
Stretch more easily than tendonsStretch more easily than tendons
Allow for stable range of motionAllow for stable range of motion
FasciaFascia
Dense fibrous connective tissueDense fibrous connective tissue
Forms bands or sheetsForms bands or sheets
Covers muscles, blood vessels, and Covers muscles, blood vessels, and nervesnerves
Supports and anchors organs to Supports and anchors organs to nearby structuresnearby structures
Pathophysiology of the Pathophysiology of the Musculoskeletal SystemMusculoskeletal System
Joint InjuryJoint Injury SprainSprain SubluxationSubluxation DislocationDislocation
Bone InjuryBone Injury Open FractureOpen Fracture Closed FractureClosed Fracture Hairline FractureHairline Fracture Impacted FractureImpacted Fracture
Pathophysiology — Mechanism of Pathophysiology — Mechanism of InjuryInjury
Five forces cause bone and joint injuryFive forces cause bone and joint injury
Direct forceDirect force
Indirect forceIndirect force
Twisting forceTwisting force
PathologicalPathological
Fatigue Fatigue
Classifications of Musculoskeletal Classifications of Musculoskeletal InjuriesInjuries
Injuries include:Injuries include: FracturesFractures SprainsSprains StrainsStrains
Joint dislocationsJoint dislocations
Musculoskeletal InjuriesMusculoskeletal Injuries
Direct traumaDirect trauma Blunt force applied to an extremityBlunt force applied to an extremity
Indirect traumaIndirect trauma Vertical fall that produces spinal fracture Vertical fall that produces spinal fracture
distant from site of impactdistant from site of impact
Pathological conditionsPathological conditions Some forms of arthritisSome forms of arthritis MalignancyMalignancy
Pathophysiology — FracturesPathophysiology — Fractures
Unstable — Proximal and distal ends move Unstable — Proximal and distal ends move freely in relationship to each otherfreely in relationship to each other
Impacted — Jammed together so there is no Impacted — Jammed together so there is no movement between proximal and distal bonesmovement between proximal and distal bones
Open — Skin is open, allowing introduction Open — Skin is open, allowing introduction of bacteria, dirt, and other foreign bodiesof bacteria, dirt, and other foreign bodies
Closed — Skin is intactClosed — Skin is intact
Fracture with dislocation — Fracture at joint Fracture with dislocation — Fracture at joint with injury to supporting structureswith injury to supporting structures
FracturesFractures
Break in continuity of bone or Break in continuity of bone or cartilagecartilage
Complete or incompleteComplete or incomplete Line of fracture through boneLine of fracture through bone
Open or closedOpen or closed Integrity of skin near fracture siteIntegrity of skin near fracture site
Classification of FracturesClassification of Fractures
OpenOpen
ClosedClosed
ComminutedComminuted
GreenstickGreenstick
SpiralSpiral
Classification of FracturesClassification of Fractures
ObliqueOblique
TransverseTransverse
StressStress
PathologicalPathological
EpiphysealEpiphyseal
Classification of FracturesClassification of Fractures
Pathophysiology — Fractures Pathophysiology — Fractures Impacted Impacted
Pathophysiology — FracturesPathophysiology — Fractures
Joint DislocationsJoint Dislocations Normal articulating ends of two or more bones Normal articulating ends of two or more bones
are displacedare displaced Luxation: Complete dislocationLuxation: Complete dislocation Subluxation: Incomplete dislocationSubluxation: Incomplete dislocation
Frequently dislocated jointsFrequently dislocated joints
Suspect joint dislocation when joint is deformed Suspect joint dislocation when joint is deformed or does not have normal range of motionor does not have normal range of motion
Dislocations can result in great damage and Dislocations can result in great damage and instabilityinstability
Pathophysiology — Fractures Pathophysiology — Fractures Dislocation - AngulatedDislocation - Angulated
Pathophysiology — FracturesPathophysiology — Fractures
SprainsSprains Partial tearing of ligamentPartial tearing of ligament
Caused by sudden twisting or stretching of Caused by sudden twisting or stretching of joint beyond normal range of motionjoint beyond normal range of motion
Common in ankle and kneeCommon in ankle and knee
Graded by severityGraded by severity First-degree sprainFirst-degree sprain Second-degree sprainSecond-degree sprain Third-degree sprainThird-degree sprain
StrainsStrains Injury to muscle or its tendonInjury to muscle or its tendon
Overexertion or overextensionOverexertion or overextension
Common in back and armsCommon in back and arms
May have significant loss of functionMay have significant loss of function
Severe strains may cause avulsion of bone Severe strains may cause avulsion of bone from attachment sitefrom attachment site
Pathophysiology of the Musculoskeletal Pathophysiology of the Musculoskeletal SystemSystem
Inflammatory & Degenerative Inflammatory & Degenerative ConditionsConditions BursitisBursitis TendinitisTendinitis ArthritisArthritis
OsteoarthritisOsteoarthritis DegenerativeDegenerative
Rheumatoid ArthritisRheumatoid Arthritis Chronic, systemic, progressive, debilitatingChronic, systemic, progressive, debilitating
GoutGout Inflammation of joints produced by accumulation of Inflammation of joints produced by accumulation of
uric acid crystalsuric acid crystals
BursitisBursitis
Inflammation of bursaInflammation of bursa Small, fluid-filled sac acts as cushion at Small, fluid-filled sac acts as cushion at
a pressure point near jointsa pressure point near joints Most important bursae are around knee, Most important bursae are around knee,
elbow, and shoulderelbow, and shoulder
BursitisBursitis
Bursitis is usually from:Bursitis is usually from: Pressure Pressure FrictionFriction Injury to membranes surrounding the Injury to membranes surrounding the
jointjoint
TreatmentTreatment Rest, ice, and analgesicsRest, ice, and analgesics
TendonitisTendonitis Inflammation of tendonInflammation of tendon
Often caused by injuryOften caused by injury
Symptoms include:Symptoms include: PainPain TendernessTenderness Restricted movement of muscle attached to affected Restricted movement of muscle attached to affected
tendontendon
TreatmentTreatment Nonsteroidal antiinflammatory drugs (NSAIDs)Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroid medicationsCorticosteroid medications
ArthritisArthritis
Joint inflammationJoint inflammation Pain, swelling, stiffness, and rednessPain, swelling, stiffness, and redness
Joint diseaseJoint disease Involving one or many jointsInvolving one or many joints Many causesMany causes
Varies in severityVaries in severity Mild ache and stiffnessMild ache and stiffness Severe pain and later joint deformitySevere pain and later joint deformity
ArthritisArthritis
Osteoarthritis (degenerative arthritis) Osteoarthritis (degenerative arthritis) most commonmost common
Pain usually managed with Pain usually managed with antiinflammatory agentsantiinflammatory agents
Extremity TraumaExtremity Trauma
Signs and symptomsSigns and symptoms Pain on palpation or movementPain on palpation or movement Swelling, deformitySwelling, deformity CrepitusCrepitus Decreased range of motionDecreased range of motion False movement (unnatural movement False movement (unnatural movement
of extremity)of extremity) Decreased or absent sensory perception Decreased or absent sensory perception
or circulation distal to injuryor circulation distal to injury
Six "P"s of Compartment Six "P"s of Compartment SyndromeSyndrome
PainPain On palpation (tenderness)On palpation (tenderness) On movementOn movement
PallorPallor——pale skin or poor capillary pale skin or poor capillary refillrefill
ParesthesiaParesthesia——pins and needles pins and needles sensationsensation
PulsesPulses——diminished or absentdiminished or absent ParalysisParalysis——inability to moveinability to move PressurePressure
Associated ComplicationsAssociated Complications HemorrhageHemorrhage
InstabilityInstability
Loss of tissueLoss of tissue
Simple laceration and contaminationSimple laceration and contamination
Interruption of blood supplyInterruption of blood supply
Nerve damageNerve damage
Long-term disabilityLong-term disability
AssessmentAssessment
Determine if life-threatening conditions Determine if life-threatening conditions are presentare present Care for those firstCare for those first
Never overlook musculoskeletal traumaNever overlook musculoskeletal trauma
Don’t allow noncritical musculoskeletal Don’t allow noncritical musculoskeletal injury to distract from priorities of careinjury to distract from priorities of care
Musculoskeletal AssessmentMusculoskeletal Assessment
Four classes of patientsFour classes of patients Life-/limb-threatening injuries or conditionsLife-/limb-threatening injuries or conditions
Includes life-/limb-threatening musculoskeletal Includes life-/limb-threatening musculoskeletal traumatrauma
Other life-/limb-threatening injuries and Other life-/limb-threatening injuries and simple musculoskeletal traumasimple musculoskeletal trauma
Life-/limb-threatening musculoskeletal Life-/limb-threatening musculoskeletal trauma trauma
No other life-/limb-threatening injuriesNo other life-/limb-threatening injuries Isolated, non-life-/limb-threatening injuriesIsolated, non-life-/limb-threatening injuries
Musculoskeletal Injury AssessmentMusculoskeletal Injury Assessment Scene Size-upScene Size-up Initial AssessmentInitial Assessment
Categories of urgencyCategories of urgency Life & Limb threatening injuryLife & Limb threatening injury Life threatening injury and minor musculoskeletal Life threatening injury and minor musculoskeletal
injuryinjury Non-life threatening injuries but serious Non-life threatening injuries but serious
musculoskeletal injuriesmusculoskeletal injuries Non-life threatening injuries and only isolated minor Non-life threatening injuries and only isolated minor
musculoskeletal injuriesmusculoskeletal injuries Rapid Trauma AssessmentRapid Trauma Assessment Focused H&PFocused H&P
6 P’s: Pain, Pallor, Paralysis, Paresthesia, 6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, PulsesPressure, Pulses
Detailed Physical ExamDetailed Physical Exam Ongoing AssessmentOngoing Assessment Sports Injury ConsiderationSports Injury Consideration
Age-Associated Changes Age-Associated Changes in Bonesin Bones
Water content of intervertebral disks Water content of intervertebral disks decreasesdecreases
Increased risk of disk herniationIncreased risk of disk herniation Loss of stature is common – ½ - 3/4 Loss of stature is common – ½ - 3/4
inch inch Bone tissue disorders shorten trunkBone tissue disorders shorten trunk
Age-Associated Changes Age-Associated Changes in Bonesin Bones
Vertebral column assumes arch shapeVertebral column assumes arch shape
Costal cartilages ossify, making thorax Costal cartilages ossify, making thorax more rigidmore rigid
Shallow breathing due to rigid thoracic cageShallow breathing due to rigid thoracic cage
Facial contours changeFacial contours change
FracturesFractures
Limb-Threatening InjuriesLimb-Threatening Injuries
Knee dislocationKnee dislocation Fracture or dislocation of ankleFracture or dislocation of ankle Subcondylar fractures of elbowSubcondylar fractures of elbow Require rapid transportRequire rapid transport
Musculoskeletal Injury ManagementMusculoskeletal Injury Management
Other Injury ConsiderationOther Injury Consideration Pediatric Musculoskeletal InjuryPediatric Musculoskeletal Injury Athletic Musculoskeletal InjuryAthletic Musculoskeletal Injury Patient Refusals & ReferralPatient Refusals & Referral Psychological SupportPsychological Support
Musculoskeletal Injury ManagementMusculoskeletal Injury Management
General PrinciplesGeneral Principles Protecting Open WoundsProtecting Open Wounds Positioning the limbPositioning the limb Immobilizing the injuryImmobilizing the injury Checking Neurovascular FunctionChecking Neurovascular Function
Musculoskeletal Injury ManagementMusculoskeletal Injury Management Splinting DevicesSplinting Devices
Rigid splintsRigid splints Formable SplintsFormable Splints Soft SplintsSoft Splints Traction SplintsTraction Splints Other Splinting AidsOther Splinting Aids
Vacuum SplintsVacuum Splints Air SprintsAir Sprints Cravats or Velcro SplintsCravats or Velcro Splints
Fracture CareFracture Care Joint CareJoint Care Muscular & Connective Tissue CareMuscular & Connective Tissue Care
Musculoskeletal Injury ManagementMusculoskeletal Injury Management
Care for Specific FracturesCare for Specific Fractures PelvisPelvis
Scoop StretcherScoop Stretcher PASGPASG Fluid ResuscitationFluid Resuscitation
FemurFemur Traction SplintsTraction Splints PASGPASG Fracture versus hip doslocationFracture versus hip doslocation
Musculoskeletal Injury ManagementMusculoskeletal Injury Management
Care Specific FracturesCare Specific Fractures Tibia/FibulaTibia/Fibula ClavicleClavicle
Most frequently fractured bond in the bodyMost frequently fractured bond in the body Transmitted to 1Transmitted to 1stst and 2 and 2ndnd rib rib Alert for lung injuryAlert for lung injury
HumerusHumerus Radius/UlnaRadius/Ulna
Musculoskeletal Injury ManagementMusculoskeletal Injury Management
Care for Specific Joint InjuriesCare for Specific Joint Injuries HipHip KneeKnee AnkleAnkle FootFoot ShoulderShoulder ElbowElbow Wrist/HandWrist/Hand FingerFinger
Joint Injuries
Alert for PMS Compromise
Musculoskeletal Injury ManagementMusculoskeletal Injury Management
Soft & Connective Tissue InjuriesSoft & Connective Tissue Injuries TendonTendon LigamentLigament MuscleMuscle
Musculoskeletal Injury ManagementMusculoskeletal Injury ManagementMedicationsMedications
Nitrous OxideNitrous Oxide 50% O2:50% N50% O2:50% N Non-explosiveNon-explosive Effects dissipate in Effects dissipate in
2-5 minutes2-5 minutes Easily diffused into Easily diffused into
air filled spaces in air filled spaces in body.body.
DoseDose Inhaled & self Inhaled & self
administeredadministered OnsetOnset
1-2 minutes1-2 minutes
Not A Biotel OptionNot A Biotel Option DiazepamDiazepam
BenzodiazepineBenzodiazepine AntianxietyAntianxiety AnalgesicAnalgesic DoseDose
5-15 mg titrated5-15 mg titrated OnsetOnset
10-15 minutes10-15 minutes DurationDuration
15-60 minutes15-60 minutes Counter AgentCounter Agent
FlumazenilFlumazenil
Dislocation of Acromioclavicular Dislocation of Acromioclavicular JointJoint
Humerus InjuryHumerus Injury Older adults and Older adults and
childrenchildren
Difficult to stabilizeDifficult to stabilize
ComplicationsComplications Radial nerve damage if Radial nerve damage if
fracture in middle or fracture in middle or distal portion of distal portion of humeral shafthumeral shaft
Humeral neck fracture Humeral neck fracture may cause axillary may cause axillary nerve damagenerve damage
Internal hemorrhage Internal hemorrhage into jointinto joint
Posterior Dislocation of the Elbow Posterior Dislocation of the Elbow Joint with Marked DeformityJoint with Marked Deformity
Severe Open Fracture of Severe Open Fracture of ForearmForearm
Penetration of Forearm Caused by Nail Penetration of Forearm Caused by Nail GunGun
Greenstick Fracture WithGreenstick Fracture WithMarked DeformityMarked Deformity
Fracture of the Distal RadiusFracture of the Distal Radius
Hand Injury from a Motorcycle CrashHand Injury from a Motorcycle Crash
Femur InjuryFemur Injury
Diameter of right Diameter of right thigh represents thigh represents increased blood increased blood volume of 2 to 3 Lvolume of 2 to 3 L
Open Fracture of the Lower LegOpen Fracture of the Lower Leg
Subtalar DislocationSubtalar Dislocation
Foot that was Run Over by the Foot that was Run Over by the Wheel of a Railway CoachWheel of a Railway Coach
Musculoskeletal Injury ManagementMusculoskeletal Injury ManagementMedicationsMedications
Oxygen Oxygen n Nitrous OxideNitrous Oxide n Morphine SulfateMorphine Sulfate FluidsFluids
Oxygen Oxygen n Nitrous OxideNitrous Oxide n Morphine SulfateMorphine Sulfate FluidsFluids
Nitrous OxideNitrous Oxide Nitrous OxideNitrous Oxide Class:Class: Gaseous Analgesic/Anesthetic Gaseous Analgesic/Anesthetic Route:Route: Inhalation Adult Dose: Instruct Inhalation Adult Dose: Instruct
patient to inhale deeply through patient-patient to inhale deeply through patient-held mask or mouthpiece Pediatric held mask or mouthpiece Pediatric
Dose:Dose: Instruct patient to inhale deeply Instruct patient to inhale deeply through patient-held mask or through patient-held mask or mouthpiece Drug mouthpiece Drug
Action:Action: Depresses the central nervous Depresses the central nervous system Increases oxygen tension in the system Increases oxygen tension in the blood thereby reducing hypoxia Onset:2 blood thereby reducing hypoxia Onset:2 minutes - 5 minutes Duration:2 minutes - minutes - 5 minutes Duration:2 minutes - 5 minutes 5 minutes
Nitrous OxideNitrous Oxide Nitrous OxideNitrous Oxide Indications:Indications: Adjunct analgesic for ischemic chest Adjunct analgesic for ischemic chest
pain Severe pain or discomfort in all patients pain Severe pain or discomfort in all patients without contraindications. without contraindications.
Precautions: Precautions: Must be self administered Check Must be self administered Check machine gauges daily for proper machine gauges daily for proper concentrations Monitor blood pressure and pulse concentrations Monitor blood pressure and pulse oximetry values during administration oximetry values during administration
Side Effects:Side Effects: Hypotension Dizziness Nausea and Hypotension Dizziness Nausea and vomiting vomiting
ContraindicationsContraindications: Any altered level of : Any altered level of consciousness or head injury Chronic obstructive consciousness or head injury Chronic obstructive pulmonary disease Chest trauma or pulmonary disease Chest trauma or actual/suspected pneumothorax Abdominal actual/suspected pneumothorax Abdominal trauma Major facial trauma Acutely psychotic trauma Major facial trauma Acutely psychotic patients Pregnancy, other than active labor Any patients Pregnancy, other than active labor Any patient (adult or pediatric) unable to self-administer patient (adult or pediatric) unable to self-administer Decompression sicknessDecompression sickness
Morphine SulfateMorphine Sulfate
IndicationsIndications Pain and anxiety secondary to AMI Pain and anxiety secondary to AMI Chest pain unrelieved by NitroglycerinChest pain unrelieved by NitroglycerinPulmonary edemaPulmonary edemaPain secondary to amputations or fractures Pain secondary to amputations or fractures
Precautions: Precautions: Monitor respiratory status and Monitor respiratory status and blood pressure closely.blood pressure closely.
Notify Biotel prior to administration if patient is Notify Biotel prior to administration if patient is >65yrs of age, debilitated, has altered mental >65yrs of age, debilitated, has altered mental status, or systolic BP<110mmHgstatus, or systolic BP<110mmHg
CHF: be prepared to intubateCHF: be prepared to intubate
Antidote: Naloxone (Narcan®)Antidote: Naloxone (Narcan®)
Morphine SulfateMorphine SulfateMorphine SulfateMorphine Sulfate ClassClass:: Narcotic Analgesic Narcotic Analgesic Route:Route: SlowSlow IV push IV push
Dose:Dose: Adult: Adult: Administer in titrated doses of 2 - Administer in titrated doses of 2 - 4mg, up to a maximum of 10mg 4mg, up to a maximum of 10mg
Pediatric:Pediatric: 0.1mg/kg0.1mg/kg
Drug Action:Drug Action: Alleviates pain Alleviates pain Decreases peripheral vascular resistance - Decreases peripheral vascular resistance -
vasodilatorvasodilator Decreases cardiac workload and oxygen demand Decreases cardiac workload and oxygen demand
on the hearton the heart