Muscle Skeletal Trauma For Ems
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Musculoskeletal Injuries
Scenario You respond to a soccer field for an “accidental injury.” Your patient is a 33-year old male who is complaining of severe right ankle pain. You note gross angulation and deformity of the ankle and carefully remove his shoe to assess his distal circulation. Your examination reveals that there is almost no perfusion to his foot.
Discussion
What exam findings would lead you to believe that perfusion to the extremity is poor?
Describe actions that should be taken immediately to improve blood flow to the foot.
How will you determine if your actions are successful?
What anatomical structures are likely involved in this injury?
Introduction to Musculoskeletal Injuries
Millions of Americans experience annually. Multiple MOI
Falls, Crashes, Violence, etc Multi-system trauma
Anatomy & Physiology of the Musculoskeletal System
Skeletal Tissue & Structure
Protections organs Allows for efficient movement Stores salts and other materials needed for metabolism Produces RBC’s
Pathophysiology of the Musculoskeletal System
Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain
Anatomy & Physiology of the Musculoskeletal System
Appendicular skeleton (126 bones)
Pectoral girdle (4) Clavicle Scapula
Upper limbs (60) Pelvic girdle (2) Lower limbs (60)
Anatomy — Skeletal System Bone Classifications
Long bones
Short bones
Flat bones
Irregular bones
Anatomy — Skeletal System Posterior view
Anatomy & Physiology of the Musculoskeletal System
Bone Aging
Birth to Adult (18-20)
Transition from flexible to firm bone
Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature
Anatomy & Physiology of the Musculoskeletal System
Muscular Tissue & Structure
600 muscle groups Types of muscles Smooth Striated Cardiac
Skeletal Muscles
Have striations
Greater strength
Referred to as striated muscle
Are under voluntary control
Also called voluntary muscles
Skeletal Muscles
Conscious control 40% of total body mass Two attachments
Origin: More fixed and proximal attachment Insertion: More movable and distal attachment
Contractions are rapid and forceful
Smooth Muscles
Walls of hollow organs (e.g., urinary bladder and uterus) Walls of tubes (e.g., respiratory, digestive, reproductive, urinary, and circulatory systems) Innervated by autonomic nervous system
Regulates size of lumen of tubular structures
Contractions strong and slow
Cardiac Muscles Cardiac Muscles
Have strength of skeletal muscle and endurance of smooth muscle
Provide for movement of blood through the body on a continuous basis
Respond to stimulation from the nervous system
Highly sensitive to lack of oxygen
Respond to lack of oxygen with pain in that area (angina)
Cardiac Muscles
Myocardium
Forms middle layer of heart
Innervated by autonomic nervous system but contracts spontaneously without any nerve supply
Contractions are strong and rhythmic
Tendons
Bands of connective tissue
Bind muscles to bones
Allow for power of movement across joints
Supplied by sensory fibers that extend from muscle nerves
Bursae
Flattened, closed sacs of synovial fluid
Where tendon rubs against bone, ligament, or other tendon
Reduce friction
Act as shock absorber
Fill with fluid when infected or injured
Cartilage
Connective tissue covering epiphysis
Surface for articulation
Allows for smooth movement at joints
Ligaments
Connective tissue that crosses joints
Attaches bone to bone
Stretch more easily than tendons
Allow for stable range of motion
Fascia
Dense fibrous connective tissue
Forms bands or sheets
Covers muscles, blood vessels, and nerves
Supports and anchors organs to nearby structures
Pathophysiology of the Musculoskeletal System
Joint Injury
Sprain Subluxation Dislocation
Bone Injury
Open Fracture Closed Fracture Hairline Fracture Impacted Fracture
Pathophysiology — Mechanism of Injury Five forces cause bone and joint injury
Direct force
Indirect force
Twisting force
Pathological
Fatigue
Classifications of Musculoskeletal Injuries
Injuries include:
Fractures Sprains Strains
Joint dislocations
Musculoskeletal Injuries
Direct trauma
Indirect trauma
Blunt force applied to an extremity
Vertical fall that produces spinal fracture distant from site of impact
Pathological conditions
Some forms of arthritis Malignancy
Pathophysiology — Fractures Unstable — Proximal and distal ends move freely in relationship to each other Impacted — Jammed together so there is no movement between proximal and distal bones Open — Skin is open, allowing introduction of bacteria, dirt, and other foreign bodies Closed — Skin is intact Fracture with dislocation — Fracture at
Fractures
Break in continuity of bone or cartilage
Complete or incomplete
Line of fracture through bone
Open or closed
Integrity of skin near fracture site
Classification of Fractures
Open
Closed
Comminuted
Greenstick
Spiral
Classification of Fractures
Oblique
Transverse
Stress
Pathological
Epiphyseal
Classification of Fractures
Pathophysiology — Fractures Impacted
Pathophysiology — Fractures
Joint Dislocations
Normal articulating ends of two or more bones are displaced
Luxation: Complete dislocation Subluxation: Incomplete dislocation
Frequently dislocated joints
Suspect joint dislocation when joint is deformed or does not have normal range of motion
Dislocations can result in great damage and instability
Pathophysiology — Fractures Dislocation - Angulated
Pathophysiology — Fractures
Sprains
Partial tearing of ligament
Caused by sudden twisting or stretching of joint beyond normal range of motion
Common in ankle and knee
Graded by severity
First-degree sprain Second-degree sprain Third-degree sprain
Strains
Injury to muscle or its tendon
Overexertion or overextension
Common in back and arms
May have significant loss of function
Severe strains may cause avulsion of bone from attachment site
Pathophysiology of the Musculoskeletal System
Inflammatory & Degenerative Conditions
Bursitis Tendinitis Arthritis
Osteoarthritis
Rheumatoid Arthritis
Degenerative Chronic, systemic, progressive, debilitating
Gout
Inflammation of joints produced by accumulation of uric acid crystals
Bursitis
Inflammation of bursa
Small, fluid-filled sac acts as cushion at a pressure point near joints Most important bursae are around knee, elbow, and shoulder
Bursitis
Bursitis is usually from:
Pressure Friction Injury to membranes surrounding the joint
Treatment
Rest, ice, and analgesics
Tendonitis
Inflammation of tendon
Symptoms include:
Often caused by injury
Pain Tenderness Restricted movement of muscle attached to affected tendon
Treatment
Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroid medications
Arthritis
Joint inflammation
Joint disease
Pain, swelling, stiffness, and redness
Involving one or many joints Many causes
Varies in severity
Mild ache and stiffness Severe pain and later joint deformity
Arthritis
Osteoarthritis (degenerative arthritis) most common
Pain usually managed with antiinflammatory agents
Extremity Trauma
Signs and symptoms
Pain on palpation or movement Swelling, deformity Crepitus Decreased range of motion False movement (unnatural movement of extremity) Decreased or absent sensory perception or circulation distal to injury
Six "P"s of Compartment Syndrome
Pain
On palpation (tenderness) On movement
Pallor—pale skin or poor capillary refill Paresthesia—pins and needles sensation Pulses—diminished or absent Paralysis—inability to move Pressure
Associated Complications
Hemorrhage
Instability
Loss of tissue
Simple laceration and contamination
Interruption of blood supply
Nerve damage
Long-term disability
Assessment
Determine if life-threatening conditions are present
Care for those first
Never overlook musculoskeletal trauma
Don’t allow noncritical musculoskeletal injury to distract
Musculoskeletal Assessment
Four classes of patients
Life-/limb-threatening injuries or conditions
Other life-/limb-threatening injuries and simple musculoskeletal trauma Life-/limb-threatening musculoskeletal trauma
Includes life-/limb-threatening musculoskeletal trauma
No other life-/limb-threatening injuries
Isolated, non-life-/limb-threatening
Musculoskeletal Injury Assessment
Scene Size-up Initial Assessment
Categories of urgency
Rapid Trauma Assessment Focused H&P
Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal injuries
6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
Detailed Physical Exam Ongoing Assessment Sports Injury Consideration
Age-Associated Changes in Bones
Water content of intervertebral disks decreases Increased risk of disk herniation Loss of stature is common – ½ - 3/4 inch Bone tissue disorders shorten trunk
Age-Associated Changes in Bones
Vertebral column assumes arch shape
Costal cartilages ossify, making thorax more rigid
Shallow breathing due to rigid thoracic cage
Facial contours change
Fractures
Limb-Threatening Injuries
Knee dislocation Fracture or dislocation of ankle Subcondylar fractures of elbow Require rapid transport
Musculoskeletal Injury Management
Other Injury Consideration
Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support
Musculoskeletal Injury Management
General Principles
Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function
Musculoskeletal Injury Management
Splinting Devices
Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids Vacuum Splints Air Sprints Cravats or Velcro Splints
Fracture Care Joint Care Muscular & Connective Tissue Care
Musculoskeletal Injury Management
Care for Specific Fractures
Pelvis Scoop Stretcher PASG Fluid Resuscitation
Femur Traction Splints PASG Fracture versus hip doslocation
Musculoskeletal Injury Management
Care Specific Fractures
Tibia/Fibula Clavicle Most frequently fractured bond in the body Transmitted to 1st and 2nd rib Alert for lung injury
Humerus Radius/Ulna
Musculoskeletal Injury Management
Care for Specific Joint Injuries
Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger
Joint Injuries Alert for PMS Compromis
Musculoskeletal Injury Management
Soft & Connective Tissue Injuries
Tendon Ligament Muscle
Musculoskeletal Injury Management Medications
Nitrous Oxide
50% O2:50% N Non-explosive Effects dissipate in 2-5 minutes Easily diffused into air filled spaces in body. Dose
Inhaled & self administered
Onset
1-2 minutes
Not A Biotel Option Diazepam
Benzodiazepine Antianxiety Analgesic Dose
Onset
10-15 minutes
Duration
5-15 mg titrated
15-60 minutes
Counter Agent
Flumazenil
Dislocation of Acromioclavicular Joint
Humerus Injury
Older adults and children
Difficult to stabilize
Complications
Radial nerve damage if fracture in middle or distal portion of humeral shaft Humeral neck fracture may cause axillary nerve damage Internal hemorrhage into joint
Posterior Dislocation of the Elbow Joint with Marked Deformity
Severe Open Fracture of Forearm
Penetration of Forearm Caused by Nail Gun
Greenstick Fracture With Marked Deformity
Fracture of the Distal Radius
Hand Injury from a Motorcycle Crash
Femur Injury
Diameter of right thigh represents increased blood volume of 2 to 3 L
Open Fracture of the Lower Leg
Subtalar Dislocation
Foot that was Run Over by the Wheel of a Railway Coach
Musculoskeletal Injury Management Medications n n
Oxygen Nitrous Oxide Morphine Sulfate Fluids
Nitrous Oxide
Class: Gaseous Analgesic/Anesthetic Route: Inhalation Adult Dose: Instruct patient to inhale deeply through patient-held mask or mouthpiece Pediatric Dose: Instruct patient to inhale deeply through patient-held mask or mouthpiece Drug Action: Depresses the central nervous system Increases oxygen tension in the blood thereby reducing hypoxia Onset:2 minutes - 5 minutes Duration:2 minutes - 5 minutes
Nitrous Oxide
Indications: Adjunct analgesic for ischemic chest pain Severe pain or discomfort in all patients without contraindications. Precautions: Must be self administered Check machine gauges daily for proper concentrations Monitor blood pressure and pulse oximetry values during administration Side Effects: Hypotension Dizziness Nausea and vomiting Contraindications: Any altered level of consciousness or head injury Chronic obstructive pulmonary disease Chest trauma or actual/suspected pneumothorax Abdominal trauma Major facial trauma Acutely psychotic patients Pregnancy, other than active labor Any patient (adult or pediatric) unable to self-administer Decompression sickness
Morphine Sulfate
Indications Pain and anxiety secondary to AMI Chest pain unrelieved by Nitroglycerin Pulmonary edema Pain secondary to amputations or fractures Precautions: Monitor respiratory status and blood pressure closely. Notify Biotel prior to administration if patient is >65yrs of age, debilitated, has altered mental status, or systolic BP<110mmHg CHF: be prepared to intubate Antidote: Naloxone (Narcan®)
Morphine Sulfate
Class: Narcotic Analgesic Route: Slow IV push
Dose: Adult: Administer in titrated doses of 2 4mg, up to a maximum of 10mg Pediatric: 0.1mg/kg
Drug Action: Alleviates pain
Decreases peripheral vascular resistance vasodilator Decreases cardiac workload and oxygen demand on the heart
Scenario You respond to a soccer field for an “accidental injury.” Your patient is a 33-year old male who is complaining of severe right ankle pain. You note gross angulation and deformity of the ankle and carefully remove his shoe to assess his distal circulation. Your examination reveals that there is almost no perfusion to his foot.
Discussion
What exam findings would lead you to believe that perfusion to the extremity is poor?
Describe actions that should be taken immediately to improve blood flow to the foot.
How will you determine if your actions are successful?
What anatomical structures are likely involved in this injury?
Introduction to Musculoskeletal Injuries
Millions of Americans experience annually. Multiple MOI
Falls, Crashes, Violence, etc Multi-system trauma
Anatomy & Physiology of the Musculoskeletal System
Skeletal Tissue & Structure
Protections organs Allows for efficient movement Stores salts and other materials needed for metabolism Produces RBC’s
Pathophysiology of the Musculoskeletal System
Muscular Injury Contusion Compartment Syndrome Penetrating Injury Fatigue Muscle Cramp Muscle Spasm Strain
Anatomy & Physiology of the Musculoskeletal System
Appendicular skeleton (126 bones)
Pectoral girdle (4) Clavicle Scapula
Upper limbs (60) Pelvic girdle (2) Lower limbs (60)
Anatomy — Skeletal System Bone Classifications
Long bones
Short bones
Flat bones
Irregular bones
Anatomy — Skeletal System Posterior view
Anatomy & Physiology of the Musculoskeletal System
Bone Aging
Birth to Adult (18-20)
Transition from flexible to firm bone
Adult to elderly (40+) Reduction in collagen matrix and calcium salts Diminution of bone strength Spinal curvature
Anatomy & Physiology of the Musculoskeletal System
Muscular Tissue & Structure
600 muscle groups Types of muscles Smooth Striated Cardiac
Skeletal Muscles
Have striations
Greater strength
Referred to as striated muscle
Are under voluntary control
Also called voluntary muscles
Skeletal Muscles
Conscious control 40% of total body mass Two attachments
Origin: More fixed and proximal attachment Insertion: More movable and distal attachment
Contractions are rapid and forceful
Smooth Muscles
Walls of hollow organs (e.g., urinary bladder and uterus) Walls of tubes (e.g., respiratory, digestive, reproductive, urinary, and circulatory systems) Innervated by autonomic nervous system
Regulates size of lumen of tubular structures
Contractions strong and slow
Cardiac Muscles Cardiac Muscles
Have strength of skeletal muscle and endurance of smooth muscle
Provide for movement of blood through the body on a continuous basis
Respond to stimulation from the nervous system
Highly sensitive to lack of oxygen
Respond to lack of oxygen with pain in that area (angina)
Cardiac Muscles
Myocardium
Forms middle layer of heart
Innervated by autonomic nervous system but contracts spontaneously without any nerve supply
Contractions are strong and rhythmic
Tendons
Bands of connective tissue
Bind muscles to bones
Allow for power of movement across joints
Supplied by sensory fibers that extend from muscle nerves
Bursae
Flattened, closed sacs of synovial fluid
Where tendon rubs against bone, ligament, or other tendon
Reduce friction
Act as shock absorber
Fill with fluid when infected or injured
Cartilage
Connective tissue covering epiphysis
Surface for articulation
Allows for smooth movement at joints
Ligaments
Connective tissue that crosses joints
Attaches bone to bone
Stretch more easily than tendons
Allow for stable range of motion
Fascia
Dense fibrous connective tissue
Forms bands or sheets
Covers muscles, blood vessels, and nerves
Supports and anchors organs to nearby structures
Pathophysiology of the Musculoskeletal System
Joint Injury
Sprain Subluxation Dislocation
Bone Injury
Open Fracture Closed Fracture Hairline Fracture Impacted Fracture
Pathophysiology — Mechanism of Injury Five forces cause bone and joint injury
Direct force
Indirect force
Twisting force
Pathological
Fatigue
Classifications of Musculoskeletal Injuries
Injuries include:
Fractures Sprains Strains
Joint dislocations
Musculoskeletal Injuries
Direct trauma
Indirect trauma
Blunt force applied to an extremity
Vertical fall that produces spinal fracture distant from site of impact
Pathological conditions
Some forms of arthritis Malignancy
Pathophysiology — Fractures Unstable — Proximal and distal ends move freely in relationship to each other Impacted — Jammed together so there is no movement between proximal and distal bones Open — Skin is open, allowing introduction of bacteria, dirt, and other foreign bodies Closed — Skin is intact Fracture with dislocation — Fracture at
Fractures
Break in continuity of bone or cartilage
Complete or incomplete
Line of fracture through bone
Open or closed
Integrity of skin near fracture site
Classification of Fractures
Open
Closed
Comminuted
Greenstick
Spiral
Classification of Fractures
Oblique
Transverse
Stress
Pathological
Epiphyseal
Classification of Fractures
Pathophysiology — Fractures Impacted
Pathophysiology — Fractures
Joint Dislocations
Normal articulating ends of two or more bones are displaced
Luxation: Complete dislocation Subluxation: Incomplete dislocation
Frequently dislocated joints
Suspect joint dislocation when joint is deformed or does not have normal range of motion
Dislocations can result in great damage and instability
Pathophysiology — Fractures Dislocation - Angulated
Pathophysiology — Fractures
Sprains
Partial tearing of ligament
Caused by sudden twisting or stretching of joint beyond normal range of motion
Common in ankle and knee
Graded by severity
First-degree sprain Second-degree sprain Third-degree sprain
Strains
Injury to muscle or its tendon
Overexertion or overextension
Common in back and arms
May have significant loss of function
Severe strains may cause avulsion of bone from attachment site
Pathophysiology of the Musculoskeletal System
Inflammatory & Degenerative Conditions
Bursitis Tendinitis Arthritis
Osteoarthritis
Rheumatoid Arthritis
Degenerative Chronic, systemic, progressive, debilitating
Gout
Inflammation of joints produced by accumulation of uric acid crystals
Bursitis
Inflammation of bursa
Small, fluid-filled sac acts as cushion at a pressure point near joints Most important bursae are around knee, elbow, and shoulder
Bursitis
Bursitis is usually from:
Pressure Friction Injury to membranes surrounding the joint
Treatment
Rest, ice, and analgesics
Tendonitis
Inflammation of tendon
Symptoms include:
Often caused by injury
Pain Tenderness Restricted movement of muscle attached to affected tendon
Treatment
Nonsteroidal antiinflammatory drugs (NSAIDs) Corticosteroid medications
Arthritis
Joint inflammation
Joint disease
Pain, swelling, stiffness, and redness
Involving one or many joints Many causes
Varies in severity
Mild ache and stiffness Severe pain and later joint deformity
Arthritis
Osteoarthritis (degenerative arthritis) most common
Pain usually managed with antiinflammatory agents
Extremity Trauma
Signs and symptoms
Pain on palpation or movement Swelling, deformity Crepitus Decreased range of motion False movement (unnatural movement of extremity) Decreased or absent sensory perception or circulation distal to injury
Six "P"s of Compartment Syndrome
Pain
On palpation (tenderness) On movement
Pallor—pale skin or poor capillary refill Paresthesia—pins and needles sensation Pulses—diminished or absent Paralysis—inability to move Pressure
Associated Complications
Hemorrhage
Instability
Loss of tissue
Simple laceration and contamination
Interruption of blood supply
Nerve damage
Long-term disability
Assessment
Determine if life-threatening conditions are present
Care for those first
Never overlook musculoskeletal trauma
Don’t allow noncritical musculoskeletal injury to distract
Musculoskeletal Assessment
Four classes of patients
Life-/limb-threatening injuries or conditions
Other life-/limb-threatening injuries and simple musculoskeletal trauma Life-/limb-threatening musculoskeletal trauma
Includes life-/limb-threatening musculoskeletal trauma
No other life-/limb-threatening injuries
Isolated, non-life-/limb-threatening
Musculoskeletal Injury Assessment
Scene Size-up Initial Assessment
Categories of urgency
Rapid Trauma Assessment Focused H&P
Life & Limb threatening injury Life threatening injury and minor musculoskeletal injury Non-life threatening injuries but serious musculoskeletal injuries Non-life threatening injuries and only isolated minor musculoskeletal injuries
6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
Detailed Physical Exam Ongoing Assessment Sports Injury Consideration
Age-Associated Changes in Bones
Water content of intervertebral disks decreases Increased risk of disk herniation Loss of stature is common – ½ - 3/4 inch Bone tissue disorders shorten trunk
Age-Associated Changes in Bones
Vertebral column assumes arch shape
Costal cartilages ossify, making thorax more rigid
Shallow breathing due to rigid thoracic cage
Facial contours change
Fractures
Limb-Threatening Injuries
Knee dislocation Fracture or dislocation of ankle Subcondylar fractures of elbow Require rapid transport
Musculoskeletal Injury Management
Other Injury Consideration
Pediatric Musculoskeletal Injury Athletic Musculoskeletal Injury Patient Refusals & Referral Psychological Support
Musculoskeletal Injury Management
General Principles
Protecting Open Wounds Positioning the limb Immobilizing the injury Checking Neurovascular Function
Musculoskeletal Injury Management
Splinting Devices
Rigid splints Formable Splints Soft Splints Traction Splints Other Splinting Aids Vacuum Splints Air Sprints Cravats or Velcro Splints
Fracture Care Joint Care Muscular & Connective Tissue Care
Musculoskeletal Injury Management
Care for Specific Fractures
Pelvis Scoop Stretcher PASG Fluid Resuscitation
Femur Traction Splints PASG Fracture versus hip doslocation
Musculoskeletal Injury Management
Care Specific Fractures
Tibia/Fibula Clavicle Most frequently fractured bond in the body Transmitted to 1st and 2nd rib Alert for lung injury
Humerus Radius/Ulna
Musculoskeletal Injury Management
Care for Specific Joint Injuries
Hip Knee Ankle Foot Shoulder Elbow Wrist/Hand Finger
Joint Injuries Alert for PMS Compromis
Musculoskeletal Injury Management
Soft & Connective Tissue Injuries
Tendon Ligament Muscle
Musculoskeletal Injury Management Medications
Nitrous Oxide
50% O2:50% N Non-explosive Effects dissipate in 2-5 minutes Easily diffused into air filled spaces in body. Dose
Inhaled & self administered
Onset
1-2 minutes
Not A Biotel Option Diazepam
Benzodiazepine Antianxiety Analgesic Dose
Onset
10-15 minutes
Duration
5-15 mg titrated
15-60 minutes
Counter Agent
Flumazenil
Dislocation of Acromioclavicular Joint
Humerus Injury
Older adults and children
Difficult to stabilize
Complications
Radial nerve damage if fracture in middle or distal portion of humeral shaft Humeral neck fracture may cause axillary nerve damage Internal hemorrhage into joint
Posterior Dislocation of the Elbow Joint with Marked Deformity
Severe Open Fracture of Forearm
Penetration of Forearm Caused by Nail Gun
Greenstick Fracture With Marked Deformity
Fracture of the Distal Radius
Hand Injury from a Motorcycle Crash
Femur Injury
Diameter of right thigh represents increased blood volume of 2 to 3 L
Open Fracture of the Lower Leg
Subtalar Dislocation
Foot that was Run Over by the Wheel of a Railway Coach
Musculoskeletal Injury Management Medications n n
Oxygen Nitrous Oxide Morphine Sulfate Fluids
Nitrous Oxide
Class: Gaseous Analgesic/Anesthetic Route: Inhalation Adult Dose: Instruct patient to inhale deeply through patient-held mask or mouthpiece Pediatric Dose: Instruct patient to inhale deeply through patient-held mask or mouthpiece Drug Action: Depresses the central nervous system Increases oxygen tension in the blood thereby reducing hypoxia Onset:2 minutes - 5 minutes Duration:2 minutes - 5 minutes
Nitrous Oxide
Indications: Adjunct analgesic for ischemic chest pain Severe pain or discomfort in all patients without contraindications. Precautions: Must be self administered Check machine gauges daily for proper concentrations Monitor blood pressure and pulse oximetry values during administration Side Effects: Hypotension Dizziness Nausea and vomiting Contraindications: Any altered level of consciousness or head injury Chronic obstructive pulmonary disease Chest trauma or actual/suspected pneumothorax Abdominal trauma Major facial trauma Acutely psychotic patients Pregnancy, other than active labor Any patient (adult or pediatric) unable to self-administer Decompression sickness
Morphine Sulfate
Indications Pain and anxiety secondary to AMI Chest pain unrelieved by Nitroglycerin Pulmonary edema Pain secondary to amputations or fractures Precautions: Monitor respiratory status and blood pressure closely. Notify Biotel prior to administration if patient is >65yrs of age, debilitated, has altered mental status, or systolic BP<110mmHg CHF: be prepared to intubate Antidote: Naloxone (Narcan®)
Morphine Sulfate
Class: Narcotic Analgesic Route: Slow IV push
Dose: Adult: Administer in titrated doses of 2 4mg, up to a maximum of 10mg Pediatric: 0.1mg/kg
Drug Action: Alleviates pain
Decreases peripheral vascular resistance vasodilator Decreases cardiac workload and oxygen demand on the heart
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