Trauma Patterns and Musculoskeletal Care

Do Not Let the Obvious Injury Hide the Critical One

Trauma scenes are visually distracting. A bent wrist, open fracture, or painful hip can grab attention, but EMR items still begin with scene safety and the primary assessment. Airway, breathing, circulation, major bleeding, and shock signs come before detailed musculoskeletal care.

Mechanism predicts hidden injury. A fall from height, high-speed crash, pedestrian impact, rollover, ejection, blast, crush, or penetrating wound can produce internal bleeding, head injury, chest injury, abdominal injury, or spine concern even when the first complaint is a limb. Request resources early when mechanism and condition suggest risk.

Trauma by body region carries specific EMR actions:

For an open pneumothorax (sucking chest wound), apply an occlusive dressing (a chest seal or improvised) taped on three sides so trapped air can escape and a tension pneumothorax is less likely. A flail chest (a segment moving paradoxically) needs airway/breathing support and rapid transport. For abdominal evisceration, never replace the organs — cover them with a sterile dressing moistened with sterile saline, then an occlusive layer, keep the patient warm, and transport.

Musculoskeletal Splinting and Burns

Musculoskeletal treatment is basic and practical: control bleeding, cover open wounds, avoid unnecessary movement, support the injured part, check distal Pulse, Motor function, and Sensation (PMS) before and after splinting as trained, apply splints within protocol, and reassess. Splinting should reduce movement and pain without delaying rapid transport for an unstable patient. Do not straighten a severe deformity unless specifically trained and directed by protocol; if distal pulse or sensation is lost, report it promptly.

Increasing swelling after a splint may mean the splint is too tight or the injury is worsening — recheck and loosen as trained.

Burns are a regional trauma the EMR manages with four anchors: stop the burning (remove from the source; smother flames; remove smoldering clothing and any jewelry, belts, and metal before swelling); assess severity including size, depth, and location; cover with a clean, dry sterile dressing for larger burns; and prevent hypothermia by keeping the patient warm. Brief cooling with clean water stops the burning for small burns, but excessive water on a large burn causes dangerous heat loss — once the skin is no longer hot, stop cooling.

Estimate burn size with the Rule of Nines (adult), each region a multiple of 9% of total body surface area:

Note that children have proportionally larger heads so adult percentages do not transfer directly. Watch for airway burns (singed nasal hair, soot, hoarseness, facial burns) — these can swell and obstruct, so they raise transport priority. Do not break blisters or apply ointments at the EMR level.

Reassessment is a frequent exam point: recheck PMS and the dressing after moving to a cot or during transport, and hand off any change — loss of pulse, numbness, increasing pain, bleeding through dressings, or shock signs. Pediatric trauma patients are more vulnerable to heat loss and may not describe symptoms well; use size-appropriate supports, involve calm caregivers when safe, and keep reassessing the whole patient, not just the obvious injury. Exam writers place the dramatic injury in the stem to see whether you keep scanning for life threats.

Tying Region, Mechanism, and Priority Together

The thread running through every trauma item is that mechanism plus condition sets priority, and life threats outrank the dramatic injury. A patient who hit the steering wheel may have only a sore chest now, but the EMR who remembers that blunt chest trauma can mean rib fractures, a flail segment, or internal bleeding keeps reassessing breathing and watches for shock. A diving injury implies a cervical spine problem until proven otherwise. A fall from a roof implies head, spine, chest, abdomen, pelvis, and extremity injury all at once. Naming the mechanism out loud helps the EMR predict what to look for and what to tell the next crew.

For head injury, the EMR's job is airway and breathing protection plus watching mental status: a patient who was talking and becomes confused or drowsy may have rising pressure inside the skull and needs rapid transport. For the chest, the threats are an open wound that lets air in (seal three sides), a flail segment that disrupts breathing, and internal bleeding; support ventilation and move quickly. For the abdomen, rigidity, bruising, and pain after blunt force suggest internal bleeding even with no open wound — treat for shock.

For extremities, the priorities are bleeding control, splinting to reduce movement and pain, and the PMS check before and after every splint and move.

Splinting principles worth memorizing:

• Check distal pulse, motor, and sensation before and after splinting.
• Immobilize the joint above and below a long-bone fracture.
• Cover open fractures with a sterile dressing before splinting.
• Do not push protruding bone back in or straighten a severe deformity unless trained and directed.
• A splint that worsens pulse or sensation is too tight — loosen or readjust as trained.

Burns deserve a final caution beyond size: an electrical burn can hide major internal injury behind small skin marks, and a chemical burn requires brushing off dry powder and flushing per protocol while protecting yourself and the patient's airway. Across all trauma, the EMR keeps the patient warm, reassesses after every move, and hands off the mechanism, the injuries found, the care given, and any change in PMS or mental status. The discipline of always returning to ABCs and shock signs — not the splint, not the burn dressing — is what the exam is measuring.