Musculoskeletal, Neurologic, and Integumentary Emergencies
Concepts to master
For musculoskeletal emergencies, understand compartment syndrome, open fractures, dislocations with neurovascular compromise, and the concept that limb-threatening injuries demand reduction and reassessment of pulses, motor, and sensation. For neurologic emergencies, know stroke recognition and time-critical reperfusion windows, seizure management, status epilepticus, spinal cord injury with neurogenic shock, and the difference between neurogenic and spinal shock. For integumentary emergencies, understand burns (rule of nines, depth, inhalation injury), electrical and chemical burns, and necrotizing soft tissue infection.
Traps to watch
- Missing compartment syndrome because pulses are present; pulses persist late and are a poor early indicator. Pain out of proportion and pain with passive stretch are earlier signs.
- Confusing neurogenic shock (loss of sympathetic tone: hypotension with bradycardia) with spinal shock (transient loss of reflexes).
- Underestimating inhalation injury: facial burns, singed nares, hoarseness, and soot in sputum predict airway compromise.
- Treating a chemical burn with neutralization; copious irrigation is correct.
Rule of thumb
For any limb injury, document and recheck the neurovascular bundle before and after every intervention. For burns, airway comes before surface area calculations.
Worked example: A patient with a circumferential forearm burn and progressive numbness has an eschar constricting perfusion. The correct action is escharotomy, not elevation alone.