The Musculoskeletal System

title of the image Introduction to the musculoskeletal system by life saving first aid dot com dot au. illustration on the right depicting a skeleton with a top hat gleefully dancing followed by Life Saving First Aid logo

Introduction to the musculoskeletal system

As a first aider, you should have at least a basic understanding of how the musculoskeletal system works. Bones and muscles are the heavy lifters when it comes to moving, standing still and even keeping us alive. Some muscles we can control, some function without our conscious input.

Can you imagine what we would look like as a species if we had no skeleton? No bones in our bodies?

Let’s start with the Skeletal System

The Skeletal system

The skeletal system – sometimes referred to as the Musculoskeletal System – consists of Bones, Ligaments, Tendons, and Joints.

The major functions of the skeletal system are:

  • Body support,
  • Facilitation of movement,
  • Protection of internal organs,
  • Storage of minerals and fat,
  • Support the production and replenishment of blood for the body

Skeletal systemBones

The adult human skeletal system has 206 bones, joined together by Joints, Ligaments, and Tendons.

Bones are a rigid form of connective tissue. Composed principally of calcium, they support the body and protect the organs. The bones also provide a surface for muscles to attach to.

A baby’s body has about 300 bones at birth. These eventually grow together to form the 206 bones that adults have. Some of a baby’s bones are made entirely of cartilage while others are partly made of cartilage. This cartilage is soft and flexible. During childhood, as a person grows, the cartilage grows and is slowly replaced by bone, with help from calcium.

Therefore, for example, when performing CPR on an Infant we use only 2 fingers, or one hand for a child, and press down with less effort. Their bones are much more flexible than adults.

Older people are more likely to suffer from osteoporosis, which affects their bones. Their bones may become more brittle and break easily, or less dense and therefore not as strong. In fact, their entire Musculoskeletal system may be weaker and less robust than a young person.

Ligaments

Ligaments are bands of tough elastic tissue around your joints. They connect bone to bone, give your joints support, and limit their movement. You have ligaments around your knees, ankles, elbows, shoulders, and other joints.

Tendons

Tendons are tough, flexible, and inelastic bands of fibrous connective tissue that connect muscles to bones.

Joints

The joints connect bone to bone, and there are 360 joints in our bodies. Joints hold the skeleton and support movement. We group joints together by their function and structure. The types of joints are ball-and-socket, hinge, and pivot joints.

Three kinds of freely movable joints play a big part in voluntary movement:

  • Hinge joints – allow movement in one direction, as seen in the knees and elbows.
  •  Pivot joints – allow a rotating or twisting motion, like that of the head moving from side to side.
  • Ball-and-socket joints – where the round end of a long bone fits into the hollow of another bone allow the greatest freedom of movement. The hips and shoulders have this type of joint.

Tendons and ligaments keep the Musculoskeletal system joined together, working with the joints to support movement.

Skeletal system problems for the first aider

For a first aider problems with bones include:

  • Fractures – when a bone is broken
  • Dislocations – where two bones have separated at a joint
  • Spinal Injuries – severed spinal cord
  • Skull injuries – fractured or punctured
  • Sprains – where the ligaments that connect and stabilise the bones in a joint are stretched or torn

According to Healthy Bones Australia, in 2022, it is estimated there will be 6.2 million Australians over the age of 50 with osteoporosis or osteopenia – commonly seen in people over age 50 who have lower than average bone density but do not have osteoporosis. Osteoporosis is rare in children and adolescents.

Muscles

Included in the Musculoskeletal system are the muscles. There are about 600 muscles in the human body; the three main types of muscle are skeletal, smooth, and cardiac.

A muscle is made up of thousands of elastic fibres bundled tightly together. Each bundle is wrapped in a thin transparent membrane called a perimysium.

Skeletal muscles are the most common muscles in the body as they move the bones. They play a vital role in everyday activities. Skeletal muscles are also responsible for generating heat in the body to maintain body temperature and help regulate blood sugar levels.

Skeletal muscle (voluntary muscle or striated muscle) is the muscle that you can consciously control. Skeletal muscles run from one bone to another, usually passing at least one joint. 

Skeletal muscle injuries or diseases can profoundly affect a person’s life.

Smooth Muscle

Smooth muscle is present throughout the body, where it serves a variety of functions.

Found in the blood vessels such as arteries assisting the heart in moving blood around the body. In the stomach and intestines, smooth muscle helps with digestion and the collection of nutrients. It exists throughout the urinary system, where it functions to help rid the body of toxins and works in electrolyte balance.

Cardiac

Cardiac muscle differs from skeletal muscle in that it exhibits rhythmic contractions and is not under voluntary control. Rapid, involuntary contraction and relaxation of the cardiac muscle are vital for pumping blood throughout the cardiovascular system. To accomplish this, the structure of cardiac muscle has distinct features that allow it to contract in a coordinated fashion and resist fatigue.

Voluntary and involuntary muscles.

As you can see, muscles have a range of functions from pumping blood and supporting movement to lifting heavy weights.

Muscle movement made consciously is called voluntary. Involuntary muscle movement is a movement made without conscious awareness.

Generally, any movement of the Musculoskeletal system is voluntary. Skeletal muscles work in pairs. As a result, if your brain signals a muscle to contract, it shortens, pulling one bone towards another across a joint. When one shortens, a corresponding muscle lengthens.

A good example of this action is your upper arm.  As you contract your bicep on the front of your upper arm, your tricep on the back of your upper arm lengthens. And vice versa.

Involuntary muscles on the other hand operate without conscious thought or input. Smooth muscle inside blood vessels and organs like the intestines for example. It contracts to move substances through the organ, and so helps regulate your blood pressure, airways, and digestion.

Muscle problems for the first aider

Some of the more common muscle problems for a first aider include

  • Strains – where the muscle is over-stretched or contracted too quickly, leading to a partial or complete tear of the muscle fibres or the tendon
  • Muscle cramps – These sudden contractions of a muscle can be very painful
  • Tendonitis – inflammation or irritation of a tendon, the fibrous cord that attaches a muscle to the bone

For how to deal with soft tissue injuries check out our post ” Ricer. Initial first aid action plan for sprains and strains”

Points to remember:

  • The Musculoskeletal system comprises the muscles, skeleton, tendons, and ligaments
  • Some muscles operate automatically without conscious input from us
  • Most body movement requires conscious input from our brain
  • The Musculoskeletal system is prone to injury and requires first aid or more advanced medical care
  • There is a difference in the strength of the system depending on the age of the person

Well, that’s that. Until next time… Stay safe.

Diabetes

Image depicts a Person consulting a general practitioner asking about her diabetic analysis. Title of image and blog is "Diabetes: Signs, symptoms, and management" followed by Life Saving First Aid logo

Introduction

In this article we are going to look at Diabetes, what it is, how to recognise the signs and symptoms of Hypoglycaemic and hyperglycaemic conditions, and how to manage them and assist the casualty.

Here’s a few quick facts about diabetes.

According to Diabetes Australia

  • More than 300 Australians develop diabetes every day. That’s one person every five minutes
  • Almost 1.9 million Australians have diabetes. This includes all types of diagnosed diabetes (almost 1.5 million known and registered) as well as silent, undiagnosed type 2 diabetes (up to 500,000 estimated)
  • Almost 120,000 Australians have developed diabetes in the past year
  • For every person diagnosed with diabetes, there is usually a family member or carer who also ‘lives with diabetes’ every day in a support role. This means that an estimated 2.4 million Australians are affected by diabetes every day
  • The total annual cost impact of diabetes in Australia is estimated at $17.6 billion (inflation-adjusted)

In fact, diabetes is the fastest-growing chronic condition in Australia, increasing at a faster rate than other chronic diseases such as heart disease and cancer.

All types of diabetes are increasing in prevalence.

What is Diabetes?

Diabetes is a chronic, lifelong medical condition which occurs when the pancreas fails to produce sufficient insulin, or the body develops a resistance to the action of its own insulin. Untreated, the absolute or relative lack of insulin will lead to a high blood glucose level.

When the body does not produce enough insulin or does not use insulin, glucose stays in your blood and does not reach the cells. This prevents the cells from functioning normally.

There are two main types of diabetes: Type 1 and Type 2.

Type 1 Diabetes

Type 1 diabetes is an auto-immune disease that often develops in childhood and requires lifelong treatment with insulin.

Type 2 Diabetes

Type 2 diabetes is more commonly recognised in adulthood and requires a treatment combination of diet, exercise, oral medication, and sometimes insulin.

A third type of diabetes is Gestational Diabetes

Gestational diabetes is a relatively common condition specific to pregnancy.

Diabetes can also occur because of another disease or as a side effect of medication.

Blood Sugar levels

When blood glucose levels become too high or too low, people with diabetes may become unwell and need first aid or treatment at a medical facility.

The normal range of glucose concentration in the blood of a healthy person ranges from 4.0 – 7.8 mmol/L.

As a result, if someone has abnormal levels of blood sugar, they can either be HYPOglycaemic – LOW blood sugar, or HYPERglycaemic – High blood sugar.

You can use a blood glucose meter to determine a person’s blood glucose level. There are different types of blood glucose meters and for more info click here.

Hypoglycaemia

Hypoglycaemia – Hypo for short, can occur because of:

• Too much insulin or other blood glucose-lowering medication.

• Inadequate or delayed carbohydrate intake after their usual insulin or oral medication dose.

• Exercise without adequate carbohydrate intake.

• Possibly delayed for up to 12 hours or more after exercise.

• In the setting of other illnesses; or excessive alcohol intake.

If the person injects too much insulin, doesn’t eat, or undertakes exercise without replenishing sugar levels they can go into a Hypo.

Signs and Symptoms of Hypoglycaemia

Some or all of the following are signs and symptoms of a Hypo.

• Weakness, shaking

• Sweating

• Faintness, dizziness

• Teariness or crying

• Hunger

• Numbness around the lips and fingers

• Sweating,

• Pallor (pale skin), especially in young children

• A rapid pulse; and a headache.

• Mood or behavioural changes, with confusion, inability to concentrate, and slurred speech.

• Inability to follow instructions.

• Unresponsive; or seizure, can lead to coma and possibly be fatal

Hypo management

The recommended way to manage a person with Hypoglycaemia is:

• Stop any exercise, make them comfortable, reassure them, and follow the person’s diabetes management plan if they have one.

• If the casualty is fully conscious and able to swallow give them some sweets such as jellybeans or a sugary drink. This will raise their glucose level and you should see some positive results within a few minutes.

• Do not give them diet beverages or sugar-free sweets.

• If their condition improves give them a meal or something to eat and monitor their condition.

If the person does not improve with this treatment, is seizing or is unconscious, call for an ambulance. I

If they are unresponsive and not breathing normally, commence resuscitation.

For an unconscious breathing person, place them into the recovery position and ensure the airway is clear.

Monitor their condition until the ambulance arrives.

Hyperglycaemia

Hyperglycaemia, Hyper for short, or high blood sugar level can occur because of

• Inadequate levels of insulin

• Incorrect doses of diabetes oral medications, infections,

• Excess carbohydrate intake,

• Stressful situations.

Hyperglycaemia can develop over hours or days, and many people do not experience symptoms from hyperglycaemia until their blood glucose levels are extremely high.

Hyperglycaemia can also occur at the time of initial diagnosis of diabetes and may go unrecognised until the person is clearly unwell.

If untreated, the person gradually deteriorates and can go into a coma.

Signs and symptoms of Hyperglycaemia

These may include:

• Excessive thirst with frequent urination/

• Dry skin and mouth, with sunken eyes (signs of dehydration)

• Recent weight loss

• Rapid pulse

• Nausea, vomiting and abdominal pain

• Rapid breathing

• Fruity sweet smell of acetone on the breath (like paint thinner or nail polish remover)

• Confusion and a deteriorating level of consciousness

• or unresponsiveness

Hyper management

The recommended way to manage a person with Hyperglycaemia is:

Follow the person’s diabetes management plan. If the person does not have a management plan, call 000 as they should be assessed by a health care professional.

• For unresponsive casualties with abnormal breathing, proceed with resuscitation.

• For unconscious casualties who are breathing normally, lay them down on their side in the recovery position and check to see that the airway is clear of any obstruction.

• Call 000

Conclusion

If you are unsure if the person has a high or low blood glucose level, the safest option is to treat hypoglycaemia (low blood glucose level).

Giving the casualty sweets may lead to a marked improvement if their blood glucose level is low. Indicating low blood sugar.

No improvement after giving sweets would indicate high blood sugar levels, and, if that’s the case, the small amount of sugar given would have little effect on blood sugar levels.

Let’s recap the main points:

• Hypoglycaemia is LOW blood sugar caused by too much insulin

• Hyperglycaemia is HIGH blood sugar. Not enough insulin.

• For a Hypo if conscious and able to swallow give the casualty sweets or a sweet drink

• If this does not improve their condition or they go unconscious call 000 Place in recovery  position or CPR as required

Remember, If in doubt about their condition, Hypo or Hyper, treat as Hypo

If you liked this article click here for more First Aid-related info

Well, that’s that. Until next time… Stay safe.