Emergencies Due To Physical Harm

Question 1

Describe the mechanism of injury for whiplash?

Answer 1

Sudden and excessive hyperextension, hyperflexion, or rotation of the neck.

Question 2

What are the most common ways in which whiplash can occur?

Answer 2

RTC - rear-ending of a car.
Sports injury
Assault

Question 3

Can whiplash occur in a low speed RTC?

Answer 3

Yes

Question 4

How does whiplash tend to present?

Answer 4

Hx of neck hyperextension/flexion/rotation

Delayed onset neck pain and stiffness
Occipital headache
Thoracic/lumbar back pain
Upper limb pain +/- parasthesia

Question 5

What are some of the red flags for serious whiplash injury?

Answer 5

• Immediate onset of neck pain
• Age over 65
• Dangerous mechanism of injury
• Unable to sit or walk following incident

Question 6

What emergency needs to be ruled out in pts presenting with an acute whiplash injury?

Answer 6

Spinal cord compression
Cervical disc herniation/spinal fracture
Intracranial bleed

Question 7

What is hypothermia?

Answer 7

Unintentional reduction of core body temperature to below 35🌡.

Divided into mild (32-35) and moderate/severe (<32)

Question 8

What is the initial physiological response to hypothermia?

Answer 8

1. Peripheral vasoconstriction

2. ACTH and TSH release to stimulate shivering and heat production

Question 9

What is the most common cause of hypothermia?

Answer 9

Exposure to cold in the environment

Question 10

What are the 2 most common forms of iatrogenic hypothermia?

Answer 10

1. Inadequate insulation/warming in operating theatres

2. Newborn babies inadequately warmed

Question 11

Which endocrine disorder is associated with hypothermia, especially in the homeless population?

Answer 11

Hypothyroidism -> myxoedema crisis

Question 12

What are the symptoms and signs of hypothermia?

Answer 12

• Shivering
• Cold pale skin
• Slurred speech
• Tachycardia, tachypnoea, and hypotension initially
• Bradycardia, respiratory depression, and hypothermia if severe
• Confusion

Question 13

How should temperature be monitored in a hypothermic patient?

Answer 13

With rectal thermometer or thermister probes, at regular intervals.

Question 14

What are the classic ECG findings in hypothermia?

Answer 14

J waves

ST elevation

Question 15

Describe the J waves seen on the ECG of a pt with hypothermia.

Answer 15

A positive deflection seen at the J point, most commonly on the precordial leads.

J point - the point marking the end of the QRS complex and the start of the ST segment.

Question 16

Describe the anomalies found in an FBC taken from a pt with hypothermia.

Answer 16

Hb and Haematocrit raised due to haemoconcentration.

Platelets and WBCs low due to sequestration in spleen.

Question 17

Describe the anomalies found in a set of U&Es taken from a pt with hypothermia.

Answer 17

Hypokalaemia as Potassium moves intracellularly

Question 18

Describe the initial management of a pt with hypothermia.

Answer 18

ABCDE

Secure airway
Administer O2 - humidified via non rebreath mask
Maintain/protect circulation with warmed fluids

Remove cold/wet clothing, warm with blankets/bear-hugger

Question 19

What is the ideal speed at which a pt with hypothermia can be warmed back up?

Why?

Answer 19

1 degree C per hour

A more rapid increase in body temperature will lead to vasodilation peripherally -> shock.

Question 20

Why is a coag screen important for a pt with hypothermia?

Answer 20

Hypothermia can cause DIC

Question 21

Why is a chest x-ray an important part of the work-up for hypothermia?

Answer 21

Pts with hypothermia are likely to have aspirated (-> pneumonia) or to have pulmonary oedema.

Question 22

What are the principles of management of fractures?

Answer 22

• Analgesia!!!
• Hx and Examination
• Protection
• X-ray

Reduce, hold, and rehabilitate.

Question 23

What rules can be used to help determine if an x-ray is needed for ? ankle or foot fractures?

Answer 23

Ottawa ankle and foot rules

Question 24

What rules can be used to help determine if an x-ray is needed for ? patellar/knee fractures?

Answer 24

Ottawa knee rules

Question 25

What are the principles of management of a neck of femur fracture?

Answer 25

• Analgesia
• Fluids
• Early bed rest
• Early operation

Question 26

What block is commonly used in A&E for upper leg pain relief?

Answer 26

Fascia Iliaca compartment block

Question 27

What are the main tyes of wrist fracture?

Answer 27

• Colles fracture (distal radius # with dorsal displacement)
• Smiths fracture (distal radius with volar displacement)
• Bartons fracture (intra-articular, displaced either direction)

Question 28

Who are scaphoid fractures most commonly seen in?

Answer 28

Younger patients who have FOOSHed.

Question 29

What are the classic signs of scaphoid fracture?

Answer 29

• Tender anatomical snuffbox

- Pain on telescoping the thumb

Question 30

Are the classic signs of a scaphoid fracture useful for diagnosing/predicting the presence of a fracture?

Answer 30

nO

Question 31

Are scans helpful in a ?scaphoid fracture?

Answer 31

Yes if they show something, but false negatives in up to 50% of cases.

A repeat scan +/- MRI after 2 weeks is required

Question 32

How should a scapoid fracture be managed?

Answer 32

Immobilisation

Question 33

How common is avascular necrosis following a scapoid fracture?

Answer 33

Depends on the location:

• 10-20% are proximal 1/3 scaphoid - these are high risk.
• 60-80% are scaphoid waist - these are moderate risk
• 10-20% are distal - AVN here is rare.