Emergencies Due To Physical Harm Flashcards
Describe the mechanism of injury for whiplash?
Sudden and excessive hyperextension, hyperflexion, or rotation of the neck.
What are the most common ways in which whiplash can occur?
RTC - rear-ending of a car.
Sports injury
Assault
Can whiplash occur in a low speed RTC?
Yes
How does whiplash tend to present?
Hx of neck hyperextension/flexion/rotation
Delayed onset neck pain and stiffness
Occipital headache
Thoracic/lumbar back pain
Upper limb pain +/- parasthesia
What are some of the red flags for serious whiplash injury?
- Immediate onset of neck pain
- Age over 65
- Dangerous mechanism of injury
- Unable to sit or walk following incident
What emergency needs to be ruled out in pts presenting with an acute whiplash injury?
Spinal cord compression
Cervical disc herniation/spinal fracture
Intracranial bleed
What is hypothermia?
Unintentional reduction of core body temperature to below 35🌡.
Divided into mild (32-35) and moderate/severe (<32)
What is the initial physiological response to hypothermia?
- Peripheral vasoconstriction
2. ACTH and TSH release to stimulate shivering and heat production
What is the most common cause of hypothermia?
Exposure to cold in the environment
What are the 2 most common forms of iatrogenic hypothermia?
- Inadequate insulation/warming in operating theatres
2. Newborn babies inadequately warmed
Which endocrine disorder is associated with hypothermia, especially in the homeless population?
Hypothyroidism -> myxoedema crisis
What are the symptoms and signs of hypothermia?
- Shivering
- Cold pale skin
- Slurred speech
- Tachycardia, tachypnoea, and hypotension initially
- Bradycardia, respiratory depression, and hypothermia if severe
- Confusion
How should temperature be monitored in a hypothermic patient?
With rectal thermometer or thermister probes, at regular intervals.
What are the classic ECG findings in hypothermia?
J waves
ST elevation
Describe the J waves seen on the ECG of a pt with hypothermia.
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.
Describe the anomalies found in an FBC taken from a pt with hypothermia.
Hb and Haematocrit raised due to haemoconcentration.
Platelets and WBCs low due to sequestration in spleen.
Describe the anomalies found in a set of U&Es taken from a pt with hypothermia.
Hypokalaemia as Potassium moves intracellularly
Describe the initial management of a pt with hypothermia.
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
What is the ideal speed at which a pt with hypothermia can be warmed back up?
Why?
1 degree C per hour
A more rapid increase in body temperature will lead to vasodilation peripherally -> shock.
Why is a coag screen important for a pt with hypothermia?
Hypothermia can cause DIC
Why is a chest x-ray an important part of the work-up for hypothermia?
Pts with hypothermia are likely to have aspirated (-> pneumonia) or to have pulmonary oedema.
What are the principles of management of fractures?
- Analgesia!!!
- Hx and Examination
- Protection
- X-ray
Reduce, hold, and rehabilitate.
What rules can be used to help determine if an x-ray is needed for ? ankle or foot fractures?
Ottawa ankle and foot rules
What rules can be used to help determine if an x-ray is needed for ? patellar/knee fractures?
Ottawa knee rules
What are the principles of management of a neck of femur fracture?
- Analgesia
- Fluids
- Early bed rest
- Early operation
What block is commonly used in A&E for upper leg pain relief?
Fascia Iliaca compartment block
What are the main tyes of wrist fracture?
- Colles fracture (distal radius # with dorsal displacement)
- Smiths fracture (distal radius with volar displacement)
- Bartons fracture (intra-articular, displaced either direction)
Who are scaphoid fractures most commonly seen in?
Younger patients who have FOOSHed.
What are the classic signs of scaphoid fracture?
- Tender anatomical snuffbox
- Pain on telescoping the thumb
Are the classic signs of a scaphoid fracture useful for diagnosing/predicting the presence of a fracture?
nO
Are scans helpful in a ?scaphoid fracture?
Yes if they show something, but false negatives in up to 50% of cases.
A repeat scan +/- MRI after 2 weeks is required
How should a scapoid fracture be managed?
Immobilisation
How common is avascular necrosis following a scapoid fracture?
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.
