MS Emergencies and Red flags Flashcards
what makes a specific condition an emergency?
- the potential for permanent injury
- potential for life-threatening complications
- potential for litigation if a “borderline situation” become a declining situation that should have been predicted and prevented
Osteomyelitis
10-15% of patients with osteomyelitis develop neurological lesion or frank
spinal cord compressio
Atlanoaxial subluxation and instability:
excessive mobility between C1 and C2 leaves the
spinal cord vulnerable to compressive injury when C1 translates anteriorly on C2 during
cervical flexion. This may progress to neurological compromise including paralysis.
Cauda equina syndrome
compression of the sacral nerve roots due to lumbar disc
herniation. Urinary retention, urinary and bowel incontinence, sphincter dysfunction and
lower extremity neurological deficits are common. Emergency surgical decompression is
mandatory.
Myelopathy, Myelitis
spinal cord compression, inflammation or other lesion. May be due
to infection, edema, tumor, spinal fracture, stenosis or inflammatory disease.
Acute non-traumatic monoarthritis
must determine if from sepsis or infection.
Considered to be infectious until proven otherwise. Emergency referral for aspiration and
synovial joint fluid culture.
Supracondylar fracture of the mid/distal humerus
puts the brachial artery (and branches)
as well as radial, ulnar and median nerves at risk for lesion and subsequent paralysis or
hemorrhage respectively.
Acute compartment syndrome
potentially irreversible muscle and/or nerve compression
injury due to inflammation, swelling, or bleeding within a fascial compartment. Usually
lower leg, but also forearm. May occur following trauma, fracture or overuse (strenuous
exercise)
Giant cell arteritis, Temporal arteritis:
may rapidly progress to blindness.
Acute red eye, including acute iritis and scleritis
may be rheumatoid arthritis, reactive
arthritis, ankylosing spondylitis, sarcoidosis which may result in blindness.
Transverse myelitis
segmental spinal cord infection. Emergency referral.
Septic arthritis
intra-articular bacterial infection that results in articular destruction and death in 5-10% of patients. Emergent referral for joint aspiration.
Neuropsychiatric lupus
neuropsychiatric manifestations in a patient with lupus.
Red flags for cancer
- Older than 50
- Hx of CA
- unexpected weight loss over 3 mos
- No relief with bed rest- No response to Tx in 1 month
- pain duration > 1month
red flags for low back in Hx
- under 20y.o
- constitutional s/sx
- increased risks
what to consider w/ hx of corticosteroid use?
fracture
osteoporosis
what to consider with hx of diabetes
avascular necrosis of the hip and spinal cord or a spinal infection
red flag for low back pain from PE
1.Neurological deficits in older patients: Malignancy must be considered.
2. The “alarm sign”: If a patient with sciatica points to a specific location in the leg or
pelvis as being aggravated during a SLR test, consider a local mass.
3. Pain with spinal percussion: If
exquisitely painful, and the pain lingers, then consider possible cancer or spinal infection.
- Hip pain with contracture: Consider infection.
- Pronounced loss of hip flexor strength can suggest a tumor affecting the spinal cord.
- Palpable mass: Consider a tumor or abscess.
- Significant bony tenderness: Palpatory bony tenderness, especially of more superficial
bones, such as the tibia and sternum, can be associated with bone disease such as
multiple myeloma. - Vascular deficits (e.g., loss of pulse): Indications of poor blood supply in the foot may
be linked to peripheral arterial disease and deep vein thrombosis contributing to a
patient’s leg symptoms, and have a weak link with abdominal aortic aneurysms. - Deformity: Kyphosis can reflect vertebral collapse. Scoliosis that is painful, acute or focal
may suggest an underlying disease process. - Abdominal mass or bruit: Abdominal Aortic Aneurysm
low back pain red fags with ancillary studies
- elevated ESR or CRP: CA, Infec, A.I
- elevated serum calcium and or alk/phos: linked to bone metastatic disease
- anemiacould be due to chronic diseases
- back pain with pathological imagin
red flags for shoulder pain possible malignancy
- Shoulder pain that cannot be reproduced or aggravated by physical examination
maneuvers - Past history of cancer
- Unrelenting pain, especially at night
- History of smoking
- Over 50 years old
- Fatigue or general feeling of ill health
- Localized edema
RED FLAGS INDICATING POSSIBLE INFECTION
- Acute non-traumatic monoarthritis is an emergent referral to rule out infection via
aspiration. - Current fever
- Recent history of infection (e.g., throat, lung, or tuberculosis)
- Recent dental work, surgeries, or other invasive procedures
- Recent open wound
- Positive tuning fork test
- Presence of localized edema
RED FLAGS INDICATING POSSIBLE MYOCARDIAL INFARCTION OR OTHER HEART CONDITIONS
- Visceral referred pain to left (or right) shoulder, jaw, or chest
- Sharp, clinching, or crushing chest pain radiating to left shoulder and jaw
- Patient demonstrates classic Le-vine’s sign over chest
- History of cardiovascular disease
- Diaphoresis or shortness of breath
RED FLAGS INDICATING POSSIBLE GALLBLADDER DISEASE
- Visceral referred pain to the right shoulder and scapula 2. Poorly defined pain that cannot be reproduced upon examining shoulder 3. Pain with percussion in upper right quadrant of the abdomen
RED FLAGS FOR INFLAMMATORY ARTHROPATHIES
- Symptoms are bilateral 2. Symptoms are episodic 3. Other joints are involved 4. Acute non-traumatic monoarthritis is an emergent referral to rule out infection via
aspiration.
RED FLAGS FOR REFERRED PAIN FROM THE NECK
- Patient also complains of neck pain 2. Motion of the neck causes shoulder pain
