Red Flags and Emergencies Flashcards
What are red flags in back pain?
age <20 or >60- first back pain on-mechanical, constant pain Hx of cancer Hx of steroids systemic symptoms- malaise; fever; unexplained weight loss structural deformity sadlle anaesthesia/parasthesai +/- loss of bowel or bladder control severe pain longer than 6 weeks
What are back pain emergencies?
cauda equina syndrome
fracture with deteriorating neurology
What are hte symptoms of cauda equina?
painless retention with overflow- full bladder and dont know
What is the problem with diagnosing cauda equina?
most patients present atypically- need high index of suspicion
What is ivolved in the intial assessment of spinal fractures?
immobilise and x-ray and do not forget other injuries
neuro exam
What is important in an initial neurological assessment of spinal fracture?
to establish a motor and sesory level and to pay particular attention to the saddle area
What is needed in injuries to the cervical spine?
make sure X-ray shows C7/T1
rigid collar
rememebr other injuries
What is needed with thoracocolumbar injuries?
visualise the whole spine and have a rigid spine board
Where is the most common spinal fracture?
T12/L1
What can cause secondary cord damage in fractures?
cord swelling; oedema; ischaemia; thrombosis of small vessels and venous obstruction
stretching; compression; undue movement; infection
What is needed in spinal fractures to prevetn secondary cord damage?
make sure the pt it well perfused and oxygenated
What is the Frankel/ ASIA grading of spinal injuries?
1-complete motor and sensory loss 2- complete motor and incomplete sensory 3- incomplete motor- no practical use 4- useful motor and incomplete sensory 5- normal motor and sensory function
When is spinal surgery undertaken?
within 7-10days- need to let swelling and tissue perfusion improve; postural reduction; internal fixation and grafting; late reconstruction
What needs to be monitred in children with growth plate disturbance?
damage to a growth plate an cause premature fusion and cessation of growth- kyphosis
What is a chance fracture and who is it seen in?
in adolescents- a very unstable fracture with ligamnet disruption due to presence of growth plates and cartilaginour rims
What should be suspected in a patient with ank, spon with any sort of back injury
fracture until proven otherise- soft porotic bone
In the cervical spine in patients with ank. spon what do you have to be careful about?
maybe made worse by collars- as natural ank. spon position is extended rather than the fixed flexion of neck collars
What is Heuter-Volkmann’s law?
increased pressure across an epiphyseal plate inhibits growth
What can cause secondary scoliosis?
neuromuscular- eg muscular dystrophy
tumours
spina bifida
What is the difference between spondylolysis and spondylolithesis?
spondylolysis is failure of union of various ossification centres whereass spondylolisthesis is slippage of one vetebra onto another
