Red Flags and Emergencies Flashcards
what are the red flags of low back pain with or without sciatica
first acute onset >55 or <20 non mechanical pain thoracic pain PH-carcinoma, steroids, HIV unwell, weight loss widespread neurology- unilateral/ bilateral limb weakness and or numbness extending over several dermatomes structural deformity trauma consider malignant spinal chord compression acute cauda equina symptoms discitis/infection symptoms inflammatory spondtloarthropathy symptoms severe pain lasting more than 6 weeks
what are acute cauda equina signs
dysfunction of the bladder, bowel or sexual function
sensory changes in saddle or perianal area
what are the signs of discitis or infection
sudden onset of spinal pain or suspicious change in pattern, no history of trauma
systemic signs: fever, high pulse
night pain
all spinal movements restricted by pain and spasm
what are the signs of inflammatory spondyloarthropathy
morning stiffness and backache, multiple joint problems (pain, stiffness, swelling)
generally unwell
associated skin rash, inflammatory bowel disease, eyes problems (uveitis/ conjunctivitis), urethritis, sacroililac pain/tenderness
what spine pains are medical emergencies
cauda equina syndrome
fracture with deteriorating neurology
what is the initial assessment of a spinal fracture
immobilise and do x ray
what should be done for cervical spine injury
make sure x ray shows C7/T1
patient should have rigid collar
accurate neuro exam +remember other injuries
give an example of something that can be missed if an cervical spine x ray doesnt show C7/T1
facet discolcation
what should be done for a thoracolumbar injury
visualise the whole spine
rigid spine board
(most commonly T12 or L1)
what can cause secondary cord damage
cord swelling oedema ischaemia thrombosis of small vessels venous obstruction stretching compression undue movement hypotension inappropriate surgery infection
(hypotension and hypoxaemia worst)
list the different patterns of spinal chord injury
complete
incomplete
- central chord
- brown- sequard
- anterior chord
what is the frankle/ ASIA grading of spinal chord injury
I- complete motor and sensory loss II- complete motor and incomplete sensory III- incomplete motor- no practical use IV- useful motor and incomplete sensory V- normal motor and sensory function
sparing of what area will drastically alter prognosis of complete chord injury
saddle
what lesion can cause complete chord injury
ascending lesion
describe a central chord injury
typically hyperextension injury
arms worse than legs
incomplete injury pattern
prognosis variable
