Red Flags and Emergencies Flashcards
give 8 red flag symptoms
age <20 or >60 non mechanical, constant pain systemic symptoms (weight loss etc) saddle anaesthesia +/- bladder/bowel symptoms history of cancer history of steroids structural deformity severe pain > 6 weeks
give 2 medical emergencies related to the spine
cauda equina syndrome
fracture with deteriorating neurology
what are the most important aspects of the initial assessment of a spinal fracture?
immobilise
X ray
neurological examination
do not forget other injuries
why must a neurological examination be performed quickly?
so that any change can be assessed which could drastically alter the management
what is focused on in a neurological examination?
establish motor level
establish sensory level
pay attention to the saddle area
document any change
how do you immobilise a cervical spine injury?
rigid collar
what is important to remember in a cervical spine X ray and why?
make sure the X ray shows C7/T1
often left out giving a false positive where there can be a serious injury
how is a thoracolumbar injury immobilised?
rigid spine board
where do you visualise on X ray in a thoracolumbar injury?
whole spine
what is the most common site of a thoracolumbar injury?
T12 or L1
what can determine whether a spinal fracture causes spinal cord involvement?
size of spinal canal
location of injury
- can be severe even in absence of major bone injury in children and elderly particularly
what can cause secondary spinal cord damage in a spinal fracture?
cord swelling oedema ischaemia thrombosis of small vessels venous obstruction stretching compression undue movement hypotension inappropriate surgery infection
what are the 2 patterns of spinal cord injury?
complete incomplete - central cord - brown-sequard - anterior cord
how are spinal cord injuries graded?
frankel/ASIA grading
- I/A = complete motor and sensory loss
- II/B = complete motor and incomplete sensory loss
- III/C = incomplete motor (no practical use)
- IV/D = useful motor and incomplete sensory
- V/E = normal motor and sensory function
what feature can often determine whether complete or incomplete spinal cord injury?
saddle region sparing
what are the common features of central cord injury?
arms worse then legs
what commonly causes a central cord injury?
hyperextension injury
typically an elderly patient who falls with a hyperextension neck injury, can be little to no evidence of bone damage
what are the typical features of a brown - sequard cord injury?
paralysis on ipsilateral side
hypaesthesia on contralateral side
how does a brown-sequard fracture typically occur?
usually associated with a fracture
which spinal cord injury has the best prognosis?
brown-sequard
what are the features usually associated with an anterior spinal cord injury?
motor loss
loss of pain, temperature sensation
preservation of deep touch, position and vibration sensation
poor prognosis
what can cause an anterior cord injury?
traumatic or vascular injury
- often a result of abdominal aneurysm repair
