Red flags in emergencies Flashcards
What are the red flags for back pain?
first acute onset age <20 or >55 non mechanical pain/constant thoracic pain PH- carcinoma, steroids, HIV Generally unwell, Wt loss-malaise fever Widespread neurology structural deformity severe pain longer than 6 wks saddle anaesthesia/parasthesia +- loss of bowel and bladder control
Loss of bowel and bladder control is just a sign of old age and shouldn’t be a worry T/F
F- this is a surgical emergency. Have 24h to treat. Cauda equina syndrome
What actually is cauda equina syndrome
loss of control-painless retention of urine w overflow and a lack of awareness of bowel opening
What is important in a neuro exam?
accurate exam essential to establish motor and sensory level
pay attention to saddle area
document any changes
What are the signs of secondary cord damage?
- cord swelling
- oedema
- ischaemia
- thrombosis of small vessels
- venous obs
If a problem is suspected with the cervical spine what is important?
- Make sure x-ray shows C7/T1
- Rigid collar
- remember other injuries
- accurate neurological examination
Where are injuries most common in the thoracocolumnar region? ( therefore what is important?)
Most commonly T12 or L1
Rigid spinal board
What is the important initial management is caudal equina is suspected
immobilise and x-ray
Spinal cord involvement is infrequent- what may be an indicator?
Size of spinal cord location of injury bone "pinching" contact pressure (bone/disc) may be severe even in the absence of major bone injury (elderly/children)
Moving a spinal patient always causes a problem T/F
F- false. contrart to popular belief moving a spinal patient rarely causes a problem. Hypoxia,hypoxaemia and for perfusion carry a much greater risk of precipitating neurological damage in comprimised tissue.
What are examples of secondary cord damage?
Cord swelling oedema Ischaemia Thrombosis of small vessels Venous obstruction
What is the Frankel/ASIA grading used for?
Spinal injuries
either I-V or A-E
1/A- complete motor and sensory loss
V/E-normal motor and sensory function
What are the two types of spinal injuries?
Complete and incomplete
What is central cord injury?
Typically hyperextension injury
Arms worse than legs
Prognosis variable but generally good
What is brown-sequard injury?
Usually traumatic and associated with fracture
Paralysis on ipsilateral side hyperaesthesia on contralateral side
best prognosis
What is anterior cord injury?
Motor loss loss of pain and temperature sense deep touch, position and vibration preserved may have traumatic or vascular cause prognosis poor
What can cause secondary cord damage?
stretching compression undue movement hypotension inappropraite surgery infection
What are the two important rarities in the growing spine
growth plate disturbance
adolescents
What can occur as a result of damage to a growth plate?
permanent fusion and cessation of growth. In the spine this can lead to kyphosis
What is ankylosing spondylitis
rigid spine
long lever arms
soft portico bone
What should you NOT do if a patient has suspected ankylosing spondylitis
put them in a collar- this can make it worse. instead immobilise them in “natural” position to stop it getting worse
