Red flags in emergencies

Question 1

What are the red flags for back pain?

Answer 1

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

Question 2

Loss of bowel and bladder control is just a sign of old age and shouldn’t be a worry T/F

Answer 2

F- this is a surgical emergency. Have 24h to treat. Cauda equina syndrome

Question 3

What actually is cauda equina syndrome

Answer 3

loss of control-painless retention of urine w overflow and a lack of awareness of bowel opening

Question 4

What is important in a neuro exam?

Answer 4

accurate exam essential to establish motor and sensory level
pay attention to saddle area
document any changes

Question 5

What are the signs of secondary cord damage?

Answer 5

• cord swelling
• oedema
• ischaemia
• thrombosis of small vessels
• venous obs

Question 6

If a problem is suspected with the cervical spine what is important?

Answer 6

• Make sure x-ray shows C7/T1
• Rigid collar
• remember other injuries
• accurate neurological examination

Question 7

Where are injuries most common in the thoracocolumnar region? ( therefore what is important?)

Answer 7

Most commonly T12 or L1

Rigid spinal board

Question 8

What is the important initial management is caudal equina is suspected

Answer 8

immobilise and x-ray

Question 9

Spinal cord involvement is infrequent- what may be an indicator?

Answer 9

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)

Question 10

Moving a spinal patient always causes a problem T/F

Answer 10

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.

Question 11

What are examples of secondary cord damage?

Answer 11

Cord swelling
oedema
Ischaemia
Thrombosis of small vessels
Venous obstruction

Question 12

What is the Frankel/ASIA grading used for?

Answer 12

Spinal injuries
either I-V or A-E

1/A- complete motor and sensory loss
V/E-normal motor and sensory function

Question 13

What are the two types of spinal injuries?

Answer 13

Complete and incomplete

Question 14

What is central cord injury?

Answer 14

Typically hyperextension injury
Arms worse than legs
Prognosis variable but generally good

Question 15

What is brown-sequard injury?

Answer 15

Usually traumatic and associated with fracture
Paralysis on ipsilateral side hyperaesthesia on contralateral side
best prognosis

Question 16

What is anterior cord injury?

Answer 16

Motor loss
loss of pain and temperature sense
deep touch, position and vibration preserved
may have traumatic or vascular cause
prognosis poor

Question 17

What can cause secondary cord damage?

Answer 17

stretching
compression
undue movement
hypotension
inappropraite surgery
infection

Question 18

What are the two important rarities in the growing spine

Answer 18

growth plate disturbance

adolescents

Question 19

What can occur as a result of damage to a growth plate?

Answer 19

permanent fusion and cessation of growth. In the spine this can lead to kyphosis

Question 20

What is ankylosing spondylitis

Answer 20

rigid spine
long lever arms
soft portico bone

Question 21

What should you NOT do if a patient has suspected ankylosing spondylitis

Answer 21

put them in a collar- this can make it worse. instead immobilise them in “natural” position to stop it getting worse