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OCS Ciccarello > CPRs > Flashcards

Flashcards in CPRs Deck (19):
1

Knee (Ottawa)

knee pain plus ANY of following --> Sn 1.00,Sp 0.49 >55yo, TTP @ head of fibula OR patella , can't flex 90deg; no NWB 4 steps

2

Knee (Pittsburgh)

Blunt trauma or fall plus Sn = .99, Sp = .60 <12yo, >50yo, inability to walk 4 steps

3

Ottawa Ankle and Foot rules

Sn 1.0, Sp 0.4

Pain in malleolar zone (ankle) / midfoot zone (foot) AND any one of following:

1) Bone tenderness at posterior edge OR tip of distal tibia/fibula (ankle)

2) base 5th MT OR navicular (foot)

3) Unable to bear weight for 4 steps immediately after injury and during exam

4

Canadian C-spine rules

Level II (validated in RCT) 1.0 Sn, (.98-1.0) Sp.42 Alert (GCS = 15 and stable trauma) Any high risk factors (ANY yes = X-ray)? •  >65yo OR • dangerous MOI Fall >1m, axial load to head, MVC >60mph, rollover, collision, motorized rec vehicle, bicycle collision OR •  Paresthesias in extremities Any low risk factor (any yes = safe assessment of ROM) • Simple rear-end MVC? • Sitting position in ED? • Ambulatory any time? • Delayed onset neck pain? • Absence midline C-spine tenderness? ANY yes => Actively rotate 45deg bilat? (no = Xray) ALL "no" = Xray

5

Hip OA

Cluster #1: Hip pain, IR<15, Flexion<115 OR ESR < 45 mm/hr Sn .86 Sp = .75 Cluster #2: Hip pain w/IR, age > 50, AM stiffness 60 min -LR .19 +LR 3.4

6

Knee OA

Knee pain and 3/6: Sn.95 Sp.69 age>50; stiff<30min; crepitus; bony tenderness; bony enlargement; no warmth +LR 3.1 -LR 0.1

7

LumboPelvic Manip CPR

Cleland

5 conditions: 4/5 Sp .92, +LR 13.2

  • FABQ-W<19,
  • Sx NOT distal to knee
  • one Hip IR > 35
  • lumbar hypomobility

with these 2 conditions: +LR 12.8

  • ONLY <16 days AND no sx distal to knee

BUT…only 10% of patients met the CPR

8

Wainner Radiculopathy CPR

1. Positive Spurling test

2. Positive neck distraction test

3. Positive upper-limb tension test (A-med)

4. < 60° cervical rotation to involved side 4 pos

4/4 positive = +LR 30.3; Sp.99 Sn.24

3/4 positive =  +LR 6.1

9

Laslett SI Joint

Distraction, Thigh thrust, Gaenslens (x2), Compression, Sacral Thrust

3 / 6 + = Sn. 91, Sp .81 +LR 6.9, -LR .12

Location: L5 (or above) UNILATERAL AND NOT CENTRAL NOT DISCOGENIC (b/c no central/peripheralization)

--> remove false positives RULE IN SI joint (Force, position, hand placement)

--> remove false negative

10

Nexus II CT s/p head injury

Level II Sn .98 (95% CI .97-.99) If NO factors present:

1. evidence of significant skull fx

2. scalp hematoma

3. neurolgic deficit

4. altered elve of alertness

5. abnormal behavior

6. coagulopathy

7. persistent vomiting

8. age > 65

11

Nexus C-spine rules

Sn. 90.7 (85-94) C-spine indicated for patients with trauma unless ALL five are true:

1. No cervical mid-line tenderness

2. No evidence of intoxication

3. Normal levels of alertness

4. No focal neurological deficit

5. No painful distracting injuries

12

Cleland Thoracic Thrust Manipulation CPR

5/6 = 100% of 3 Thoracic manipulations giving 1 week improvement  

  1. Sxs < 30 days
  2. No sxs distal to shoulder
  3. Sxs not worse with looking up
  4. Cx extension <30deg
  5. FABQ < 12
  6. diminished T3-T5 kyphosis

13

Hicks stabilization CPR

3/4 --> 50% improvement in disability (with coordination/stability exercises)

  1. Age < 40
  2. + PIT test
  3. + aberrant movment
  4. SLR > 91

14

Tseng Cervical Manip CPR

CPR for  immediate improvement in either pain, satisfaction, or perception of condition

1. <11.5 NDI

2. Bilateral involvement pattern

3. NOT sedentary work > 5hrs / day

4. feel better moving neck

5. cervical extension = not worse

6. spondylosis without radic

>= 4/6factors 60% to 90% chance of immediate improvement

15

Raney Traction Cervical CPR

1. Peripheralization with C4-C7 mobility testing

2. Positive shoulder ABD sign

3. age >= 55

4. +ULTT (median)

5. sxs decrease with distraction

3/5 +LR 4.81

4/5 +LR 11.7

16

Serious Spinal Conditions DDX

(list)

  • cancer
  • infection
  • cauda equina
  • spinal fracture

 

17

Spinal Fracture CPR

  1. Female
  2. Age > 70
  3. Trauma (major in young, minor in elderly)
  4. Corticosteroid

1 positive  = Sn .88, Sp .50 +LR 1.8

2 positive = Sn .63, Sp .96, +LR 15.5

3 positive = Sn .38, Sp 1.00 +LR 218

 

18

Meniscal CPR

 

 

  1. hx mechanical catching/locking
  2. joint line tenderness
  3. pain w/ forced knee hyperextension
  4. pain w/ maximum passive knee flexion
  5. pain/audible click with McMurray

5/5 --> Sn .11 Sp .99 +LR 11.2, -LR .90

4/5 --> Sn .16 Sp .96 +LR 4.3 -LR .87

for medial: JLT (rules in / out)

for lateral: Thessaly at 5o (rules out) + JLT (rules in)

 

19

Puentedura et al 2012 Cervical manip

  1. <38 days
  2. positive expectation for cervical manip
  3. side to side difff in cervical ROT ROM >10 deg
  4. pain with PA of middle cervical spine