EM Flashcards
Most common cause of sudden cardiac death in adults?
V fib
GCS
Eyes - open spontaneously (4), to verbal command (3), to pain (2), no response (1)
Motor - obeys verbal command (6), localizes pain (5), flexion withdrawal (4), decorticate (3), decerebrate (2), no response (1)
Verbal - converses (5), confused (4), inappropriate (3), incomprehensible (2), no response (1)
Measures to decrease ICP (HIVED)
Hyperventilation Intubation with pretreatment sedation Ventriculostomy (burr holes) Elevated HOB Diuretics (mannitol, furosemide)
Anterior cord syndrome
Injury/compression of anterior spinal arteries (flexion injuries)
Full/partial loss of bilateral pain/temp (STT) and (CST) with preservation of posterior column functions
Brown-Sequard Syndrome
Hemisection of spinal cord secondary to penetrating injury/disc protrusion/hematoma/tumor
Ipsilateral loss of motor (CST) and posterior column function
Contralateral loss of pain/temp
Central cord syndrome
Injury to area of spinal cord, often in patients with pre-existing narrowing of spinal cord - hyperextension injuries, buckling of ligamentum flavum into cord and/or ischemic etiology in distribution of branches of the anterior spinal artery
Weakness in UE > LE
Distal > proximal
Better prognosis with characteristic pattern of recovery; LE progressing upward to LE
Jefferson fracture
Mechanism?
C1 (atlas) burst fracture
Fx of both anterior and posterior rings of C1
Increased predental space on lateral XR and displacement of lateral masses on ondontoid view.
Results from axial loading.
C1 rotary subluxation
How do they present?
What patients should you think about?
Asymmetry between lateral masses of dens and odontoid.
Present with head held in rotation
Special patients: children or patients with RA
Hangman’s Fracture
Mechanism?
Fx of both pedicles “posterior elements” of C2
- unstable; not associated with spinal cord injury bc canal is widest through CT
Hyperextension mechanism
Burst fracture C3-C7
Mechanism?
Axial loading → compression of vertebral body → protrusion of anterior portion anteriorly, posterior portion posteriorly into spinal canal → spinal cord injury (usually anterior cord syndrome)
Chance fracture
Mechanism?
Horizontal fracture through vertebral body, spinous processes, laminae, pedicles, and tearing the posterior spinous ligament
NEXUS low-risk criteria for C-spine
Films are not indicated for patients with: No posterior midline tenderness No evidence of intoxication Normal level of alertness No focal neuro deficit No painful distracting injuries
