Ortho Problems in the ER Flashcards
(35 cards)
NEXUS c-spine injury clinical guidelines
IF: 1. no midline C-spine tenderness 2. no focal neuro deficit 3. nml level of alertness 4. no evidence of intoxication 5. no painful distracting injury THEN: fairly certain don't need an x-ray
Canadian C-spine guidelines mandating x-ray
-any high risk factors: > 65 yo paresthesias in extremities MVA>62 mph fall from height >3ft/5 stairs axial load to head/neck ejection from vehicle/ rollover
Canadian C-spine guidelines not requiring x-ray
pt can sit up in ED ambulatory at any time post injury delayed onset of neck pain no midline c-spine tenderness simple rear-end collision can rotate neck 45 degrees to both sides
torticollis in kids
pain in the neck & holding head in rotated position
usually unwilling to “un bend” neck
no neuro S&S
*this is a bony problem-atlantoaxial instability/ rotary subluxation
atlantoaxial rotary subluxation
CT to establish dx soft collar, rest (Philly collar) refer to neurosurgery w/in 72 hrs usually reduce themselves tx for kids is rest
Ottawa foot & ankle guidelines
tenderness to palpation: ANKLE A-posterior edge/tip of lateral malleolus 6 cm B-posterior edge/tip of medial malleolus 6 cm FOOT C-base of 5th metatarsal D-navicular unable to bear wt at scene or ED if have these- get x-ray 95-100% sensitive for fx
Ottawa Rules for the knee
not as sensitive or specific tenderness to palpation over patella cannot flex past 90 tenderness over head of fibula age>55 inability to bear wt at scene or in ED
Caveat of Ottawa Rules
data NOT validated in kids
have higher index of suspicion in kids & get the x-rays, esp. if less than 16 yo
ALWAYS palpate knee in every ankle injury
ALWAYS ALWAYS ALWAYS ALWAYS
Maisonneuve fx
reason you want to palpate the knee in any ankle injury
tib/fib & ankle x-ray
Tillaux fracture
a fracture of the anterolateral tibial epiphysis that is commonly seen in adolescents
septic arthritis sx’s
pain (usually out of proportion to how they look), crescendo erythema edema in joint \+/- fever monoarticular/polyarticular often atraumatic
risk factors for septic arthritis
age extremes immune compromise IVDU DM RA
labs to order for septic arthritis
c-reactive protein erythrocyte sed rate cbc w/ diff *complex to rule in/out when suspicious- have to tap it
causes of septic arthritis in adults
staph
strep
causes of septic arthritis in kids
staph
strep
causes of septic arthritis in teens
gonococcus
alos associated w/ gonococcal dermatitis
causes of septic arthritis in elderly, immune compromised
E. coli
definitive (mostly) tap
suppurative reactive transient synovitis gram stain, cultures AFB (acid fast bacillus), spirochetes, fungus TIME IS JOINT!!!!!
achilles tendon injury
Thompson test to check for plantar flexion- do bilaterally
surgical fix w/in 3 days for both partial & total
splint, give crutches,
patellar tendon injury
uncommon
surgically repair
biceps tendon injury
may or may not fix surgically
dependent on several different factors
acute osteomylitis
more likely to be a kid
spontaneous or d/t trauma
fever or feeling bad recently
get blood test- CRP, WBC
usually admit to peds
nerve & blood supply
ALWAYS examine the nerve(s) & blood supply w/ injuries
injuries w/ N/V compromise become true emergencies
5 P’s of compartment syndrome
Pain Pallor Paresthesias Pulselessness Paralysis *not super sensitive
