Ortho Problems in the ER Flashcards
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
