Flashcards in Red Flags and Emergencies Deck (20):
What are red flags in back pain?
age <20 or >60- first back pain
on-mechanical, constant pain
Hx of cancer
Hx of steroids
systemic symptoms- malaise; fever; unexplained weight loss
sadlle anaesthesia/parasthesai +/- loss of bowel or bladder control
severe pain longer than 6 weeks
What are back pain emergencies?
cauda equina syndrome
fracture with deteriorating neurology
What are hte symptoms of cauda equina?
painless retention with overflow- full bladder and dont know
What is the problem with diagnosing cauda equina?
most patients present atypically- need high index of suspicion
What is ivolved in the intial assessment of spinal fractures?
immobilise and x-ray and do not forget other injuries
What is important in an initial neurological assessment of spinal fracture?
to establish a motor and sesory level and to pay particular attention to the saddle area
What is needed in injuries to the cervical spine?
make sure X-ray shows C7/T1
rememebr other injuries
What is needed with thoracocolumbar injuries?
visualise the whole spine and have a rigid spine board
Where is the most common spinal fracture?
What can cause secondary cord damage in fractures?
cord swelling; oedema; ischaemia; thrombosis of small vessels and venous obstruction
stretching; compression; undue movement; infection
What is needed in spinal fractures to prevetn secondary cord damage?
make sure the pt it well perfused and oxygenated
What is the Frankel/ ASIA grading of spinal injuries?
1-complete motor and sensory loss
2- complete motor and incomplete sensory
3- incomplete motor- no practical use
4- useful motor and incomplete sensory
5- normal motor and sensory function
When is spinal surgery undertaken?
within 7-10days- need to let swelling and tissue perfusion improve; postural reduction; internal fixation and grafting; late reconstruction
What needs to be monitred in children with growth plate disturbance?
damage to a growth plate an cause premature fusion and cessation of growth- kyphosis
What is a chance fracture and who is it seen in?
in adolescents- a very unstable fracture with ligamnet disruption due to presence of growth plates and cartilaginour rims
What should be suspected in a patient with ank, spon with any sort of back injury
fracture until proven otherise- soft porotic bone
In the cervical spine in patients with ank. spon what do you have to be careful about?
maybe made worse by collars- as natural ank. spon position is extended rather than the fixed flexion of neck collars
What is Heuter-Volkmann's law?
increased pressure across an epiphyseal plate inhibits growth
What can cause secondary scoliosis?
neuromuscular- eg muscular dystrophy