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14.01.16 A+E notes

Spinal cord injury without radiographic abnormality (SCIWORA) 
  • Spinal injuries in the absence of identifiable bony or ligamentous injury on complete, technically adequate plain radiographs or computed tomography
  • Typically located in the cervical region
  • Most children with SCIWORA do have demonstrable injury of the spinal cord, spinal ligaments, or vertebral body end plate on magnetic resonance imaging (MRI)
  • Suspect if history of blunt trauma with early (immediate) or transient symptoms of neurologic deficit or who have existing findings upon initial assessment
  • Treatment and prognosis are based upon neurologic presentation and MRI findings

Testicular torsion
  • Tricksy
  • May cause intermittent pain due to transient torsion
  • Suspect in all patients with non-specific abdo pain 
    • c.f. Referred pain pathways
    • Check testes!
    • Check hernial orifices 

#NOF
  • Classically shortened and externally rotated
  • But ONLY if displaced - Most actually are not

Renal colic
  • Most effective analgesic is PR diclofenac
  • Better even than morphine

Lhermitte's sign
  • Electrical sensation that runs down the back and into the limbs
  • May be elicited by bending the head forward
  • Suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla
    • MS
    • Transverse myelitis
    • Behçet's disease
    • Trauma
    • Radiation myelopathy
    • Vitamin B12 deficiency (subacute combined degeneration), incl. N2O abuse
    • Compression of the spinal cord in the neck from any cause: cervical spondylosis, disc herniation, tumor, Arnold-Chiari malformation

Resuscitation guidelines

Notes
  • GCS must be 15 to clinically clear C-spine
  • Neurological injury can => ischaemic ECG changes
  • CN VI is the first to go with raised ICP
  • WCC can rise in head trauma, MI
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