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


    • 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


    • 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