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

• http://www.resus.org.uk/pages/glpostr.htm

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