indications for imaging
What are the 3 indications in the Ottawa Ankle Rules to see if they need imaging?
Bone tenderness at posterior edge or tip of lateral OR medial malleolus
Inability to bear weight immediately and in emergency dept.
What is the exclusion criteria for the Pittsburgh Decision Rules?
Knee injury sustained more than 6 days before presentation
Patients with only superficial lacerations/abrasions
History of previous surgeries or fractures on affected knee
Patient being assessed for same injury
What are the risk factors for a stress reaction injury?
High volume/repetitive activity with little rest
Sudden change in training
Poor muscle strength/endurance
White & asian women at greater risk than african american women
Hypoestrogenic states in women
For the Canadian CT head rule, when would a patient be considered to have suffered a minor head tauma?
Loss of consciousness, GCS: 13-25, confusion, amnesia after event
What are the indications in the Ottawa Foot Rules to see if a patient needs imaging?
Bone tenderness at base of 5th metatarsal
Bone tenderness at navicular
Inability to bear weight immediately and in emergency dept.
What do the Canadian C-spine rules identify?
Identifies cervical fractures, dislocation or instability
What are the higher risk sites for a stress fracture or injury?
Femoral neck, anterior cortex of tibia, medial malleolus, tarsal navicular, base of 2nd and 5th metatarsal, talus, patella
What is the exclusion criteria for the Canadian CT Head rule?
Anticoagulant medication or bleeding disorder
Age<16
Seizure
What are some indications in the Ottawa Knee Rules to obtain imaging?
Patients >55
Tenderness at head of fibula
Isolated tenderness at patella
Inability to flex to 90
Inability to bear weight immediately after or in ER
What are some red flags for spinal fracture risk?
Women>75, Men>65
Prolonged use of corticosteroids
Severe trauma
Presence of contusion or abrasion
During the auscultation with bony percussion test, what would a positive test be? What does this tell us?
A decreased percussion sound on the involved side
Determines if there is a possible stress fracture
What are some high risk signs for neurosurgery intervention after a head injury?
GCS lower than 15 2 hours after injury
Suspected open/depressed skull fx
Signs of basal skull fx (racoon eyes, csf, battle sign)
2 or more episodes of vomiting
>65 yrs old
What is the exclusion criteria for Ottawa Knee Rules?
Younger than 18
Isolated superficial skin injuries
Injuries older than 7 days
Recent injuries being re evaluated
Paraplegia or multiple injuries
What is the strongest red flag for malignant bony tumors?
Previous history of cancer
For the test using a tuning fork for pain provocation, what frequency (Hz) is best to use?
What is a positive test?
256 Hz
Production of patients pain
What criteria needs to be met for the Pittsburgh Decision Rules to obtain a radiograph for a knee?
Patient younger than 12 or older than 50
Inability to walk more than 4 WB steps in ER
What are the differences between minor and major overuse fractures?
Minor: stress reaction where there is NO cortical disruptions, few weeks recovery
Major: stress fracture with clear fracture line, several months recovery
What are some red flags which require immediate referral to physician after a TBI?
Double vision, severe or worsening headache, seizure or convulsion, loss of consciousness, deteriorating consciousness, vomiting, agitation, combativeness