indications for imaging
Rules/red flags
Fractures
Head Injury
100

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.

100

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 

100

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 

100

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 

200

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.

200

What do the Canadian C-spine rules identify?

Identifies cervical fractures, dislocation or instability 

200

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 

200

What is the exclusion criteria for the Canadian CT Head rule?

Anticoagulant medication or bleeding disorder

Age<16

Seizure 

300

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

300

What are some red flags for spinal fracture risk?

Women>75, Men>65

Prolonged use of corticosteroids

Severe trauma

Presence of contusion or abrasion

300

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 

300

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

400

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 

400

What is the strongest red flag for malignant bony tumors?

Previous history of cancer

400

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

500

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 

500

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

500

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