Compartment Syndrome

Risk Factors:

• Fractures (especially tibia and forearm)
• Crush injuries
• Vascular injuries with reperfusion

Presentation:

• 6 P’s (pain, pallor, paresthesia, paralysis, pulselessness, poilikothermia)
• Escalating analgesia requirements

Diagnosis: Centurion needle is stocked at ULH. Pressure >30 mmHg is diagnostic for compartment syndrome.

Dispo: admit to surgical service for fasciotomy

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Septic Arthritis

Risk Factors:

• Recent joint instrumentation
• Joint damage
• Other infection

Presentation:

• Red, warm, swollen, painful joint with decreased ROM

Workup: CBC, ESR, CRP, STI urine/swabs, arthrocentesis

Diagnosis: WBC >/= 50k, PMNs 90%

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Cervical Spine Injuries & Clearance

Jefferson Bit Off a Hangman’s Thumb

Spinal Cord Injuries

• Central cord
• Anterior cord
• Brown-Sequard
• Posterior cord

NEXUS: sens 99-99.6%, spec ~12%

Canadian: sens ~100%, spec ~42%

• Stiell et al., NEJM 2023 Canadian missed less injuries compared to NEXUS

MRI after negative CT in awake, neuro intact patients with midline tenderness very rarely identifies an unstable injury requiring acute management.

• West Trauma study does not recommend MRI

PECARN 2024: sens ~94%, NPV ~99.9%

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Low Back Pain Emergencies

Red Flags:

• Fever
• h/o malignancy
• IVDU
• Incontinence
• Recent instrumentation
• Weight loss
• Age >50
• Immunocompromise
• Anticoagulation

Broad Diagnostic Categories:

1. Vascular – AAA, aortic dissection, spinal epidural hematoma
2. Infectious – epidural abscess, osteomyelitis/discitis
3. Malignancy – pathologic fx, bony metastatic disease
4. Anatomic

Imaging: MRI with contrast of the C/T/L Spine