Canadian CT head rule for adults
Exclusion criteria
- age < 16yrs
- on anticoagulants
- seizure after injury
High risk criteria
- GCS < 15 2hrs post injury
- suspected open or depressed skull fracture
- signs of BOS # (haemotympanum, battles sign, raccoon eyes, CSF leak)
- > 2 episodes of vomiting
- age > 65yrs
Medium risk criteria
- retrograde amnesia > 30 mins
- dangerous mechanism (fall > 3ft or > 5 stairs, Ped vs vehicle, occupant ejected from motor vehicle
If any high or medium risk criteria CT head is necessary
Ottawa ankle and foot rules
Could they walk 4 steps in ED
Tenderness over distal 6cm of tibia or tip of medial malleolus
Tenderness over distal 6cm of fibula or tip of lateral malleolus
- if any order ankle xray
Pain in the mid foot plus any:
Could they walk 4 steps in ED
Tenderness over base of 5th metatarsal
Tenderness over navicular
- if meets criteria order foot xray
Ottawa knee rule
Inability to weight bear immediately and for 4 steps in ED
Age > 55
Isolated patella tenderness
Tenderness at head of fibula
Inability to flex knee to 90 degrees
- if one or more findings after knee injury then order knee xray
- 100% sensitivity, reduces X-rays by 28%
Anticoagulant reversal
Warfarin
- vitamin K 10mg IV
- TXA 1g
- prothrombinex 25-50u/kg
Dabigatran
- check thrombin time
- idarucizumab 5g IV
- prothrombinex 25-50u/kg
- haemodialysis
Apixaban/rivaroxaban
- Xa levels
- adnexenet alpha
- prothrombinex 25-50u/kg
Alteplase
- TXA 1g
- cryoprecipitate 10u
- target fibrinogen > 20mg/dl
Unstable c spine fractures
Jefferson
- C1 burst fracture
- axial load, assoc with C2 # in 33% of cases
Bilateral facet dislocation
- flexion
Odontoid
- type II and III unstable
- flexion
Atlanto axial dislocation
- flexion, often fatal
Hangman’s
- C2 pedicular fracture
- extension
Teardrop
- flexion at C2 often with central cord syndrome
- extension C5 MOST SEVERE C SPINE # with anterior cord syndrome
CTB in trauma
Blood Can Be Very Bad
Blood
Cisterns
Brain
Ventricles
Bones
