9 - Back pain Flashcards Preview

Emerg > 9 - Back pain > Flashcards

Flashcards in 9 - Back pain Deck (15)
1

how much back pain is potentially serious

5-10%

2

2 main classes of non-traumatic serious back pain

1. spinal
2. vascular

3

3 spinal causes

1. cauda equina and cord compression
- CA
- epidural abcess
- epidural hematoma
- disc herniation
2. osteomyelitis
3. transverse myelitis

4

5 vascular causes

1. aortic dissection
2. rupturing AAA
3. PE
4. MI
5. retroperitoneal bleed

5

11 red flags for something more serious

1. constitutional Sx
2. IV drug use
3. immunocomromised
4. pain worse at night
5. urinary retention and fecal incontinence
6. CA Hx
7. spinous process tenderness
8. saddle anesthesia
9. neurodeficit at several levels
10. anti-coag use or bleeding disorders
11. recent invasive spine surgery

6

what does cough or valsalva pain idicate

disc

7

classic triad of epidural abcess

1. fever
2. back pain
3. neuro deficits
- only 13% of time

8

PHx maneuvers

1. vitals
2. inpect
3. abdo exam for AA
4. straight leg raise
5. neuro exam of each nerve root
6. saddle sensation

9

investigations for someone fitting slipped disc and no red flags

none

10

invest for AAA

US

11

invest for CA or infections

CRP or ESR

12

other invest.

1. cutures for infection
2. urinalysis for renal
3. post void residual for cauda equina
4. CXR for red flags for CA
5. MRI for cauda equina or an cord compression

13

Tx of strain and hernaiation

- activity as tolerated
- no rest
- low potency pain killers
- no Tx
- follow up with primary care in 4-6 weeks if not better
-

14

Tx of spinal infection

- IV ABx - #rd gen ceph
- consult ID and neuro

15

Tx of cauda equina

- IV opioids
- IV dexa
- neuro surg