Back Pain Flashcards
(14 cards)
Back Pain
Deadly Differential Diagnosis
Spinal
Cauda equina and spinal cord
compression
Spinal metastasis
Epidural abscess/hematoma
Disc herniation
Spinal fracture with subluxation
Back Pain
Deadly Differential Diagnosis
Other Spinal
Meningitis
Vertebral osteomyelitis
Transverse myelitis
Back Pain
Deadly Differential Diagnosis
Vascular
Aortic Dissection
Ruptured AAA
Pulmonary Embolism
Myocardial Infarction
Back Pain
Assessment
Hx
Fracture history
Cancer risk
Infection risk
Steroid use
Back Pain
Assessment
Hx Red Flags (BACK PAIN)
Bowel/Bladder dysfunction,
Anesthesia (saddle)
Constitutional symptoms (night pain, weight loss,fever/chills),
Chronic disease
Paresthesias
Age >50
IVDU/infection,
Neurological deficits
Back Pain
Assessment
Physical
Vitals + pulse deficits
Inspect skin for infection/trauma
Abdo exam for AAA
Cardiac exam (aortic murmur)
MSK lower back exam,
Neuro exam (lower extremity, reflexes, rectal tone)
Post void residual
Back Pain
Investigations
Labs
usually not indicated unless suspected infection (CBC, ESR,
CRP)
Back Pain
Investigations
Imaging
Bedside U/S : rule out AAA, look for bladder distention post-void
Back Pain
Investigations
Other
PVR: cauda equina syndrome (PVR >200cc has 90% sensitivity for CES)
Back Pain
Management
Cauda Equina Syndrome
Urgent MRI
Spine consult
Analgesia
IV Dexamethasone
Back Pain
Management
Aortic Dissection
Immediate specialist consultation
IV Labetalol to control HR and BP
Back Pain
Management
Ruptured AAA
Blood resuscitation
Immediate OR if unstable
Back Pain
Management
Epidural Abscess or Vertebral Osteomyelitis
MRI to definitively diagnose
+/- bone scan (osteomyelitis)
Broad spectrum antibiotics
Orthopedics consult
Back Pain
Management
MSK Back Pain
Analgesia: Acetaminophen, NSAIDs
Multidisciplinary approach with GP follow-up
