BACK PAIN

Question 1

DDX: CRITICAL CAUSES

Answer 1

CANCER
Spinal metastasis

FRACTURE
Traumatic or Pathologic Vertebral Fracture

INFECTION
Epidural abscess
Discitis
Spinal / Epidural hematoma
Vertebral osteomyelitis
Transverse myelitis

VASCULAR
Thoracic Aneurysm or Dissection
Ruptured AAA
Pulmonary Embolism
Myocardial Infarction

CORD COMPRESSION
Cauda equina

OTHER
Ectopic Pregnancy

Question 2

MANAGEMENT

Answer 2

A - STRIDOR.
B - RESPIRATORY RATE. >/ 30, 02 sats 90% on Fi02 30%. Work of breathing. Tracheal Position. Chest wall crepitus / chest rise.
C - MOTTLED APPEARANCE. GCS. Pallor. Cap Refill. Distal Pulses. Palpate Abdomen.
D - CHECK GLUCOSE. GCS, PERRLA, lateralizing signs
E - EXPOSURE, TAKE DOWN DRESSINGS

INVESTIGATIONS

CRP, ESR

bHCG

Bedside POCUS

PVR (>200 90% sensitive for CES)

MRI: CES, Epidural Abscesss

CTA Chest / Abdo

Question 3

DOCUMENTATION

Answer 3

HISTORY

Trauma

Night pain, weight loss

History of Cancer

Bowel Incontinence

Urinary Retention

Anesthesia
(saddle)

Bilateral Symptoms Neurological deficits

OR

Progressive Neurological Deficits

Syncope

Age >50

Fever/chills

Chronic disease

IVDU

Steroid Use

PHYSICAL EXAM

Pain on percussion of spine

Motor:

L4: Quadriceps
L5: Foot dorsiflexors
S1: Plantar flexors

Reflexes:

L4: Knee jerk
S1: Ankle jerk

Perianal Pinprick

Rectal Tone

PVR (Abnormal > 150 ml)

Palpate Abdomen for pulsatile mass

CVA tenderness

Straight Leg Raise

FABER

POCUS

Abdominal Aorta (abnormal > 3 cm)