Round 6 (Back Pain)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!











Case Introduction











A notorious, disheveled frequent flyer presents to your emergency department for her back pain and is asking for more Dilaudid…











Initial Vitals











* Temp 99.0* HR 99* RR 18* BP 118/78* O2 99%











Critical Actions











* Ask about Red Flags for Spinal Infection* Perform a Thorough Spinal Exam* Obtain MRI Spine with Contrast* Initiate Broad Spectrum Antibiotics* Treat Pain when Pathology Identified











Final Diagnosis











Spinal Epidural Abscess











Tips and Tricks











Don’t let consultants or other members of your team talk you out of appropriate management of a patient











Additional Reading











* Basic approach to Back Pain (EM Clerkship)* Epidural Abscess Overview (AAFP Website)