HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!
description
Transcript of HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!
![Page 1: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/1.jpg)
HIGH RISK BACK PAIN: MORE THAN
JUST MOTRIN!Nilesh Patel
February 19, 2009St. Joseph’s Regional Medical Center
Paterson NJ
![Page 2: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/2.jpg)
OBJECTIVES Epidemiology
Differential
Red Flags
High Risk Presentations
Pearls & Pitfalls
![Page 3: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/3.jpg)
![Page 4: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/4.jpg)
EPIDEMIOLOGYVery common chief complain in ED
>90% benign >> will resolve in 4-6 weeks“The majority of patients who present to the ED have a non-
specific etiology that has no life or limb threatening concerns”“70-90% of all individuals will suffer back pain at some point in
their lives”
5-10% serious pathology“One can develop an indifference to this complaint and
potentially overlook serious causes of back pain”
History & Physical key to diagnosis
![Page 5: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/5.jpg)
BACK PAIN EMERGENCIESVascular
Aortic Dissection AAA
Infectious Osteomyelitis/Diskitis Spinal epidural abscess Transverse Myelitis
Spinal Cord Compression Syndromes Cauda Equina Syndrome—malignancy, herniation Epidural Hematoma
Trauma
Malignancy
![Page 6: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/6.jpg)
BACK PAIN EMERGENCIESPulmonary
PE
GI/GU Retroperitoneal bleed Ovarian torsion, diverticulitis, appendicitis
Renal Renal abscess Renal infarction
Neurologic Spinal cord infarction
![Page 7: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/7.jpg)
RED FLAGSAge < 20 or > 60
Untraditional pain
Constitutional symptoms
Neuro S & S
Hx: Trauma Cancer Immunosuppression IVDA Recent instrumentation
![Page 8: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/8.jpg)
PHYSICAL EXAMVital signs
Abdomen/GU
Back
NeuroMotorSensoryReflexesGaitRectal
![Page 9: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/9.jpg)
CASE # 1CC:
Back pain
HPI:67 y/o maleLeft lower lumbar painAcute onsetPain sharp, moderate to severe, non-radiatingPositive SOB
![Page 10: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/10.jpg)
CASE # 1PMHx/PSHx:
Severe COPD, HTN
Meds:Spiriva, Norvasc
Alleriges:NKDA
SHx:Former heavy tobacco use. No alcohol or drugs. No IVDA
![Page 11: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/11.jpg)
CASE # 1Review of Systems—positive back pain, sob, cough
VS-- 105/58, 120, 20, 96.4, 96% on 3 L
Gen-- AAO, in moderate respiratory distress
CVS-- RRR, tachy, no murmurs
Lungs-- b/l very diminished breath sounds, no W/R/R
Abd-- soft, nontender, normal bowel sounds, no masses
Back-- mild tenderness L flank, no vertebral point tenderness
Neuro-- nonfocal
![Page 12: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/12.jpg)
CASE # 1 14.3 Neutrophils 80%
21.4 153 Bands 0
43.0 Cardiac enzymes negative
137 100 20 UA negative
199 EKG sinus tachycardia
4.3 22 1.1
![Page 13: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/13.jpg)
![Page 14: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/14.jpg)
ED COURSE11:02 pm…Pt presented to ER via EMS and had initial VS
105/58 120 20 96.4 96% on 3 LPain level 6/10
11:18 pm…Pt. evaluated by ER physicianAlbuterol 10 mg/Atrovent 1 mg neb, Solumedrol 125 mg IV,
Morphine 2 mg IV, NSS 500 cc bolus
1:00 am…108/80 100 20 98% on 2 LPain level 5/10
CT scan a/p without contrast ordered
![Page 15: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/15.jpg)
ED/HOSPITAL COURSE1:30 am
73/52 112 24 97% on 3 L
Vascular surgery urgently consulted
PRBCs ordered
Pt went to OR
7:30 am…Surgery completed, pt received several units of blood
Pt. expired in SICU shortly after surgery
![Page 16: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/16.jpg)
RUPTURED AAA
![Page 17: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/17.jpg)
EPIDEMIOLOGYIncidence 36.2 cases/100,000
Increased incidence with aging
Increased incidence in Caucasians
5-10% patients age 60-80 will have AAA
15,000 deaths/year
Very high mortality with rupture
![Page 18: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/18.jpg)
NATURAL HXRisk of rupture increases with size of aneurysm
Average expansion rate 0.4 cm/year
Aneurysms > 5-6 cm expand more rapidly
Surgical threshold 5-6 cm
![Page 19: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/19.jpg)
PATHOGENESISAtherosclerosis…Familial
Infra-renal
Risk FactorsTobacco useAge > 60HTNAtherosclerosisFamily HxMale genderCOPD
![Page 20: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/20.jpg)
CLINICAL FEATURESTRIAD
Hypotension
Abdominal Pain/Back pain
Pulsatile abdominal mass
![Page 21: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/21.jpg)
CLINICAL FEATURESAbdominal pain
Back pain/flank pain
Syncope
Vomiting
SOB
Weakness
Groin pain
VS abnormalities
Pulsatile abdominal mass
Abdominal bruit
Peripheral embolic events
Pulse deficits
![Page 22: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/22.jpg)
DIAGNOSTICSClinical
UltrasoundSensitivity 95-100%ED Ultrasound!
CT scanSensitivity/Specificity close to 100%
![Page 23: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/23.jpg)
![Page 24: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/24.jpg)
![Page 25: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/25.jpg)
TREATMENTED
ABC IV/O2/Monitor IVFPRBCsUrgent vascular surgery consult
DefinitiveSurgery
![Page 26: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/26.jpg)
![Page 27: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/27.jpg)
![Page 28: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/28.jpg)
CASE # 2CC:
Back pain
HPI:52 y/o maleLower right sided back painStarted 5 days ago and worseningConstant pain, radiates to R hip/groin/abdomenWorsened by movementSeen in ER 3 days ago and discharged on pain meds
![Page 29: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/29.jpg)
CASE # 2PMHx/PSHx, Meds, Allergies:
None
SHx:Denied tobacco/alcohol useFormer IV heroin use, quit 8 months ago
ROS positives:Fever/ChillsAbdominal painBack painUrinary frequencyWeakness
![Page 30: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/30.jpg)
CASE # 2VS-- 102/70 100 20 98.0 100% RA
Gen-- AAO times three, in moderate discomfort
Abd-- soft, mild tenderness rlq, suprapubic area
Back-- tenderness L3-L5, R CVA tenderness, pain with any range of motion
Neuro-- 4/5 motor LE bilaterally (? due to pain); 5/5 motor UE b/l
![Page 31: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/31.jpg)
ED COURSEToradol, Percocet
UA—moderate blood (5-9 rbc), no LE or WBC
CT a/p without contrast negative
Upon discharge, pt still with pain
Temp 103.5
![Page 32: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/32.jpg)
CASE # 2 14 Neutrophils 80%
23.3 156 Bands 11%
43 ESR 59
135 95 21 CT--? Inflammatory changes
186 anterior to L5-S1
4.2 25 1.7
![Page 33: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/33.jpg)
ED COURSEAdmit
Vancomycin IV
MRIOsteomyelitis involving L4, L5Spinal epidural abscess causing mass effect on cauda equina
Blood Cultures2/2 MRSA
![Page 34: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/34.jpg)
![Page 35: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/35.jpg)
![Page 36: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/36.jpg)
SPINAL EPIDURAL ABSCESS
![Page 37: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/37.jpg)
EPIDEMIOLOGY0.2-1.2 cases/10,000 hospital admissions
Rare
High morbidity
![Page 38: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/38.jpg)
PATHOGENESISHematogenous spread
Direct Innoculation
Spread from contiguous site
Idiopathic
Staph aureus (MRSA)– 2/3 cases
Staph sp.
Gram negatives (E. coli, Pseudomonas)
![Page 39: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/39.jpg)
RISK FACTORSUnderlying disease
IVDA
Recent instrumentation
Indwelling catheters
Contiguous/hematogenous spread
![Page 40: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/40.jpg)
CLINICAL FEATURESTRIAD
Back pain
Fever
Neurologic deficit
![Page 41: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/41.jpg)
CLINICAL FEATURESJournal of EM 2004
63 patients
SymptomsBack pain—95%Radicular pain—62%Neuro deficit—41%Fever—33%Triad—8%
![Page 42: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/42.jpg)
CLINICAL FEATURES98% had at least one risk factor
68%--multiple ER visits
75%--diagnostic delay
45%--neuro deficit due to delay
62%--concurrent osteomyelitis
37%--concurrent diskitis
Take Home Points…
![Page 43: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/43.jpg)
DIAGNOSTICSCBC, ESR,CRP, Blood Cultures
MRIDiagnostic test of choice
X-ray
CT myelography
Bone Scan
CT scan
![Page 44: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/44.jpg)
TREATMENTED
ABCs IV antibioticsUrgent neurosurgical consultation
Definitive IV antibioticsCT-guided needle aspirationSurgical drainage
![Page 45: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/45.jpg)
OSTEOMYELITIS/DISKITIS
![Page 46: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/46.jpg)
EPIDEMIOLOGY/PATHOGENESIS
Risk factors similar to SEASickle cell disease
MicrobiologyStaph aureus leading causeOther Staph sp.Gram negativesPolymicrobialTBFungal
![Page 47: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/47.jpg)
CLINICAL FEATURESAcute/subacute/chronic
Back pain
Fever
Systemic symptoms
Cellulitis
![Page 48: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/48.jpg)
DIAGNOSTICSCBC, ESR, CRP, Blood cultures
X-ray
Bone scan
CT, MRI
Needle biopsy/bone biopsy
![Page 49: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/49.jpg)
TREATMENTIV antibiotics (prolonged treatment)
Surgical debridement
![Page 50: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/50.jpg)
CASE # 3CC:
Weakness
HPI:78 y/o maleWeakness over past 1 week, progressively worseningWeakness pronounce in LE, unable to ambulateBack painFecal incontinence
![Page 51: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/51.jpg)
CASE # 3PMHx/PSHx, Meds, Allergies, SHx:
None
ROS positives:WeaknessNumbnessUrinary incontinenceFecal incontinence
![Page 52: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/52.jpg)
CASE # 3VS-- 165/90 115 24 99.2 98% RA
Gen-- AAO times three, anxious
CVS-- RRR, tachy, no murmurs
Neuro-- 2/5 motor LE b/l, no sensation in LE, reflexes absent; UE motor, sensation preserved
Rectal-- loss of tone, enlarged firm prostate
![Page 53: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/53.jpg)
CASE # 3 9.2 PT 13.5
15.5 125 INR 1.2
132 105 25 UA 5-9 WBC, 0-5 RBC
154
4.4 20 1.4
![Page 54: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/54.jpg)
ED COURSEMRI
Spinal cord compression consistent with cauda equinaDestructive bony lesions lumbar vertebra consistent with
metastatic disease
Transferred to MICU, neurosurgery consult
Prostate CA with bony metastasis
![Page 56: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/56.jpg)
SC COMPRESSION SYNDROMES
Malignancy--mets
Central disk herniation
Epidural hematoma
SEA
Trauma
Transverse myelitis
![Page 57: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/57.jpg)
EPIDEMIOLOGYPrevalence low back pain patients 4/10,000
Most common in 4th-5th decades
Male predominance
![Page 58: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/58.jpg)
PATHOGENESISCompression of conus medullaris or nerve roots of cauda
equina
Disk herniation
Malignancy
L4-L5
![Page 59: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/59.jpg)
![Page 60: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/60.jpg)
![Page 61: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/61.jpg)
EXAM NORMALSMotor
L1-L2…hip flexion
L3…hip adduction
L4…hip abduction
L5…foot dorsiflexion
S1-S2…foot plantar flexion
S2-S4…rectal tone
Reflexes
L4….patellar
S1…ankle
![Page 62: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/62.jpg)
CLINICAL FEATURESTRIAD
LE weakness
Saddle anesthesia
Loss of bowel/bladder function
![Page 63: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/63.jpg)
CLINICAL FEATURES (AJEM March 2004)
Low back pain
Radicular symptoms
LE paresthesias
LE weakness
Urinary/fecal retention
Urinary/fecal incontinence
Gait abnormalities
LE motor weakness
Saddle anesthesia
Decreased/absent DTR’s
Decreased/absent sphincter tone
Post void residual
![Page 64: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/64.jpg)
DIAGNOSTICSClinical diagnosis!
X-ray
MRIGold standard for diagnosis
CT myelography
![Page 65: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/65.jpg)
TREATMENTED
ABCs IV steroids (high dose)Pain controlUrgent neurosurgery consultation
DefinitiveEarly surgical intervention
![Page 66: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/66.jpg)
MALIGNANCYMost common cause of spinal cord compression syndromes
Usually metastaticBreast, Prostate, LungKidney, Thyroid, Colorectal, Non-Hodgkin’s, MM
DiagnosticsX-ray, CT, MRI
ManagementUrgent neurosurgery consultRadiation-onc consult—localized radiotherapy IV steroidsHypercalcemia
![Page 67: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/67.jpg)
PEARLS & PITFALLSPearls
Assess for red flags—history & physical examKeep high risk diagnoses in mind—DDx
PitfallsChronic back painPerception of drug-seeking behaviorsSevere pain—incomplete evaluationBounce-back patients
![Page 68: HIGH RISK BACK PAIN: MORE THAN JUST MOTRIN!](https://reader031.fdocuments.net/reader031/viewer/2022013004/5681588e550346895dc5eda6/html5/thumbnails/68.jpg)
SUMMARYRed Flags in history…Risk Factors
Physical Exam—Vital signs, Back, Neuro
DDx
AAA
SEA
Osteo
Cauda equina
Malignancy