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)