Attending Version: Back Pain Emergencies Module; created by Dr. Wendy Gerstein

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Outline for discussion:
I. Differential Diagnosis of life (or limb) -threatening back pain and clues to presentation:
A. Dissecting aortic aneurysm (h/o male sex, advanced age, chronic hypertension, connective tissue syndromes, decelerating trauma, aortitis, cocaine use).

B. Cauda equina syndrome (disc herniation below termination of spinal cord – can have h/o arthritis or injury)

C. Vertebral osteomyelitis/epidural abscess (IVDU, recent procedure, fever)

D. AAA rupture (male sex, advanced age, hypertension, tobacco use, family h/o).

E. Spinal metastasis of underlying malignancy (h/o breast, prostate, lung, kidney, or thyroid cancer; insidious onset, awakens at night, weight loss).

F. Epidural hematoma (recent procedure, anticoagulated, trauma).

G. Spinal cord compression from large disc herniation (h/o trauma/injury)

H. Vertebral fracture with potential spine instability (h/o trauma/malignancy/compression fractures, osteoporosis).

II. History:
Pain – location, duration, radiation, presence at night, severity, what exacerbates it, what relieves it, any sensory deficits or muscle weakness noted, any bowel/bladder dysfunction?
Red Flags” in history:
A. IVDU or recent procedure that could cause bacteremia

B. Immunosuppression

C. Previous cancer diagnosis

D. Fevers, weight loss, other constitutional symptoms

E. Unremitting pain not relieved by lying down/bed rest

F. Constant pain at night

G. Leg weakness

H. Bowel/bladder/sexual dysfunction

I. Older age (>50)

J. H/o trauma

K. Thoracic back pain

L. Knife-like/ripping/tearing pain

M. Syncope

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