Back Pain

 

History:

 

  • Age
  • Past medical history
  • Past surgical history
  • Medications
  • Onset of pain / injury
  • Previous back injury
  • Traumatic mechanism
  • Location of pain
  • Fever
  • Improvement or worsening with activity

 

Signs and Symptoms:

 

  • Pain (paraspinous, spinous process)
  • Swelling
  • Pain with range of motion
  • Extremity weakness
  • Extremity numbness
  • Shooting pain into an extremity
  • Bowel / bladder dysfunction

 

Differential:

 

  • Muscle spasm / strain
  • Herniated disc with nerve
  • Compression
  • Sciatica
  • Spine Fracture
  • Kidney stone
  • Pyelonephritis
  • Aneurysm
  • Pneumonia
  • Spinal Epidural Abscess
  • Metastatic Cancer

 

 

Injury or traumatic mechanism ?

 

  • Yes

 

 

 

 

  • No

 

 

 

 

 

Signs of Shock ?

 

  • Yes

 

 

 

 

  • No

 

 

 

 

 

Positive Orthostatic ?

 

  • Yes

 

 

 

 

 

 

    • Contact Medical Control

 

Negative Orthostatic / Unable to Perform ?

 

  • Yes

 

 

 

 

 

Pearls:

 

  • Recommended Exam: Mental Status, HEENT, Neck, Chest, Lungs, Abdomen, Back, Extremities, Neuro
  • Abdominal aneurysms are a concern in patients over the age of 50.
  • Kidney stones typically present with an acute onset of flank pain which radiates around to the groin area.
  • Patients with mid-line pain over the spinous processes should be spinally immobilized.
  • Any bowel or bladder incontinence is a significant finding which requires immediate medical evaluation.
  • In-patient with history of IV drug abuse a spinal epidural abscess should be considered.

 

 

NREMT

National Registry Emergency Medical Technician

NREMR

National Registry Emergency Medical Responder

NRAEMT

National Registry Advance Emergency Technician

OLMC

Online Medical Control - Contact Medical Control

NRAEMT

National Registry Advance Emergency Technician

OLMC

Online Medical Control - Contact Medical Control

OLMC

Online Medical Control - Contact Medical Control