Page 37 - 2026 SMOG

BACK/NECK PAIN
Signs and Symptoms Differential Diagnosis
• Pain • Muscle spasm/strain
• Swelling • Degenerative disc disease
• Pain with motion • Fracture
• Weakness/numbness • Kidney stone/infection
• Bowel/bladder dysfunction • Abdominal aortic aneurysm
• Pneumonia/PE
• Cauda equina syndrome
• Tumor/mass/infection
• Thoracic pain: thoracic or abdominal aortic
aneurysm
Rule out MOI as a differential diagnosis. UNIVERSAL PATIENT CARE PROTOCOL,
O (if hypoxemic), IV/IO PROTOCOL (prn), Cardiac monitor (prn)
2
Injury Treatment Medical Treatment
• Mechanisms that increase suspicion of • Suspicion of AAA
possible spinal cord injury: ˚ Severe acute back pain
˚ Blunt trauma to the head or neck ˚ Pulsatile abdominal mass
˚ Injury associated with high energy ˚ Hypotension (likely ruptured; consider
transfer (e.g., blast, motor vehicle)
blood products)
˚ Fall from a height greater than standing • Suspicion of ACS/chest pain
ACS PROTOCOL
˚
height
˚ Fall directly onto head/neck • Arrhythmia
˚ History of back/neck arthritis plus any ˚ ADULT BRADYCARDIA PROTOCOL
ADULT TACHYCARDIA PROTOCOL
trauma
• HEAD INJURY PROTOCOL ˚ ˚ CARDIAC ARREST PROTOCOL
(VF/Pulseless VT or Asystole/PEA)
Notes, Cautions, Warnings
• EXAMINE: Mental status, HHENT, neck, chest, abdomen, back, extremities, and neurologic.
• Abdominal Aortic Aneurysm is a concern in hypertensive/diabetic/>50 y/o populations—feel
for pulsatile abdominal mass. Symptoms may mimic kidney stones.
• Patients with trauma and midline tenderness should be immobilized.
• Any bowel/bladder incontinence, saddle paresthesia, and bilateral numbness/weakness in lower
extremities are significant and may represent a true medical emergency.
Reference: CPG ID #15 (Cervical & Thoracolumbar Spine Injury, Surgical Management, and Transport)

2026 Standard Medical Operating Guidelines (SMOG) • 29