Page 32 - 2023 SMOG Digital

Medical

BACK and 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
Universal Patient Care Guideline BACK OR NECK PAIN ASSOCIATED
Continued from: O2 (if Hypoxemic) WITH A NEUROLOGIC OR
Tactical Evacuation Guideline IV/IO Guideline (prn) VASCULAR DEFICIT IS AN
Cardiac Monitor (prn) EMERG GENCY!
Mechanisms that increase suspicion
YES Injury / Trauma? of possible Spinal Cord Injury:
NO • Blunt trauma to head or neck
SPINAL IMMOBILIZATION • Injury associated with high energy
Guideline Extremity BP difference? transfer (e.g., blast, motor vehicle)
Suspicion of AAA? NO • Fall from >3 feet
• Fall directly onto head/neck
HEAD INJURY Guideline YES • History of back/neck arthritis plus
1000mL IVF IV any trauma
OR Consider:
MULTIPLE TRAUMA Guideline Blood Product for AAA
Bradycardia with
Pulse Guideline
Arrhythmia?
NO YES Tachycardia with
CHEST PAIN Suspicion of ACS? Pulse Guideline
Guideline YES Chest Pain? Cardiac Arrest
NO Guideline
(VF/Pulseless VT or
PAIN MANAGEMENT Guideline
Asystole/PEA)
When appropriate, return to:
Tactical Evacuation Guideline
Pearls:
• Examine: mental status, HEENT, neck, chest, lungs, abdomen, back, extremities,
neurologic.
• Abdominal aortic aneurysm is a concern in hypertensive/diabetic/>50yo populations–
feel for pulsatile abdominal mass. Symptoms may mimic kidney stones.
• Patients with trauma/midline tenderness should be immobilized.
• Any bowel/bladder incontinence is significant and may represent a true surgical
emergency (Cauda Equina Syndrome).

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