Emergency Medicine Cases Episode 26: Low Back Pain Emergencies
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Sep 12, 2012 Dr. Walter Himmel, an award-winning emergency physician and educator, joins Dr. Brian Steinhardt, a dual-certified expert in acute care, to tackle low back pain emergencies. They unpack complex cases including spinal epidural abscesses and cauda equina syndrome, highlighting key risk factors and diagnostic strategies. The pair emphasizes the importance of recognizing red flags, understanding lab results, and applying evidence-based management. Their insights help demystify the urgent approach to serious back pain, offering valuable clinical pearls for practitioners.
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Back Pain Isn’t Always Benign
- Back pain presentations are mostly benign but ED clinicians must still screen for serious causes.
- Serious diagnoses are uncommon but frequently missed on repeat visits, so maintain vigilance.
Give Fast Analgesia Then Reassess
- Treat severe back pain with rapid adequate analgesia to enable a valid re-examination.
- Reassess neurological findings after pain control to distinguish pain-limited exam from true deficits.
Start Antibiotics And Get MRI Fast
- If spinal infection is likely, start broad empiric antibiotics immediately and consult spine surgery.
- Obtain urgent MRI rather than waiting for lab confirmation when suspicion is high.