Back pain. A chief complaint generally not considered among the top 5 most thrilling for EM docs. Hiding among a sea of benign musculoskeletal conditions, however, lurk a handful of diagnoses which will result in irreversible paralysis and severe loss of function for our patients. The trick, of course, is figuring out who needs expensive advanced imaging and who can go home with NSAIDS....read on for a case that definitely falls into the former category....
A 5 year old boy presents to the ED with epistaxis in the setting of a recent respiratory illness. On exam you note a diffuse petechial rash with scattered bruises and the child appears mildly fatigued. Her vital signs are normal. Her blood work reveals a normal WBC and Hgb however platelets are 9,000.
With several anticoagulants now on the market, one needs to be well versed in the various reversal options in the setting of lifethreatening bleed (or if supratherapeutic on coumadin). Here's your quick review.
The overwhelming majority of patients with back pain have a benign etiology and require nothing more than pain control and time to recover fully. A good emergency medicine physician, however, should always keep in mind the "can't miss" diagnoses and take a careful history focusing on "red flag" symptoms and risk factors. Failure to make the diagnosis in our patient today would result in irreversable paraparesis, incontinence, and impotence. Read on to see why!