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Step 1: Identify Classic Red Flags for Can’t Miss Diagnoses

  • Aortic Dissection and Abdominal Aortic Aneurysm (AAA)
    • Age >50
    • Hypertension
    • “Ripping” or “Tearing” pain
    • Absent pulses in lower extremities
  • Spinal Infections
    • Fever
    • Immunocompromized
      • HIV
      • Diabetes mellitus
      • Transplant patients
  • Spinal cord compression (especially cauda equina)
    • Urinary retention
      • Consider obtaining post-void residual
    • Saddle anesthesia
    • Fecal incontinence/decreased rectal tone
  • Fracture
    • Recent trauma
    • Advanced age
  • Cancer
    • History of cancer
    • Night sweats
    • Weight loss

Step 2: Testing Plan (If Patient Has Red Flags)

  • X-ray or CT scan if concerned for fracture
  • MRI if concerned for infection, cord compression, or cancer

Step 3: Symptom Management

  • NSAIDS
    • Naproxen
    • Ibuprofen
  • “Muscle relaxants”
    • Cyclobenzaprine
  • Other agents
    • Opiates
    • Topical therapy
    • Lidocaine patches

Step 4: Counseling

  • Remain active
  • Avoid heavy lifting
  • Red flags = immediate return to ED

Additional Reading