back pain

[ERDoc]

What does the abd exam show?

[Scaramedic]

What does the abd exam show?

Looks good to me.

[zzyzx]

Here's what the actual abd exam reveals:

http://www.grimmemennesker.dk/data/media/1...-beer-belly.jpg

The abd is soft, nontender, nondistended.

Yes, he is complaining of some numbness and weakness to both legs. Also now complaining of pain shooting down to both legs, but mostly it's his lower back that's killing him. As per the previous post, he's got good pedal pulses and cap refill.

[ERDoc]

Any saddle parasthesia? Incontinence? Reflexes?

[zzyzx]

ER Doc wrote: "Any saddle parasthesia? Incontinence? Reflexes?"

Okay, so you do a complete exam of his legs. The first thing you notice when you pull the blanket off is that he's incontinent, which he's quite embarrassed about. You check range of motion and ask him to describe where he feels pain and numbness. He says the pain is mostly in his lower back but also shoots down to his legs. He can move his legs but he says they've been getting progressively weaker. You ask him if he also feels numb between his legs in the area of his genitals and he says yes to that also.

So these are all red flags for what? (ER Doc already knows.)

By the way, is it realistic that someone with all this going on would not want to see a doctor and would not volunteer all the information about what's going on? Heck yes! This all happened to my cousin when he injured his back playing tennis. He didn't want to go to the hospital, and his wife had to call his doctor and have his doctor plead with him to call for an ambulance.

[Eydawn]

Sounds to me that he may have fractured or otherwise injured a vertebrae in his lumbar region, causing a compression injury (from movement of the vertebrae or from swelling) to his spinal cord. That would lead to the radiating pain (compression or injury of the pain and temperature sensing neurons) and the progressive weakness (compression or injury of the motor neurons) AND the numbness (touch and proprioception neurons). Wouldn't backboard this guy, but I'd definitely get him seated as comfortably and stably as possible on the cot, padding to make sure he's nice and snugly held.

Then it's off to MRI and X-ray land for this fellow! Provided I can articulate my concerns to him well enough to get him to go with us. I'd be very very careful in moving him...

Do I get a cookie?

Wendy

CO EMT-B

[ERDoc]

Aye. But this is a specific condition. What does this unfortunate gentleman have?

[zzyzx]

Thanks everyone for all your posts. This was fun! I encourage others to post more scenarios because I think it's a great way to learn.

The patient is suffering from cauda equina syndrome caused by a herniated spinal disc.

Check out these very interesting articles below...

http://www.emedicine.com/emerg/topic85.htm

http://en.wikipedia.org/wiki/Cauda_equina_syndrome

http://www.neurosurgerytoday.org/what/patient_e/cauda.asp

[Eydawn]

Ah hah! Ok. That makes sense. So how would you advocate transporting this fellow and what could we do other than palliative care prehospital?

Wendy

CO EMT-B

[Dustdevil]

I thought for sure that Wendy was going to say it. I think too many people are afraid to lay it "out there" and give a specific diagnosis. Go for it!

Of course, regardless, she was on the right track, where most others got distracted by the vital signs and didn't take an overall look at the patient and his symptoms.

Excellent scenario! This is the kind of thing that separates the technicians from the medical professionals!