Other things to consider would be immunocompromised patients besides just those on steroids (ex: patients with HIV, diabetes, alcoholics or taking biologic agents) who are at risk for spinal epidural abscess, discitis, or osteomyelitis. One simple red flag list is called TUNA FISH. There are multiple “Red Flag” lists to help identify patients at risk for more serious causes of their back pain. Physician frustrations with managing acute non-traumatic low back pain include considering rare dangerous back pain patient (epidural abscesses, osteomyelitis, pathological fractures, etc), patients demanding imaging, difficulty in relieving pain and concern about opiate abuse or diversion. While the vast majority of presentations are benign, these cases can be time consuming and frustrating for both patients and physicians.

You decide to give her low dose ketamine, as this has worked in the past.īackground: Low back pain is a common and challenging presentation to the emergency department. She has been given intravenous hydromorphone, diazepam, and ketorolac without relief of her symptoms. She denies bowel or bladder issues, saddle paresthesia, lower extremity weakness, but does feel radicular pain down both of her legs. She was lifting something heavy and felt a “pop” in her back.

He is the founder and creator of REBEL EM and REBEL Cast.Ĭase: A 54-year old female patient with acute back pain comes to your emergency department for her forth visit in seven days for recurring pain. Guest Skeptic: Dr. Salim Rezaie is a faculty physician at Greater San Antonio Emergency Physicians (GSEP) in San Antonio, Texas. A Prospective Randomized, Double-Dummy Trial Comparing Intravenous Push Dose of Low Dose Ketamine to Short Infusion of Low Dose Ketamine for Treatment of Moderate to Severe Pain in the Emergency Department.

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