Acute back pain


• Scene – IV 18g, 100mcg fentanyl bolus
• En route – 50mcg x 4 fentanyl, 300mcg total fentanyl given
• Hospital – not known


• Response to treatment – Improved after fentanyl; no changes until 150mcg given. No relief until 300mcg given.
• Disposition – unknown


• Elliot Williams, Paramedic Woodburn Ambulance


• David Tauber, EMT Editorial Board
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

• Back Pain

Differential Diagnosis

• Back pain
• Fracture
• Nerve damage
• Slipped disc
Patient Workup


• Patient states – injured his back lifting something off a trailer at work 6 days ago. X-rays revealed no fracture; scheduled for MRI and Rx for diazepam. Patient has been in bed, sleeping as much as possible, has not been eating and doesn’t drink very much water. States he doesn’t remember the last time he ate. Pain has gotten worse and worse, now affecting his right leg with extreme pain and changes in sensation. He was just in bed when pain got much worse. No movement, no falls since original insult.

Physical Exam

• No deformities of back or leg noted. Pupil not dilating due to past injury. Pain with any movement of back or right leg. Patient got some relief from us pulling the middle seat belt on the cot as tight as we could across his hips to hold him down. Decreases sensation in right foot, right leg in extreme pain. Lumbar tender to palp.
• GCS – 15
• CBG – 90

Editor’s Notes

The patient may be slurring words; I would inquire how much prescribed medication he had taken over what period. I would also ask about self-prescribed pain relief? EtOh? THC? The paramedic eliciting history in the film was “leading the witness” that is suggesting answers to the questions. This can invalidate the answers. Ask the question and wait for the answer at least 8 seconds of silence. Then it is necessary give some multiple choice answers but not suggest just one answer. The tightening of the hip strap brining relief suggests a pelvic injury ~ David Tauber, Director, Paramedic Education, Yale New Haven Sponsored Hospital

Suggested References

Mechanical Back Pain Treatment and Management


• Gender: Male
• Age: 49 years
• Height: Not Available


• Temperature: Not Available
• Blood Pressure: 150/101
• Heart Rate: 120
• Respiratory Rate: 22
• Pulse Oximetry: 97% RA
Signs and Symptoms
Severe back pain


• PMH: Hernia, L eye injury (split in half by sheet metal at work, required multiple surgeries and two cornea transplants).
• Allergies: None


• Lives at home with mom and brother.
• Valium, flexeril, hydrocodone

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