Back pain following diving injury part 2


• Scene – assessment, C-collar placed, modified C-spine precautions taken.
• En route – EKG, vitals. Pt refused IV, said that he really needed pain meds but really did not want an IV because he did not like needles. When we arrived at the hospital he did say that he would like some pain meds.
• Hospital – unk


• Patient diagnosed with T2, T3, T4, T5 compression fractures.
• Placed in brace for 6w
• Expected to make a full recovery.
• Pain well-managed with Tylenol.
• See follow-up videos ~2w after accident, below, in “Supporting Materials” section.


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Compression fractures

Differential Diagnosis

• Cervical spine injury
• Thoracic spine injury
• Injuries to the thorax or back (eg, myocardial contusion)
• Back contusion
• Fracture of the spine
• Subluxation injury

Patient Workup History

• Patient states – “I was going down the slide head first with my arms by my side. When I hit the water I somersaulted and hit the bottom of the pool with the back of my head. I had pain in my back immediately.”
• “I came to the top of the water and was yelling and swimming to the side of the pool. Then my mom picked me up out of the pool and lay me down.”
• Caregiver states – Mom says that she did not see the patient go into the water, but heard him yelling and flailing his arms and legs while trying to get to the edge of the pool.
• Mom was able to lift the patient out of the water and lay him on a boogie board.
• Mom says, “I could see that he was moving all of his extremities, so I just picked him up from under his armpits and lay him down.”

Physical Exam

• Physical findings – back pain at approx. T5-6
• GCS – 15
• EKG – SR
• CBG – n/a

Editor’s Notes

The patient seems to have a GCS of 15 with good motor strength throughout. This is reassuring, but does not exclude significant injury to the spinal cord or fracture of the spine. Also remember that pain can be referred – back pain also can suggest an injury to the thoracic or abdominal cavities. Vital signs are reassuring, and need to be trended. Pool injuries are often unwitnessed, so it is reasonable to be conservative in the assessment and treatment of suspected injuries. The follow-up videos are outstanding and suggest a great relationship between medic and patient. This is why we practice medicine.

-Dr. David Spiro

Suggested References

Board to death
Pediatric spinal injuries


• Gender: Male
• Age: 11 years
• Height: Not Available
• Weight: Not Available


• Temperature: 97.9 F/36.6 C Blood Pressure: 120/63
• Heart Rate: 83
• Respiratory Rate: 18
• Pulse Oximetry: 98% RA

Signs and Symptoms

Acute back pain

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