Back Pain 

Patient Care Goals

Identify treatable causes of back pain.

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg

□ Back pain without trauma is concerning in the pediatric patient 		□ Weakness
□ Numbness 
□ Fever
□ Difficulty urinating/controlling bowel movement
□ Hematuria (renal stone)		□ Herniated disk
□ Cauda equina
□ Muscle strain
□ Renal stone
□ Aortic aneurysm
□ Aortic dissection
□ Osteomyelitis

Clinical Management Options

EMT-B
• Oxygen target SpO2 92% – 96%  
• Check movement/sensation in extremities
• Perform Pain Management procedures
Paramedic
• Vascular access as appropriate for patient condition 
• Consider cardiac monitor and 12 ECG 
• Consider additional pain management
Consult Online Medical Control as Needed

Pearls

  • Tearing back pain that radiates to several locations can be signs of aortic dissection. Consider blood pressures in both arms. Abdominal aneurysms may present as back pain and are a concern in patients over the age of 50. 
  • Any new bowel or bladder incontinence is a significant finding which requires immediate medical evaluation. 
  • In patients with history of IV drug abuse or pain management injections, an epidural abscess should be considered. 
  • Pulsatile abdominal mass with back pain can be an abdominal aneurysm.
  • Hematuria and back pain can be signs of renal stones