By Guilherme H. M. Oliveira, Gillian C. Nesbitt, Joseph G. Murphy
In case you are a doctor on name, you wish a analysis and remedy advisor that can assist you make quickly and exact decisions-one that is accomplished concise. Now, for the 1st time, the recent Mayo health facility scientific guide offers simply the best details to accomplish nearly any differential analysis you come across. Conceived at Mayo health facility, this new guide comprises every thing you must instantly check and overview signs and laboratory abnormalities in a condensed but concise easy-to-access guide.
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CBC, blood cultures, X-rays ■ Fluid hydration, analgesia, oxygen as needed, appropriate antibiotics as necessary ■ Infectious History of IV drug use, urinary tract infection, skin infection (including herpetic lesions), previous back surgery ▲ Back pain plus fever; patient may have progressive neurologic involvement ▲ CBC, ESR, C-reactive protein, blood cultures, empiric IV antibiotics (vancomycin, nafcillin) ▲ CT/MRI, plain X-rays ▲ May need biopsy to confirm organism ■ Infectious or inflammatory myelitis can present with focal neck or back pain with progressive neurologic involvement.
Right extremities ▲ Pulses may be absent. ▲ Patient may have new-onset aortic regurgitation, pulmonary 25 ■ edema, or neurologic deficits. , motor vehicle accident). Cord Compression (Due to Trauma, Tumor, or Infection) Pain is localized to back and/or lower limb, worsens with movement, coughing, sneezing, or straining (Valsalva effect). ▲ Patient may have Lhermitte phenomenon, a shock-like sensation along the spinal cord precipitated by head flexion. ▲ Exam often reveals spinal percussion tenderness, upper motor neuron signs, and possibly a sensory level.
Consider hemorrhage in a patient with acute-onset lumbar pain who takes anticoagulants. TEST ORDERING Urgent assessment required if fever >38°C for 48 hours, unrelenting night pain, pain with weakness or numbness below knee, leg weakness, loss of bowel or bladder control, progressive neurologic deficit, hypotension/shock; consult the appropriate service. , cyclobenzapine [Flexeril] or baclofen) may be used initially but may cause sedation. ■ Narcotics are rarely indicated. Osteoarthritis NSAIDs ■ Intra-articular (facet joint) corticosteroid injections may be useful.