Lower back pain is a really common cause for patients to present to primary care, urgent care and emergency care.
Thankfully many of these cases are self limiting, but somewhere in the region of 1:300 patients with back pain in the ED will have Cauda Equina Syndrome.
Cauda Equina Syndrome is something that is challenging for all clinicians because many patients with simple lower back pain may have many similar symptoms, but if we miss it, or if there is a delay to surgery that can lead to potentially avoidable long-term disability for our patients and on top of that its a major cause of healthcare litigation.
And we’re not talking about a delay in weeks being a problem here, we’re talking about hours to days, with big potential complications like impaired bowel/bladder/sexual dysfunction or lower limb paralysis - so you can see why litigation is a big part of some missed cases.
In this episode we run through the the signs, symptoms, investigations and treatment with a strong reference back to the underlying anatomy and disruption.
We also cover the recently published national Cauda Equina Pathway, which is a great resource but poses some real challenges in it’s implementation!
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon, Rob & James
Welcome back to the podcast! Three more papers covering topics that are relevant to all of our practice.
The importance of removing wet clothes from patients is often discussed, both to prevent hypothermia and increase patient comfort. But how important is it to get wet clothes off and is it something we can defer to a different point? We start off taking a look at an RCT on this very question.
Next up another RCT, this time looking at the efficacy of morphine, ibuprofen and paracetamol for patients with closed limb injuries. Which one, or combination, would you think would be most efficacious…
Lastly, following on from our most recent Roadside to Resus episode, we take a look at a paper on the association between end tidal CO2 levels and mortality in prehospital patients with suspected traumatic brain injury. This paper highlights really well the need understand the fundamentals that contribute to ETCO2 when applying to clinical practice.
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob