# Back Pain in a Clear for Confinement Call



## Psych (Apr 9, 2014)

You are an ALS fly car unit dispatched at 0200 to assist a BLS unit unit with clearing a patient to be held in PD custody. You arrive on scene to meet with the BLS unit, already there, and the arresting officer. Per PD, the patient was the subject of a routine traffic stop for a moving violation. Upon first contact, the patient told the officer she was on her way to the emergency room to be evaluated for severe back pain. The officer noted the patient was speaking excessively and rapidly, as well as profusely sweating and asked the patient to step out of the car under suspicion of DUI. The officer noticed white powder on the passenger seat and searched the car, turning up a small amount of cocaine. He provides you with four bottles of medication he found in her purse, which are: Amlodipine, Metoprolol, Atvorstatin and Trazodone. The officer  The EMT already on scene tells you the patient is a 52 y/o F complaining of 10/10 constant "upper back pain" with a sudden onset about 30m prior to arrival, made worse with any movement, also complaining of nausea. She has been uncooperative and agitated during the assessment, denied chest pain or shortness of breath. Their vitals are BP 100/60 sitting upright, Pulse Rate 104 strong/regular, RR 18 adequate tidal volume. You find the patient sitting on the pavement in obvious distress, A+Ox3, respiring normally, skin is pink, warm and diaphoretic. What's your next move?


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## NomadicMedic (Apr 9, 2014)

What did the pain feel like? BP in both arms? Put her in the truck and off we go. A 12 lead would be nice. ETCO2. Treatment is a couple of larger bore IVs and a smooth, rapid transport to r/o an acute aortic dissection.


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## DrankTheKoolaid (Apr 9, 2014)

You transport to the ED and tell
PD they can follow you in while
You transport or they can send a rider and then treat your patient.


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## Psych (Apr 10, 2014)

DEmedic said:


> What did the pain feel like? BP in both arms? Put her in the truck and off we go. A 12 lead would be nice. ETCO2. Treatment is a couple of larger bore IVs and a smooth, rapid transport to r/o an acute aortic dissection.



You're good. 

Pain described as sharp, not reproduced with palpation or inspiration. No BP difference was noted between arms. 12 Lead showed NSR/Sinus Tachy with left axis deviation, ventricular strain/LVH. EtCO2 was WNL. Tx was POC (pt had orthopnea below high-fowlers) transport to the nearest capable facility, 15 LPM O2 and RL TKO via dual 16G IVs, then permissive hypotension (MAP to 60) as pt's BP decreased enrt. She ended up getting diagnosed with an ascending/thoracic aortic aneurysm.

I thought it was an interesting share-worthy call because it's really not what you expect from the 0200 back pain while getting arrested haha.


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## Psych (Apr 10, 2014)

DrankTheKoolaid said:


> You transport to the ED and tell
> PD they can follow you in while
> You transport or they can send a rider and then treat your patient.



This is going to sound random but have you ever taught a PHTLS class at AMR on rollins rd in Burlingame, CA?


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## DrankTheKoolaid (Apr 10, 2014)

Haha uhhhh


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## Psych (Apr 10, 2014)

No way haha I knew it. One of the best courses I ever took I was still in medic school when I took it and when I went back home I was teaching my preceptor how to do seated intubation lol.


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## DrankTheKoolaid (Apr 10, 2014)

Haha I'm not who your thinking of. I've assisted with PHTLS here but haven't main instructed on yet as the person your talking about has historically done them all.   But my guess is you know who I am since you nailed it on where I work


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## Psych (Apr 10, 2014)

DrankTheKoolaid said:


> Haha I'm not who your thinking of. I've assisted with PHTLS here but haven't main instructed on yet as the person your talking about has historically done them all.   But my guess is you know who I am since you nailed it on where I work



Ohhh okay, I saw your post history about working in Eureka and the triangle and I remembered all his crazy stories about the grow operations and cultists and :censored::censored::censored::censored:. Small world eh?


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## DrankTheKoolaid (Apr 10, 2014)

Haha we went through the same medic program up north


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## DrankTheKoolaid (Apr 10, 2014)

Yeah people here in the city are absolutely shocked when I tell them stories of what it's like working up there.  

Ambulances stopped at gunpoint and told they are not going down such and such road and to find another route, USFS refusing to respond to woodland fires until SO/CHP make sure it's not a setup to lure them In etc etc which can literally take an hour plus depending on the area and staffing


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## mycrofft (Apr 10, 2014)

And College of the Redwoods used to be a big law enforcement teaching center!
Are they even still accredited? Again?


I guessed aneurysm versus BS then went back to looking for citations.

LE would kick that pt loose unless they were Staties or Feds because that cASE sounds expensive and dangerous to house.


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## Psych (Apr 27, 2014)

mycrofft said:


> And College of the Redwoods used to be a big law enforcement teaching center!



HAHA I got my medic at CR.


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