Emergency medicine is a subspecialty of medicine that deals with the urgent evaluation and disposition of all types of medical emergencies. Though ER doctors face the whole breadth of medical scenarios, they are trained to make quick decisions and get specialists involved when warning signs warrant. I had the pleasure of speaking with a brilliant Harvard-educated neurosurgeon today about a potential case. He described for me common neurologic emergencies that ER doctors face.
One part of my job as a medical malpractice attorney that I enjoy is speaking with leading experts in various fields of medicine. Always a student, I enjoy learning about different medical conditions and treatments from those who know best. Today, I was discussing a spinal abscess case with a knowledgeable neurosurgeon. He made an off-hand comment that I’ve been thinking about all day: there are only 4 major things that can cause severe back pain with neurologic signs that ER doctors worry about. These include spinal epidural abscess, hematoma, cancer and abdominal aortic aneurysm (AAA).
Back pain is a common ER presentation. Typically, back pain is caused by nonemergent conditions like muscle strain or sprain, or something more severe like a herniated disk. However, severe back pain accompanied by neurologic signs or symptoms, like radiating pain, loss of sensation, paresthesia, paralysis, or loss of bowel or bladder function, should raise the level of concern and prompt a more detailed evaluation. Lab studies can help sort the diagnosis out. For example, with an infectious cause, the patient’s white blood count may be elevated. However, imaging by CT scan or MRI or a lumbar puncture (LP), depending on the circumstances, may be warranted to rule out abscess, hematoma, malignancy or AAA when those are possibilities.
Emergency departments are for emergencies. It doesn’t get any simpler than that. Physicians who specialize in emergency medicine provide a key role in the hospital process. Often, their most important role is to decide whether the patient should be admitted for a more thorough workup by a specialist or discharged. The ER physician’s role in this regard is critical. A failure to rule out a potentially catastrophic condition, one that if left untreated may lead to death or paralysis, may equate to medical negligence.