In the ED, their vitals/exam are as above.  Likely recurrence of patient’s chronic pain exacerbated by lumbar strain. Lower suspicion for fracture considering lack of focal midline TTP, cord compression considering lack of weakness/foot drop, cauda equina considering lack of bilateral radiculopathy/bowel or bladder incontinence/saddle sensory loss, epidural abscess considering lack of fever/IVDU/point TTP, pyelonephritis as patient without fever/urinary sxs, PE as patient is without tachycardia/hypoxia/respiratory distress, aortic dissection as patient without significant vital sign instability. Despite above, patient with significant weakness and inability to ambulate and hence will proceed as below
– Labs/Tests: CBC, BMP, UA
– Imaging: MRI of entire spine
– Treatments: Pain control per chronic pain recommendations, IVF as needed, antiemetics as needed
– Consults: None at this time, low threshold for spine surgery/pain management consultation
– Dispo: Likely admission to ED observation for plan as above