In the ED, their vitals/exam are as above. Patient with*** concern for cord compression considering with*** extremity weakness and with*** change in normal rectal tone. With*** concern for cauda equina considering with*** bilateral radiculopathy, with*** saddle sensory loss, with*** loss of bilateral ankle/knee reflexes, and with*** bowel or bladder incontinence/. Lower suspicion for acute fracture considering lack of focal midline TTP. I doubt 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.
– Labs/Tests: Rectal tone exam, PVR (>100 is abnormal), Pre-op labs including ESR/CRP, COVID-19 RT-PCR
– Imaging: Flexion/Extension XRs of lumbar spine, MRI of entire spine
– Treatments: Pain control with tylenol/lidocaine patches/opioids, IV decadron 10mg -> 6mg q6h if found to have cord compression
– Consults: Spine surgery
– Dispo: Likely admission to spine surgery