We hope to identify the effects of adjunctive 5% lidocaine patches in the treatment of acute non-radicular low back pain in patients discharged from the emergency department.
We hypothesize that in patients with acute non-radicular low back pain (LBP), treatment with adjunctive lidocaine 5% transdermal patches will lead to improved pain at one week compared with standard therapy alone.
Using a prospective randomized controlled study design, we will compare the addition of lidocaine 5% patches to standard therapy vs standard therapy alone in the relief of pain for patients discharged from the emergency department (ED) with acute non-radicular LBP.
Chest pain is a very common cause of complaint in the Emergency Room. The diagnosis of non-ST-elecation acute coronary syndrome often causes uncertainty in physicians thus the HEART Score we developed to help with risk stratification. HEART is an acronym for History, ECG, Age, Risk factors and Troponin. The goal of our study is to determine if the HEART score is actually effective on admission rates and if it’s helping to save cost.
Patient had fallen down on his side two days ago; he came to the ER this morning and complained of shoulder pain. Patient was asked to remove his t-shirt. The doctor took a quick glance and checked for symmetry. The left and right side (frontal view) of the patient’s did not look symmetrical. The left side of the patient’s shoulder region was swollen and there was slight redness (the redness, however, was not a cause of concern). The patient was asked to take his left arm and touch his right shoulder. The patent groaned ,due to the pain, as he tried to touch his right shoulder. However, the patient was able to complete the task. This was a sign that the clavicle (shoulder bone ) was not dislocated. If a dislocation had occurred, the patient would not have been able to reach for the other side of his body at all. The patient had initially thought that he had a protrusion of the clavicle bone (one would have seen something like a bump or “tent” deformity) but this was not the case. The patient was asked for any other important information. The patient was diabetic and had blood sugar of about 370. The patient had stopped taking his diabetic medications almost a year ago. The doctor prescribed appropriate medication to treat the high level of blood sugar. The best treatment option for the patient was to use a sling for about 6-8 weeks. Popping the bone back into position would not have been possible in this case, because even if the bone were to be popped back, the bone would pop back out due to the muscle that was pulling on the clavicle bone. Surgery was definitely not an option, because the surgery would not have provided any extra benefit. Even being in the sling for the appropriate amount of time would allow the patient to have full-range motion. If the patient had the clavicle bone protruding through the skin, the patient would have needed to undergo surgery to fix the issue; pushing the bone back in would not work in this case. If something like this is left for too long, the bone can protrude through the skin and can lead to an open wound infection. A fracture of this kind in the clavicle bone wouldn’t allow for full-range motion; however, something like protrusion of the clavicle bone may still allow the patient to have full-range of motion, but this situation is more of a concern as it may lead to an open wound infection.