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A 30-year-old male presented to the Fast Track component of an inner city emergency department (ED) as a level IV trauma. The patient reported a 6-month history of back pain and was initially evaluated by a nurse practitioner. The practitioner's evaluation demonstrated no evidence of trauma. The patient's pain was in the low back with radiation into the posterior aspect of both lower extremities extending to the knees. The patient denied any nausea, vomiting, or fever and reported no changes in his bowel and bladder habits. Over the past few months, he has had multiple visits to the ED for the same problem and he reports the only management of his symptoms to date has been prescribed opiates for pain. The patient has not worked in the past 2 years and he has no medical insurance. The physical therapist is consulted in the evaluation and treatment of this patient in the ED.

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What are the most appropriate examination tests?

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How would this individual's contextual factors influence or change your patient/client management?

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What are possible complications that may limit the effectiveness of physical therapy?

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What are the most appropriate physical therapy interventions?

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Identify the psychological (or psychosocial) factors apparent in this case.

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What relevant questions about the patient remain unanswered?

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  • DISC EXTRUSION: When the nucleus pulposus of the intervertebral disc has ruptured through the annulus fibrosus, causing a wide range of signs and symptoms depending on the tissues impinged
  • FAST TRACK: A fast track service within the ED allows patients with acute but non-life-threatening conditions to be treated more quickly and then released; this system is designed to improve the efficiency and decrease the patient's wait time in the ED1
  • LEVEL IV TRAUMA: Many EDs in the United States triage patients into different levels of trauma based on severity of their condition; the triage system usually places patients on a scale of I-V, with a level I trauma patient being a life-threatening injury and levels IV and V being non-life-threatening and requiring fewer diagnostic needs

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  1. Describe the differences between a patient evaluation performed by a physical therapist (PT) and an evaluation performed by a medical doctor (MD) and nurse practitioner (NP) in the ED.

  2. Explain how a physical therapist may contribute to the management of a patient in the ED.

  3. Describe the types of patients managed by PTs in the ED and how their examination and treatment approach differs from that of other healthcare providers.

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PT considerations during management of the individual presenting in the ED with low back pain:

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  • General physical therapy plan of care/goals: Pain relief and increased function; self-management and prevention strategies; patient understanding of current condition and prognosis; individualized follow-up plan
  • Physical ...

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