Team Sergeant with Low Back Pain

[ender18d]

Scenario:
You and your team are deployed to train a special operations element of a friendly host nation in CQB techniques. Your team picked up this mission at the last minute, and there was something of a rush to get everything and everyone ready for deployment. The only other US medical asset in country is a family medicine physician at the embassy 3-4 hours away by truck. The host nation medical system is… not providing a standard of care with which you feel comfortable.

You’ve been in country for about a week when your team sergeant pulls you aside and asks you for some “Motrin.” Being a good medic, you ask him why he wants the ibuprofen, and he tells you that he has some “low back pain.”

I will give you the following:

The patient WDWN 45 y/o steely-eyed barrel-chested team sergeant in moderate distress.

C/C: “Low back pain”
O: “It’s been kinda funky for the past few days but it’s really pissing me off now.”
P: “No, nothing seems to help. Running around in full kit hurts.”
Q: “Sharp”
R: “The pain doesn’t seem to go anywhere else but my back.”
S: “Its pretty f’ing bad or I wouldn’t be asking you for meds.”
T: “It hurts pretty constantly.”

What other questions do you want to be sure to ask this patient as part of the history? What “red flags” in the history would differentiate a typical lumbago from something more serious? (physical exam will come after we discuss history)