Prompt Diagnosis and Treatment in a Case of Acute Lower Back Pain in a Patient with Marfan Syndrome

 

Title: Prompt Diagnosis and Treatment in a Case of Acute Lower Back Pain in a Patient with Marfan Syndrome

Thesis Statement

In a clinical setting where a patient presents with acute lower back pain and has a history of Marfan syndrome, it is crucial for healthcare providers to recognize the implications of the patient’s medical history, abnormal vital signs, and physical examination findings to expedite appropriate interventions and ensure patient safety.

Question #1: Significance of Marfan Syndrome

Marfan syndrome is a hereditary connective tissue disorder that can predispose individuals to aortic aneurysms and dissections. In the context of the patient presenting with acute lower back pain and a pulsatile mass in the abdomen, the history of Marfan syndrome raises concerns for a potential aortic dissection. Aortic dissection is a life-threatening condition that requires prompt recognition and intervention due to the risk of catastrophic outcomes such as aortic rupture.

Question #2: Vital Signs to Report

The LPN should immediately report the elevated blood pressure reading of 174/90 mmHg. Hypertension in the setting of acute lower back pain and Marfan syndrome raises suspicion for aortic involvement. The combination of hypertension, cool and clammy skin, and a pulsatile mass warrants urgent attention to rule out an aortic dissection.

Question #3: Significance of Pulsatile Mass

The presence of a pulsatile mass in the abdomen is concerning for an abdominal aortic aneurysm. This finding, coupled with the patient’s history of Marfan syndrome and abnormal vital signs, reinforces the suspicion of aortic pathology. Aortic aneurysms can lead to life-threatening complications such as rupture, emphasizing the need for immediate evaluation and intervention.

Question #4: IV Placement without IV Fluids

The physician ordered the insertion of large bore IVs without initiating IV fluids to prepare for potential interventions such as administering medications or contrast for imaging studies. In cases of suspected aortic pathology, establishing IV access is crucial for rapid administration of medications like nitroglycerin to help lower blood pressure and stabilize the patient before definitive treatment.

Question #5: Need to Lower Blood Pressure

Lowering the patient’s blood pressure is essential in the management of suspected aortic dissection. Hypertension increases the risk of further aortic dilation and potential rupture. Nitroglycerin is commonly used to reduce blood pressure and myocardial oxygen demand, aiming to minimize the shear stress on the weakened aortic wall and mitigate the risk of complications associated with aortic dissection.

In conclusion, timely recognition of red flags in patients with acute back pain and underlying conditions like Marfan syndrome can guide healthcare providers in delivering prompt and appropriate care. By understanding the significance of the patient’s medical history, vital signs, and physical findings, healthcare teams can work collaboratively to ensure optimal outcomes for patients in critical situations.