The 58-year-old patient presents to the emergency department complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. Which assessment is most important?

Question

The 58-year-old patient presents to the emergency department complaining of worsening back pain that started a few days ago. He states, &ldquo;I thought maybe I had slept wrong and gotten a spasm, but I&rsquo;m not sure. I didn&rsquo;t fall or get hit or anything. The ibuprofen I took definitely didn&rsquo;t help.&rdquo; His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. Which assessment is most important?

Accepted Answer

Abdominal auscultation and palpation. The patient&rsquo;s medical history (smoker, hypertension with medication noncompliance) and back pain without a causative event suggest the possibility of an abdominal aortic aneurysm (AAA), which presents with a pulsating abdominal mass. Lower extremity strength and range of motion can help to determine the cause of the back pain if an AAA isn&rsquo;t present, but a symptomatic AAA requires urgent medical attention. Four quadrant blood pressures and pulse deficit assessment are less important than assessing for an aortic abdominal assessment.

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