1. Decadron is good for vasogenic edema, such as that caused by an abscess or tumor, but not so great for edema associated with an acute hemorrhagic event
2. Antiepileptics and intracranial hemorrhage:
-Bleeds in the temporal lobe have the highest risk of leading to an epileptic event, although all lobar bleeds are relatively high risk and should probably get epilepsy prophylaxis.
-Bleeds in the cerebellum are extremely unlikely to cause seizures
-Dilantin used to be standard of care for seizure prophylaxis, but given its significant side effects, is now only given to people who have already seized to try to prevent future seizures
-In someone actively seizing, you would give Ativan to break the seizure and load them with dilantin to prevent future seizures.
-In people who have a risk of seizures but have never seized before, Keppra is a safe prophylactic agent.
3. MRI is indicated for evaluation of low back pain if the following are present 
-Neurological deficit
-Radiculopathy
-Progressive major motor weakness
-Cauda equina compression (sudden bowel/bladder disturbance)
-Suspected systemic disorder (metastatic or infectious disease)
-Failed six weeks of conservative care
4. MRI & low back pain: 
-75% of herniated discs improve with six weeks of conservative therapy.
-MRI testing is not associated with clinical benefit in randomized trials.
-Early MRI is not associated with improved outcomes in patients with acute back pain or radiculopathy (Level 2/mid-level evidence).
-If surgery is being considered, some physicians recommend, in the absence of red flags, to obtain an imaging study after one month of symptoms.

5. Reading AP spine plain films: 

-Count the lumbar vertebral bodies (non-rib bearing vertebra). 5 is normal. 

-Look to see that each vertebral body has 2 pedicles and 1 spinous process (eyes/nose) 

-Look for vertical alignment of the spinous processes.  Misalignment suggests a rotational injury such as unilateral facet dislocation.

-Look for smooth undulating borders.

-Look for uniformity among the disc spaces.

-Compare the pedicles with the spinous processes. Widening of the pedicles may represent a compression fracture. Comparison of these will also show rotation of the spine.

-Look at the lateral curvature, which may reveal scoliosis.

-Look at the sacroiliac joints to ensure the white margin is intact. Is the joint sclerotic, ankylosed (fused), or destroyed?

6. Reading latera; spine plain films: 

-Check for height loss in the vertebral bodies. This height loss may be due to trauma, metabolic disease, or metastatic disease.

-Look at the configuration of the end plates. Are the end plates crisp? Irregular endplates could reflect degeneration or infectious disease.

-Look at the disc space thickness. The disc space thickness should diminish as you go down the spine, but this should be subtly and uniformly.

-Check for alignment in the AP direction. Are the anterior and posterior spinal lines intact?

-Look to see if there any osteophytes projecting from the vertebral bodies. Are there any calcifications in discs?

-Check that the spinous processes are present. Did the patient have previous spine surgery?

-Last but not least, look for other abdomen and pelvic pathology. AP and lateral films can show calcifications in the kidney, vascular calcifications, or foreign bodies.

7. Algorithm for diagnostic testing in LBP

-LBP <3 months, no red flags = no testing, no imaging

-Suspected fracture: plain film. If its negative but pt still has multiple sites of pain or fracture is still suspected, bone scan before CT 

-Suspected infection: CBC, ESR, UA 

-Suspected cancer: CT, MRI 

-Suspected cauda equina: call neurosurgery

8. Pharmacologic management of LBP

-First line: NSAIDs, tylenol, muscle relaxants

-Evidence shows little difference between different NSAIDs and different muscle relaxants; choose less sedating ones. 

-Unclear whether NSAIDs are superior to tylenol. 

-Little evidence that opiates help; second or third line

-No evidence that PO steroids help

9. Prognosis of LBP: 

-90% resolve within one month

-5% remain disabled longer than three months

-Patients who are out of work >6 months = 50% chance of returning to work

-Out of work >2 years = almost 0 chance of returning to work. 

-Worse prognosis: older (>45), psychosocial stress. 

-35-75% recurrence rate. 

10. Succinylcholine can be given IM or IV. In IV form, the onset is 20-30 seconds, while in IM form the onset is 2-3 minutes.