›Critical patient workflow
›Monitoring
›Continuous pulse oximetry if unstable
›Cardiac monitor if syncope or hemodynamic concern
›IV access
›Two large bore IV for shock physiology
›One IV for parenteral analgesia if needed
›Oxygen
›Titrate to SpO2 target per local protocol dependent
›Escalate if respiratory distress
›Time critical imaging triggers
›If cauda equina concern then urgent MRI
›If hypotension with abdominal pain then immediate AAA ultrasound
›Early consult triggers
›Neurosurgery for cauda equina concern
›Spine surgery for suspected epidural abscess
Analgesia and symptom control
›Analgesic pathway
›Acetaminophen
›PO 1000 mg once
›Maximum 3000 mg per day in older adult or liver disease risk
›NSAID option
›Ibuprofen PO 400 mg once
›Avoid with CKD
›Avoid with GI bleed history
›Topical NSAID option
›Diclofenac topical per product instructions
›Lower systemic exposure
›Muscle relaxant option
›Cyclobenzaprine PO 5 mg once at night
›Avoid with older adult fall risk
›Opioid rescue
›Hydromorphone PO 1 mg once
›Avoid with concurrent benzodiazepines when possible
Etiology directed treatment
›Targeted management
›Radicular pain
›Activity as tolerated
›Consider short consideration of neuropathic agent by outpatient plan
›Suspected pyelonephritis
›Antibiotics per local protocol dependent
›Sepsis screening if unstable
›Suspected renal colic
›NSAID first line if safe
›Tamsulosin use per local protocol dependent
›Testing logic
›No red flags
›No routine imaging in first 6 weeks
›Symptom guided follow up plan
›Neurologic deficit
›MRI priority
›Emergent consult pathway
›Infection concern
›CBC
›CRP
›ESR
›Blood cultures
›MRI with contrast when feasible
›Vascular concern
›POCUS AAA
›CT angiography if ultrasound nondiagnostic and high concern
›Reassessment cycle
›Interval
›Recheck pain after analgesia
›Repeat neuro exam after pain control
›Escalation triggers
›New weakness
›New urinary retention symptoms
›New fever
›Persistent severe pain despite therapy