›Stabilization and monitoring
›Airway concern triggers
›Altered mental status
›Respiratory failure
›Cardiorespiratory monitoring
›Continuous pulse oximetry
›Cardiac monitor when unstable
›IV access
›Two large bore peripheral IV when sepsis or instability
›Single IV acceptable when stable
›Time critical actions
›Emergent spine consultation trigger
›Suspected cauda equina syndrome
›Rapidly progressive motor deficit
›Early MRI pathway activation
›Contact MRI and radiology immediately when cauda equina suspected
›Transfer planning if MRI unavailable
›Priority testing
›MRI spine per localization and red flags
›PVR measurement when bladder symptoms present
›Infection pathway when suspected
›Blood cultures before antibiotics when feasible
›CRP and ESR integration with imaging urgency
›Hematoma pathway when suspected
›Coagulation studies
›Anticoagulant reversal planning per agent
›Analgesia
›Acetaminophen PO 1000 mg once
›Ketorolac IV 15 mg once
›Hydromorphone IV 0.5 mg once for severe pain
›Cauda equina or cord compression support
›Urinary retention management
›Bladder decompression if retention
›Strict I and O when admitted
›Steroids for suspected metastatic cord compression
›Dexamethasone IV 10 mg once
›Then dexamethasone 4 mg IV every 6 hours
›Suspected spinal epidural abscess
›Broad spectrum antibiotics after cultures when feasible
›Vancomycin IV per weight and renal function
›Ceftriaxone IV 2 g once daily
›Local protocol dependent regimen selection
Consultation and transfer
›Spine service activation
›Neurosurgery
›Orthopedic spine
›Transfer triggers
›MRI not available within clinically appropriate window
›No spine surgical coverage
›Progressive neurologic deficit
›Scheduled reassessment
›Pain score response within 30 to 60 minutes
›Repeat focused motor exam after analgesia
›Repeat bladder symptoms and voiding ability
›Escalation triggers
›New weakness
›New saddle anesthesia
›Rising fever or hypotension