Question

You are called to the bedside of a diabetic patient who has a continuous epidural catheter in place, 4 days aft er exploratory laparotomy for a small bowel obstruction. He has appropriate abdominal pain relief but notes signifi .cant back pain at the insertion site as well as fever and an inability to move his legs. What is the next step of action?

A. Halve the epidural rate and re-evaluate the patient in 4 hours.
B. Continue the epidural and obtain a stat neurosurgical consult.
C. Stop the epidural and perform stat plain fi lm x-rays.
D. Stop the epidural and perform an emergent MRI.
E. Stop the epidural and administer oral opioids.

Answer 1

The correct step of action for the patient with back pain, fever, and inability to move legs after having an epidural catheter is to stop the epidural and perform an emergent MRI to diagnose potential serious conditions such as an epidural abscess or hematoma.

Step-by-step explanation:

The symptoms described for the diabetic patient with a continuous epidural catheter in place after an exploratory laparotomy indicate a potentially serious condition, such as an epidural abscess or epidural hematoma, both of which require immediate action. Additionally, the patient's fever suggests an infectious process, and the inability to move his legs raises concerns for a neurological complication. Therefore, the appropriate next step of action is D. Stop the epidural and perform an emergent MRI. An MRI will provide detailed images of the spine and can help diagnose conditions like abscesses, hematomas, or other spinal pathology. The epidural should be stopped to prevent further potential neurologic damage or spread of infection.