J Emerg Med
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Compartment syndrome is a life-threatening complication of traumatic injury, most commonly, direct trauma. Back pain is a common cause of visits to the emergency department (ED) and often is treated without imaging or diagnostic testing. Lumbar paraspinal compartment syndrome is a rare cause of acute back pain. ⋯ A 43-year-old woman presented to the ED after direct trauma to the lower back. Laboratory studies revealed rhabdomyolysis and acute kidney injury, with examination findings and imaging consistent with lumbar paraspinal compartment syndrome. She was taken to the operating room for emergent fasciotomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is the job of the emergency physician to identify the red flags in history and physical examination that warrant further diagnostic testing. Early diagnosis and surgical consultation is the key in avoiding morbidity and achieving good outcomes in all forms of compartment syndrome.
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Emergency medicine residencies are commonly based out of large, urban medical centers with very little, if any, exposure to the practice of rural emergency medicine. With one-third of all hospitals and one-fifth of the entire United States population residing in rural areas, more can be done to prepare residents for a career in such a setting. Potential changes include increasing access to rotations at rural sites and altering didactic content and bedside teaching to take into consideration practice with limited access to specialists. In doing so, emergency medicine residents will be better trained and the residents of rural America will be better served.