EM physicians see patients with headaches every day in the ED. The vast majority have a simple primary headache, but a tiny fraction of patients will have a much more serious etiology that might result in death, blindeness, or crippling neurologic complications if not promptly diagnosed. The trick, of course, is picking up on the serious causes of headaches...

An 87 yo male is brought in by EMS after a syncopal event while on the toilet, resulting in a fall and head injury. EMS reports a heart rate in the 30s en route. As your approach the resuscitation bay you begin to think about the causes of bradycardia and what your approach will be to stabilize this potentially very sick patient....

EMS brings in a patient who was found down in his front lawn. They report he is dry and very hot to the touch, and has been unresponsive during transport. As you approach the resuscitation bay you quickly run down potential causes of a heat emergency and begin to think about the best way to treat this patient.....

The overwhelming majority of patients with back pain have a benign etiology and require nothing more than pain control and time to recover fully. A good emergency medicine physician, however, should always keep in mind the "can't miss" diagnoses and take a careful history focusing on "red flag" symptoms and risk factors. Failure to make the diagnosis in our patient today would result in irreversable paraparesis, incontinence, and impotence. Read on to see why!