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Case presentation. History of Present Illness. 25 y/o EOD technician, history of 10 blast exposures over 4 months. Head and back injury when vehicle struck 80 pound IED on 28 Oct 2011. Vehicle destroyed. SM wearing a helmet. Initial evaluation: GCS 13/15 with pre and post amnestic symptoms.

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history of present illness
History of Present Illness
  • 25 y/o EOD technician, history of 10 blast exposures over 4 months.
  • Head and back injury when vehicle struck 80 pound IED on 28 Oct 2011. Vehicle destroyed. SM wearing a helmet.
  • Initial evaluation: GCS 13/15 with pre and post amnestic symptoms.
  • Complaint of headache and low back pain upon initial evaluation.
history of present illness cont d
History of Present Illness (cont’d)
  • MACE at time of injury: 30/30.
  • Headache resolved, but continues to have low back pain.
  • MRI of lumbar spine shows 4mm disc herniation at L5-S1 with bilateral abutment of S1 nerve.
  • Ortho consult ordered, but unclear if patient saw the specialist.
  • Chiropractic manipulations in the past with some relief.