Linda Green is a 68 year old African-American woman with metastatic breast cancer admitted to the hospital with severe back pain and dehydration. She had an appointment with her oncologist on the day of admission, but her daughter called the clinic saying she was too weak and in too much pain to get in the car. Her oncology nurse told her daughter to call an ambulance to bring her to the Emergency Department. Soon after arrival to the ED, she received intravenous morphine reducing the severity of her back pain from 9/10 to 3/10 on the pain assessment scale.
In the ED, her evaluation was notable for:
- PE - normal mental status, orthostatic blood pressure readings, dry mucous membranes, generalized weakness with no focal neurologic findings.
- Lab results: hematocrit =28; BUN 50, creatinine 2.2, elevated ALT=130, AST=100; alkaline phosphatase=260.
- Non-contrast CT of spine: multiple bony metastases with no significant impingement of spinal canal, compared with scan 4 months earlier, progression in size and number of lesions.