Further Reading
Musculoskeletal and Soft-tissue Emergencies 333(iii) >60 years:
(a) as (ii) above
(b) osteoporosis
(c) Paget’s disease
(d) osteoarthritis
(e) spinal stenosis.3 Also enquire specifically about previous back trouble, joint trouble, minor
trauma and for associated abdominal, pelvic or urinary tract symptoms.
4 Check the vital signs and note any temperature or tachycardia. Perform a full
examination including respiratory system, breasts, abdominal, rectal and
neurological system.
5 X-ray the chest and thoracic and lumbosacral spine.
6 Perform a urinalysis.
MANAGEMENT1 Refer the patient to the appropriate specialist team according to the most
likely suspected aetiology.
Mild to moderate, non-traumatic back pain
DIAGNOSIS AND MANAGEMENT
1 This nebulous group with no abnormal physical signs, apyrexial with a
normal urinalysis may be discharged.
2 Prescribe a non-steroidal anti-inf lammatory analgesic such as ibuprofen
200 –400 mg ora lly t.d.s. or naproxen 250 mg ora lly t.d.s.
3 Give patients a letter for their GP to follow them up and to arrange physio-
therapy, an abdominal and back exercise regimen, and behaviour modifica-
tion, including weight reduction and safe lifting techniques, as appropriate.
FURTHER READING
Australian Department of Health and Ageing (2008) The Australian Immunisation
Handbook. 9th edn. http://www.health.gov.au/internet/immunise/publishing.
nsf/Content/Handbook-home (tetanus).
Department of Health UK. Immunization Against Infectious Diseases ‘The
Green Book’. Last updated Aug 2009. http://www.dh.gov.uk/en/Publichealth/
Immunisation/Greenbook/index.htm (tetanus).