The elderly patient with back pain in the ED
Mx of the elderly:
essentials of ED Mx:
exclude AAA early - if epigastrium is tender discuss with ED consultant for urgent US or CT
if chest pain radiating to back - exclude dissection, PE, pneumothorax, etc.
urinalysis as above under adults
lower threshold for plain Xrays of Tx or Lx spine as even minor injury such as a trip/fall can cause a crush fracture in osteoporotic elderly or those with occult metastatic disease.
look carefully for neurology in lower limbs & esp. bladder/bowel dysfunction which may indicate acute spinal cord compression
and need for urgent neurosurgical assessment.
take extra care in prescribing NSAID's - risk of gastric bleed; avoid if on ACE inhibitors as risk of renal failure.