Back Pain – Induction

Mr Regular is a 69 year old who attends the department frequently with multiple complaints. This time, he’s here “time wasting” with back pain. His observations are normal.

What causes of back pain need excluding in the emergency department?

Your next patient has been unprofessionally skipped over by several FY2s before you. It’s their third attendance with back pain. Triage notes say that the patient is “wailing” and appears “urine stained”. You approach the waiting room and your patient waves at you, immobilised in a wheelchair.

The patient tells you they have had back pain for “ever”, but it’s been worse for the last three days. They keep wetting themselves – it’s like a floodgate just opens and the urine just comes out. Their bowels have been normal. They’ve got a funny feeling down both legs – they both feel really tingly. They’re far too uncomfortable to move out of the wheelchair, let alone let you do a PR.

As you go to get them some analgesia, your senior asks what the likely plan is. What is it?

Your next patient is an 82 year old with some back pain. After careful probing, they admit to falling down the stairs. They know they’ll be fine after just a smidge of paracetamol.

Their examination reveals tenderness over L3, with normal tone, power, sensation, reflexes and rectal examination. What’s next?

Which are signs of cauda equina syndrome?