Case 4

As you near the end of your shift, your senior house officer asks you for some advice. He has been looking after an 82-year-old lady who has collapsed at home. She is complaining of pain in the middle of her back. She has a past history of ischaemic heart disease and hypertension and is on aspirin, a statin, nicorandil and furosemide.

On examination, she is sat at 30° on a trolley and is in obvious discomfort. She has fine crepitations confined to both lung bases and a soft ejection systolic murmur. She has tenderness over her lower thoracic/upper lumbar spine but no neurological deficit. She has no neck pain.

Her observations are:

• HR 102 reg
• BP 135/96
• RR 18
• SpO₂ 93% in air
• GCS 15

No other injury is detected.

What actions would you take at this stage?

Select one or more options.

The patient's x-rays are shown below.

Click on the x-rays to enlarge.

Report your findings below.

Fig 1: Patient x-ray, lateral view	Fig 2: Patient x-ray, AP view

Although she still has discomfort in her back, she is much more settled than previously. She is asking what the x-ray findings mean.

Select one or more options.