2) Managing Falls Flashcards
Epidemiology on falls
- Make up a lot of A&E attendances
- 30% > 65
- 50% > 80
fall at least once a years or several times a week - Falls are a cause of reduced quality of life, loss of confidence and independence and ultimately;
mortality
Give some differential for falls
- Trips
- UTI
- Resp infection
- Stroke
- Severe sepsis
- HF
- Parkinson’s disease
and many more
Need to differentiate them during Hx
Give some intrinsic risk factors for falling
- Demographic
- General health and functioning
- Medical conditions
- MSK and Neurological conditions
- Sensory problems
- Gait and balance
- Cognitive, psychological
Give some extrinsic RF for falls
- Environmental hazards
- Risk-taking
- Transfer manoeuvres
Give some environmental RF for falls
- Poor stairway design
- Inadequate lighting
- Clutter
- Slippery falls
- Unsecure mats/rugs
- Non-skid surfaces in bathtubs
Give a brief falls assessment
History
- History of Presenting Complaint
- System Review
- Past Medical History
- Medication
- Social
Examination
Investigations
What do you need to ask in history?
History of presenting complaint
- Who?
- What? – Before, During, After
- Where?
- When?
- How?
What questions would you ask in who section?
Did anyone else witness the fall?
If yes - take a collateral history
What questions would you ask in what section?
Before
- Any symptoms prior to the fall (light headedness/dizziness)
- Chest pain
- Did they trip or fall?
During
- Loss of consciousness (beware of this in
unwitnessed falls)
- Incontinence, tongue biting, shaking
- Any injuries?
After
- Did they regain consciousness quickly?
- Were they able to get up without help?
- Any confusion or neurological symptoms?
What questions would you ask in where section?
In the house?
At the shops?
If at home, Which room?
Any trip hazards?
Flashing lights from TV?
What questions would you ask in when section?
When did the fall occur?
If at night, is vision an issue?
What were they doing at the time?
Were they looking up?
Just got up from a chair/bed?
Just been to the toilet ?
What questions would you ask in when section?
How many times has the patient fallen over in the last 6 months?
What system would you check in history taking of a falls patient?
- CVS (chest pain, palpitations)
- Resp (coughing, haemoptysis)
- Neurological (slurred speech, weakness or numbness, headache, photophobia)
- Genitourinary (discharge, dysuria, frequency, nocturia)
- GI (vomiting, diarrhoea)
- MSK (hip pain, joint pain, pain anywhere else)
Difference between syncope and non-syncope
- Syncope: Transient loss of consciousness due to reduced cerebral blood flow
- Non-syncope: With or without loss of consciousness, not due to cerebral hypoperfusion
Identify 4 types of syncope
- Neurocardiogenic (aka Vasovagal syncope)
- Orthostatic hypotension
- Cardiac Arrhythmia
- Structural cardio-pulmonary
Identify some causes of neurally-mediated syncope.
- Vasovagal
- Carotid sinus
- Situational: cough, micturition, defecation, swallow, others
Identify some causes of orthostatic hypotension syncope
- Drug induced
- ANS failure: primary or secondary
- Volume depletion
Identify some causes of cardia arrhythmia syncope
- Brady: sick sinus, AV block
- Tachy: VT, SVT
- Inherited
Identify some causes of structural cardio-pulmonary syncope
- AMI
- Aortic stenosis
- HOCM
- Pulmonary hypertension
- Others
Exaplain the baroreceptor reflex
- Low arterial pressure
- Reduced baroreceptor firing
- increases sympathetic activity and reduces vague activity ( in medulla)
- Increases CO and SVR
Explain Non-syncope
Without Impairment of consciousness
- Fall
- Psychogenic
- TIA/Stroke
With partial or complete loss of consciousness
- Epilepsy
- Metabolic (hypoglycaemia, hypoxia, hypocapnia)
- Intoxications
What can be provided to elderly to prevent falls?
Walking aids
What do we need to check in examination?
- CVS
- Resp
- GI
- MSK
- Neurological
What bedside investigations can we do?
Bedside
- Bladde scan
- Urine dip
- Lying and standing BP
- MC&S tissue samples
- ECG
What bloods investigation can we do?
Bloods
- VBG
- Blood glucose
- FBC
- U&E’s
- LFT
- Bone
- CRP
- CK
What imaging investigation can we do?
- ECHO
- CT
- X-ray
What procedure investigations can we do?
Tilt table
What condition can falls cause?
Rhabdomyolysis
What presents in rhabdomyolysis?
- Long lie on the floor, unable to move, pressure on muscle leading to muscle breakdown
- Raised CK
- Dark urine
- Myoglobin released into bloodstream
- Can lead to AKI as myoglobin toxic to kidneys (intrinsic)
