2.2 Managing Falls Flashcards
What do falls cause in the elderly?
Reduced QoL
Loss of confidence and independence
Mortality
Give some differentials for causes of falls
Trip
UTI
Stroke
Osteoarthritis
MI
Medicine side effects
Polypharmacy
(Bascially anything just be able to name a few)
What are the 3 types of risk factors for falls?
Intrinsic- patient
Extrinsic
Environmental
What are some examples of intrinsic risk factors for falls?
Demographic
General health and functioning
Medical conditions
MSK + Neuro
Sensory
Gait and Balance
Cognitive, pyschological
What are some examples of extrinsic risk factors for falls?
Environmental hazards
Risk-raking
Transfer manoeuvres
What are some examples of environmental risk factors for falls?
Poor stairway design
Inadequate lighting
Clutter
Slippery falls
Unsecure mats/rugs
Non-skid surfaces in bathtubs
What is involved in a falls assessment?
History- presenting complaint, system review, pmh, medication, social
Examination
Investigations
What is involved in the history taking of a fall?
Who - did anyone see the fall? take collateral history if yes
When did the fall occur? Night? What were they doing at the time?
Where - Inside? outside? Trip hazards?
What - Before, during and after
How - how many falls have they had in the last 6 months?
What else needs to be considered in taking a fall history?
Before - Symptoms prior to fall? chest pain? did they trip or fall?
During - Loss of conciousness? 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?
List each system covered in a system review during a history
CVS
Respiratory
Neuro
GU
GI
MSK
CVS system review questions
Chest pain?
Palpitations?
Dizzy?
Clammy?
Respiratory system review questions
Cough, was it productive?
Haemoptysis?
Dyspnoea?
Wheeze?
COPD/asthma?
Neuro system review questions
Slurred speech?
Weakness/numbness?
Headaches?
Photphobia?
Neck pain?
GU system review questions
Discharge?
Dysuria?
Frequency?
Nocturia?
Colour of urine?
GI system review questions
Vomiting?
Diarrhoea?
Constipated?
Abdominal pain?
MSK system review questions
Pain?
Full range of motion?
Swelling of joints?
What are the two types of falls?
Syncope- transient loss of consciousness due to reduced cerebral blood flow
Non-syncope- with or without loss of consciousness, not due to cerebral hypoperfusion
What are the 4 different types of syncope falls?
Neurocardiogenic
-Vasovagal
-Carotid sinus
-Situational e.g. cough, micturition
Orthostatic hypotension
-Drug induced
-ANS failure
-Volume depletion
Cardiac arrhythmia
-Bradycardia (sick sinus or AV block)
-Tachycardia (VT or SVT)
Structural cardio-pulmonary
-Aortic stenosis
-Pulmonary hypertension
How is BP controlled?
Baroreceptor reflex
Done it 9million times should know it by now
What change in blood pressure is suggestive of postural hypotension?
Change of 20mmHg from sitting to standing
What are the causes of non-syncope related falls?
Without Impairment of consciousness
- Fall
- Psychogenic
- TIA/Stroke
With partial or complete loss of consciousness
- Epilepsy
- Metabolic (hypoglycaemia, hypoxia, hypocapnia)
- Intoxications
What social history questions do we need to ask for a fall history?
Are they living alone?
Any carers?
Walking aids?
Any stairs, bungalow?
Smoking or drinking?
What investigations should be done for a fall?
Start by doing all examinations
Bedside
Bladder Scan
Urine dip,
(MC&S)
Lying/Standing
BP
ECG
Bloods
VBG
Blood Glucose
FBC, U&Es,
LFTs, Bone, CRP,
CK
Imaging
ECHO
CT
X-ray
Procedures
Tilt table
What in a history can suggest rhabdomyolysis?
Long lie, raised CK, dark urine/ tea coloured
Why do you develop rhabdomyolysis in long lie?
Pressure on muscle leading to ischaemia causing muscle breakdown
Why does rhabdomyolysis cause AKIs?
Myoglobin released into the blood stream which is toxic to the kidneys
Intrinsic AKI
Who is involved in managing a fall patient?
MDT approach
Physiotherapist
Tertiary care
Nursing staff
Occupational therapist
Senses
Discharge team
