2.2 managing falls

Question 1

Name 5 differential diagnosis for falls

Answer 1

trip 
stroke
epilepsy
MI 
DKA

Question 2

what factors should you consider when a patient falls?

Answer 2

who? (saw the fall)

when? (day/night, what were they doing)

where? (home, what room?/shops?)

what? - before symptoms, during (loss of consciousness, incontinence, injuries?), after (what happened, confused? could they get up without help?

How? (long were they on the floor for, how many times has this happened, any serious injuries?)

Question 3

what is syncope?

Answer 3

a transient loss of consciousness characterised by fast onset and spontaneous recovery

caused by reduced brain perfusion

once horizontal, will fix low blood pressure (beware of people who are held upright)

Question 4

what are the symptoms of pre syncope?

Answer 4

• light headedness
• sweating
• pallor
• blurred vision

Question 5

what is reflex syncope?

Answer 5

a disorder of the autonomic regulation of postural tone
SO, activation of part of medulla leads to decrease in sympathetic output and increase and parasympathetic

Fall in CO = reduced HR and BP leads to reduced cerebral perfusion

e. g vasovagal = simple faint from prolonged standing/stress/pain
e. g situational syncope e.g coughing, straining, weight lifting
e. g carotid sinus massage

Question 6

how can orthostatic hypotension lead to syncope?

Answer 6

symptoms occur after standing from a sitting/lying position

can cause syncope if drop in BP is severe enough (defined as a drop of 20mmHg or more, with pre-syncopal symptoms on standing)

pathophysiology:

• stand = 500-800ml blood pools in legs
• reduced EDV
• reduced cardiac stretch = reduced SV and CO
• normally managed by baroreceptor reflex
• if this fails then cerebral perfusion will drop and syncope occurs

Question 7

why would the baroreceptor reflex fail and what consequences can this have?

Answer 7

baroreceptors become less sensitive with age, and become less sensitive with hypertension (which happens with age)

medications can also impair the response as well as dehydration

consequence = syncope upon standing

Question 8

what is cardiac syncope?

Answer 8

syncope caused by a cardiac disease or abnormality
can be electrical, structural or coronary cause

electrical = Brady/tachycardia

structural = artic stenosis

coronary = MI/IHD

Question 9

what are the features of cardiac syncope?

Answer 9

• exertional syncope
• family history of cardiac disease/sudden cardiac death
• preceding chest pain or palpitations
• past medical history of heart disease
• Abnormal ECG

Question 10

what investigations would you do following a fall?

Answer 10

x ray
echo
24hr ECG
CT

Question 11

what is the baseline advise following a fall?

Answer 11

drink plenty
stand up slowly
remove loose carpets/leads
sensible slippers
good lighting