Case 3 - Fall and acute confusion Flashcards

1
Q

Common causes of falls

A
  • Slips/trips
  • Cardiac - postural hypotension, arrhytmia, stroke, HF
  • Abnormal electrolytes
  • UTI
  • Medications - sedatives, anti-hypertensives, opitaes
  • Hypoglycaemia
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2
Q

Investigations to assess cause for fall

A
  • ECG
  • Lying and standing BP (immediate, 3 and 5 minutes)
  • CT head - stroke?
  • Urine dip and MSU
  • U&Es, LFTs, FBC, CRP
  • Echo?
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3
Q

Examination for falls

A
  • Cardio exam - inc ECG and lying and standing BP
  • Neurological exam - CN and PNS
  • MSK exam
  • Assessment of mobility - how mobilise and gait
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4
Q

Multidisciplinary teams involved in discharge of someone at risk of falls

A
  • Social worker
  • Occupational theraptist
  • Physiotherapist
  • Dieticians
  • Specialist discharge nurse
  • Pharmacists
  • GP
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5
Q

Common consequences of falling

A
  • Fractures/sprains
  • Loss of confidence/independence
  • Head trauma
  • Long term pain
  • Reduced QOL
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6
Q

Common drugs increasing falls risk

A
  • Antihypertensives
  • Sedatives eg diazepam and Z drugs eg Zopiclone
  • Thiazide diuretics
  • Opiates
  • Antidepressants
  • Benzodiazepines
  • Antiepileptics
  • Antipsychotics eg haloperidol
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7
Q

Common causes of acute confusion

A
  • Infection
  • Hypoxia
  • Electrolyte imbalance
  • Drugs eg opiates
  • Urinary retention
  • Constipation
  • Uncontrolled pain
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8
Q

Examinations for acutely confused pt

A
  • Neurological exam
  • Psychological tests inc screening for depression etc
  • Abdo, Cardiac and Resp - exclude common causes
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9
Q

Investigations for acute confusion

A
  • Urine dip and MSU
  • U&E, LFTs, FBC, CRP
  • Bladder scan - retention
  • ECG
  • Abdo X-ray - constipated
  • CXR - infection?
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10
Q

Management of pt with acute confusion

A
  • Supoortive care
  • Orientate time and place
  • Optimise other conditions
  • Haloperidol if risk to themselves or others - not recommended in parkinsons and LBD
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11
Q
A
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12
Q

History for fall

A
  • What were they doing?
  • What did they look like on the floor?
  • Collateral?
  • How did it happen?
  • Feeling before fall?
  • Dizziness/light headed?
  • Lose conc?
  • Cardiac symptoms?
  • Weak anywhere?
  • Happened before?
  • Near misses?
  • Medications - sedatives? antiHTN? anticholinergics, hypoglycaemics, opiates
  • Normal mobilisation techniques
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13
Q

What disease is important to assess for in someone who has fallen?

A
  • Osteoporosis risk
  • If fracture large bones with minimal trauma, commence osteoporosis treatment if over age 75
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14
Q

Osteoporosis investigations

A

Offer a dual-energy X-ray absorptiometry (DXA) scan, then bone-sparing drug treatment if the T-score is -2.5 or lower.

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15
Q

Bone sparing drug treatment

A
  • Bisphosphonate eg alendronate (alendronic acid)
  • Vitamin D - even if calcium levels are adequate, just depends on dose
  • Calcium if intake inadequate
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16
Q
A