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Clinical Ageing > faints, falls and trauma > Flashcards

faints, falls and trauma Flashcards

1
Q

what percentage of syncope has CVD has a reason for it?

A

55%

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2
Q

what are the signs that a syncopal event occurred?

A

face/ head injuries, unexplainable injuries, falls, fractures, amnesia

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3
Q

what medication is used to increase bp?

A

fludocortisone - lowers by na and water rentention

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4
Q

what are the risks to cause a fall?

A
  1. intrinsic - visual, cog, impairment, cog, gait/ balance abnormalities
  2. extrinsic - polypharmacy, environmental factors (uneven ground, wet, stairs etc0, walking aids
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5
Q

what analgesics are given to those who have fell?

A

acetaminophen - most freely available drug on the market, NSAIDs (with PPI), opiates

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6
Q

what are the issues with prolonged NSAIDs?

A

GI issues, kidney, liver issues

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7
Q

what is the issue with opioids?

A

1-3% of those prescribed with opioids will experience dependency - drug addiction

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8
Q

what surgery is used in neck of femur fractures?

A

anthroplasty - total or partial

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9
Q

what is the mdt approach to falls and syncope?

A

falls and syncope service - largest in europe based in ncl

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10
Q

name the roles and jobs involved in the falls service mdt

A
  1. doctors - consultant led
  2. nursing staff - allow the service to run
  3. pharmacy
  4. physio
  5. OT
  6. opticians?
  7. neuro?
  8. podiatry
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11
Q

what is the purpose of the mdt falls service?

A

to produce patient centred care from each speciality to give rounded and beneficial care and build confidence again for the user of the service

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12
Q

what happened to the ncl falls and syncope service in 2006?

A

the first rapid access - not just gp referral but can be from NEAS, A&E

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13
Q

where is the ncl falls and syncope service located?

A

Belsay Unit within the Campus for Ageign and Vitality

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14
Q

what is fraility?

A

lack of physiological reserve leaving the person with increased vulnerability to fractures and injuries as well as illness

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15
Q

define postural hypotension

A

when a person goes from sitting to standing and drops systolic bp by 20mmHg or diastolic drop by 10mmHg

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16
Q

define falls

A

an event resulting in a person inadvertently coming to rest on th ground or a low level and can be with/ without consciousness or injury

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17
Q

define syncope

A

syncope is the loss of consciousness characterised by unresponsiveness, loss of postural tone and the spontaneous recovery without resuscitation efforts or interventions.

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18
Q

what is the rate of incidence of a fall in the 65+?

A

30%

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19
Q

what is the rate of incidence of a fall in the 80+?

A

40%

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20
Q

what percentage of falls result in serious injury?

A

5-10%

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21
Q

how many hip fractures occur yearly?

A

70,000

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22
Q

what is the survival rate post hip fracture?

A

1/3 will die in the first year following

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23
Q

what percent of A&E attendances was from the 65+ with an associated fall?

A

45%

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24
Q

how much do falls cost the NHS yearly?

A

£2.3bn

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25
Q

what is the issue with patients with unknown syncope?

A

as it hard to distinguish whether it has occurred because only 40-60% of syncopal events are witnessed
- a large proportion of the elderly forget they had a fall within three months

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26
Q

what does the tilt table test do?

A

mimics postural hypotension - see if the feeling can be recreated - so that they can get a diagnosis

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27
Q

what happens to some elderly patients if the carotid is activated?

A

it can cause syncope

28
Q

what is postural hypotension also known as?

A

orthostatic

29
Q

what is the most serious and frequent accident in the 65+

A

falls

30
Q

what is the main cause of disability and death in the 75+

A

falls

31
Q

in the 2017 study, what does strength and balance training do?

A

reduce falls by 35%

32
Q

how is frailty measured?

A

assessed by the rockwood sore

1- very fit and 9- terminally ill

33
Q

what year was the study for falls from?

A

2017

34
Q

what did the 2017 study show relating to falls?

A
  1. that strength and balance training reduced falls by 35%
  2. falls are the most common cause of disability and death in the 75+
  3. falls are the most serious and common accident in 65+
35
Q

how does a neck of femur fracture present?

A
  1. pain
  2. shortened
  3. eternally rotated leg
36
Q

when does NICE recommend arthroplasty after neck of femur fracture?

A

day of injury, or the day after

37
Q

how many patients does the ncl falls service see yearly?

A

4000 patients

38
Q

who recommends falls mdt service?

A

NICE

39
Q

what percentage of people have experienced a synoptic event?

A

40-50%

40
Q

what groups of people are most likely to experience syncope?

A

young adults and then over 50+

41
Q

what system/ mechanism describes vasovagal syncope?

A

Bezold- Jarish Reflex

42
Q

what starts of the chain of Bezold -Jarish Reflex

A

drop in blood pressure

43
Q

describe the baroreceptor route of vasovagal syncope

A
  1. BP drops
  2. drop detected by baroreceptors
  3. there is an increase in HR and inotropy via catecholamines
  4. there are vigorous ventricular contractions - activates LV mechanoreceptors
  5. vasovagal reactions
44
Q

describe the venous return route of Bezold- Jarish Reflex

A
  1. BP drops
  2. venous return drops
  3. Cardiac Output drops - limited
  4. vigorous ventricular contractions - activates LV mechanoreceptors
  5. vasovagal reactions
45
Q

what are vasovagal reactions?

A

decrease in HR and decrease in BP

46
Q

why is syncope an evolutionary flaw?

A

syncope was to control blood loss by reducing BP and HR - to minimise blood loss, but the body is sensing the signal incorrectly

47
Q

how does syncope present?

A

myoclonus movements, pale, sweaty, rolling eyes while open, light-headed, black out, restless, strong urge to sit/ lie down

48
Q

what are myoclonus movements?

A

involuntary jerking movements

49
Q

what is inotropy?

A

contractions of the heart

50
Q

what is the medial term for blackout?

A

retinal ischaemia

51
Q

what symptoms to elderly experience through syncope

A

may not have the signals - no symptoms and therefore they fall more and get injured

52
Q

what are the situational triggers?

A

pain, cough, deglutination, gelastic, shock, emotion, standing, heat, dehydration, vasodilation

53
Q

what is deglutination

A

the process of swallowing - situational trigger of syncope

54
Q

what is gelastic

A

laughing - situational trigger of syncope

55
Q

how do you treat vasovagal syncope?

A

water, salt, caffeine, physical counter manoeuvres, trigger avoidance

56
Q

how does caffeine help prevent syncope?

A

it increases bp

57
Q

what is carotid sinus syndrome?

A

affects older people - no warning

it is the exaggerated response to carotid baroreceptor stimulation

58
Q

how would you treat carotid sinus syndrome?

A

need to control the response so surgery - pacemaker to control or carotid sinus denervation

59
Q

describe the pathway/ mechanism of orthostatic hypotension

A
  1. go from lying where there is venous pooling in thoracic areas
  2. when you stand, gravity pools blood in legs which decreases venous return
  3. CO decreases and BP drops
  4. baroreceptors end up less stretched
  5. medulla detects this and increases HR
  6. trying to get CO back up
60
Q

what is the treatment for orthostatic hypotension

A

water, salt, caffeine, physical counter manoeuvres, compression socks

61
Q

what do systolic and diastolic bp drop by?

A

systolic drops by 20 mmHg

diastolic drops by 10 mmHg

62
Q

what heart blocks cause syncope

A

1st does not
2nd does
3rd does

63
Q

what is 2nd degree heart block?

A

paroxysmal atrioventricular block - sudden change in physiology of AV conduction

64
Q

what is third degree heart block?

A

ventricular asystole

65
Q

how many people over 60 forget having fallen in last three months?

A

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Clinical Ageing (10 decks)

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