faints, falls and trauma Flashcards
what percentage of syncope has CVD has a reason for it?
55%
what are the signs that a syncopal event occurred?
face/ head injuries, unexplainable injuries, falls, fractures, amnesia
what medication is used to increase bp?
fludocortisone - lowers by na and water rentention
what are the risks to cause a fall?
- intrinsic - visual, cog, impairment, cog, gait/ balance abnormalities
- extrinsic - polypharmacy, environmental factors (uneven ground, wet, stairs etc0, walking aids
what analgesics are given to those who have fell?
acetaminophen - most freely available drug on the market, NSAIDs (with PPI), opiates
what are the issues with prolonged NSAIDs?
GI issues, kidney, liver issues
what is the issue with opioids?
1-3% of those prescribed with opioids will experience dependency - drug addiction
what surgery is used in neck of femur fractures?
anthroplasty - total or partial
what is the mdt approach to falls and syncope?
falls and syncope service - largest in europe based in ncl
name the roles and jobs involved in the falls service mdt
- doctors - consultant led
- nursing staff - allow the service to run
- pharmacy
- physio
- OT
- opticians?
- neuro?
- podiatry
what is the purpose of the mdt falls service?
to produce patient centred care from each speciality to give rounded and beneficial care and build confidence again for the user of the service
what happened to the ncl falls and syncope service in 2006?
the first rapid access - not just gp referral but can be from NEAS, A&E
where is the ncl falls and syncope service located?
Belsay Unit within the Campus for Ageign and Vitality
what is fraility?
lack of physiological reserve leaving the person with increased vulnerability to fractures and injuries as well as illness
define postural hypotension
when a person goes from sitting to standing and drops systolic bp by 20mmHg or diastolic drop by 10mmHg
define falls
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
define syncope
syncope is the loss of consciousness characterised by unresponsiveness, loss of postural tone and the spontaneous recovery without resuscitation efforts or interventions.
what is the rate of incidence of a fall in the 65+?
30%
what is the rate of incidence of a fall in the 80+?
40%
what percentage of falls result in serious injury?
5-10%
how many hip fractures occur yearly?
70,000
what is the survival rate post hip fracture?
1/3 will die in the first year following
what percent of A&E attendances was from the 65+ with an associated fall?
45%
how much do falls cost the NHS yearly?
£2.3bn
what is the issue with patients with unknown syncope?
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
what does the tilt table test do?
mimics postural hypotension - see if the feeling can be recreated - so that they can get a diagnosis
what happens to some elderly patients if the carotid is activated?
it can cause syncope
what is postural hypotension also known as?
orthostatic
what is the most serious and frequent accident in the 65+
falls
what is the main cause of disability and death in the 75+
falls
in the 2017 study, what does strength and balance training do?
reduce falls by 35%
how is frailty measured?
assessed by the rockwood sore
1- very fit and 9- terminally ill
what year was the study for falls from?
2017
what did the 2017 study show relating to falls?
- that strength and balance training reduced falls by 35%
- falls are the most common cause of disability and death in the 75+
- falls are the most serious and common accident in 65+
how does a neck of femur fracture present?
- pain
- shortened
- eternally rotated leg
when does NICE recommend arthroplasty after neck of femur fracture?
day of injury, or the day after
how many patients does the ncl falls service see yearly?
4000 patients
who recommends falls mdt service?
NICE
what percentage of people have experienced a synoptic event?
40-50%
what groups of people are most likely to experience syncope?
young adults and then over 50+
what system/ mechanism describes vasovagal syncope?
Bezold- Jarish Reflex
what starts of the chain of Bezold -Jarish Reflex
drop in blood pressure
describe the baroreceptor route of vasovagal syncope
- BP drops
- drop detected by baroreceptors
- there is an increase in HR and inotropy via catecholamines
- there are vigorous ventricular contractions - activates LV mechanoreceptors
- vasovagal reactions
describe the venous return route of Bezold- Jarish Reflex
- BP drops
- venous return drops
- Cardiac Output drops - limited
- vigorous ventricular contractions - activates LV mechanoreceptors
- vasovagal reactions
what are vasovagal reactions?
decrease in HR and decrease in BP
why is syncope an evolutionary flaw?
syncope was to control blood loss by reducing BP and HR - to minimise blood loss, but the body is sensing the signal incorrectly
how does syncope present?
myoclonus movements, pale, sweaty, rolling eyes while open, light-headed, black out, restless, strong urge to sit/ lie down
what are myoclonus movements?
involuntary jerking movements
what is inotropy?
contractions of the heart
what is the medial term for blackout?
retinal ischaemia
what symptoms to elderly experience through syncope
may not have the signals - no symptoms and therefore they fall more and get injured
what are the situational triggers?
pain, cough, deglutination, gelastic, shock, emotion, standing, heat, dehydration, vasodilation
what is deglutination
the process of swallowing - situational trigger of syncope
what is gelastic
laughing - situational trigger of syncope
how do you treat vasovagal syncope?
water, salt, caffeine, physical counter manoeuvres, trigger avoidance
how does caffeine help prevent syncope?
it increases bp
what is carotid sinus syndrome?
affects older people - no warning
it is the exaggerated response to carotid baroreceptor stimulation
how would you treat carotid sinus syndrome?
need to control the response so surgery - pacemaker to control or carotid sinus denervation
describe the pathway/ mechanism of orthostatic hypotension
- go from lying where there is venous pooling in thoracic areas
- when you stand, gravity pools blood in legs which decreases venous return
- CO decreases and BP drops
- baroreceptors end up less stretched
- medulla detects this and increases HR
- trying to get CO back up
what is the treatment for orthostatic hypotension
water, salt, caffeine, physical counter manoeuvres, compression socks
what do systolic and diastolic bp drop by?
systolic drops by 20 mmHg
diastolic drops by 10 mmHg
what heart blocks cause syncope
1st does not
2nd does
3rd does
what is 2nd degree heart block?
paroxysmal atrioventricular block - sudden change in physiology of AV conduction
what is third degree heart block?
ventricular asystole
how many people over 60 forget having fallen in last three months?
1 in 3
