Falls

Question 1

Silver trauma.
a) Define
b) Observations thresholds that trigger
c) Common injuries to screen for
d) Imaging
e) Injury severity score

Answer 1

a) Age >65 + frailty
- Fall from standing height can be as damaging as a high impact collision in a younger person

b) BP < 110 systolic
HR >90 (esp if on BBs)

c) Rib # - any chest discomfort
Hip/pelvic #
IC bleeds
C-spine #

d) CT is best modality
- Consider whole-body CT if 2 or more body regions involved
- Use Canada CT rules to consider CT head

e) ISS
- Grades worst injury in the (1) head and neck, (2) face, (3) chest, (4) abdomen, (5) extremities, (6) external
- If total score 18+ should be at trauma centre

Question 2

Urinary incontinence in chronic fallers - optimal treatment and why

Answer 2

Mirabegron (Beta-3 agonist); preferred to antimuscarinics like oxybutynin as lower risk of postural drops and falls