Falls Flashcards
What are some causes of falls?
Infection Postural hypotension Arrhythmia Balance problems: vertigo, BPPV, menieres Hypoglycaemia Epilepsy Syncope Poor vision Hazards in the home
What should you ask about the fall when taking history?
What where they doing at the time? Events leading up to the fall.
Can they remember what happened before and after?
How did they feel before they fell? Dizzy, palpitations etc.
Was there LOC? How long for?
How did they feel after the fall? Any injuries?
Could they get up? How long were they on the floor?
What could be relevant in the PMH of a patient who has fallen?
Previous falls? What is their mobility usually like?
Recent infections, or symptoms of infections?
Any conditions that increase risk of falling (diabetes, epilepsy, hypertension, arrhythmias, dementia etc)
Do they have any sensory deficit?
Osteoporosis: is a fracture likely?
Why could having hypertension increase an elderly person’s risk of falling?
A side effect of being on some anti-hypertensives is postural hypotension
An elderly man has a fall. He felt faint when he stood up from his chair and then collapsed.
What’s the likely cause of his fall?
Sounds like postural hypotension
An elderly lady has a fall. She was on her way home after doing the shopping and collapsed. She reports her chest feeling ‘fluttery’ just before she fell.
What’s the likely cause of his fall?
Probably an arrhythmia, sounds like she had some palpitations before falling
An elderly lady has a fall.
She was feeling unwell 2 days prior to the fall and OE she has a high temperature. She also self-catheterises.
What’s the likely cause of his fall?
She might have a UTI, causing her to develop delirium increasing her likelihood of falling
Why do infections cause falls in elderly patients?
Infections can cause a drop in blood pressure resulting in a fall.
Also they can cause confusion and cognitive impairment (delirium) increasing risk of falling
An elderly man has a fall.
He has no memory of how he fell, but his wife reports that he was incontinent and his limbs were jerking.
What’s the likely cause of his fall?
A seizure, could be an epileptic seizure
If a patient has a long lie after a fall, what are they at risk of?
Rhabdomyolysis Dehydration Hypothermia Infections, CAP Pressure ulcers
What is rhabdomyolysis?
What blood results would you see?
When skeletal muscle breaks down rapidly causing a release of myoglobin
Myoglobin
Creatinine kinase high
High P, K
Low Ca
Symptoms of rhabdomyolysis?
Muscle pain Tenderness Weakness Low BP Nausea, vomiting Tea coloured urine
Why do patients get tea coloured urine in rhabdomyolysis?
Muscles are made of proteins, including myoglobin.
When muscles are broken down myoglobin is released into the bloodstream
Myoglobin colours the urine brown.
Why should we be worried about a patient with rhabdomyolysis?
The excess myoglobin can lead to AKI, coma etc.
Also hyperkalaemia can occur: cardiac arrhythmias
Management of rhabdomyolysis?
Fluids to reduce concentration of myoglobin, reducing toxicity to kidneys
Treat underlying cause
Treat any electrolyte imbalances
- hyperkalaemia (calcium gluconate)
- dextrose insulin infusions
What investigations would you do (and why) for an elderly patient who has come in after having a fall?
*Don’t do bloods on this card!
ECG: look for arrhythmias
Blood glucose: was a hypo the cause?
Urine dip: looking for UTI
Bloods
CXR: look for infection, rib fractures
CT head: any head injury?
What bloods would you do (and why) for an elderly patient who’s had a fall?
FBC:
- anaemia causing SOB?
- raised white count (infection)
U+E:
- electrolyte imbalance
- uraemia leading to confusion
- creatine kinase
CRP: infection
Ca + phosphate: any bone pathologies
LFTs: alcohol?
Clotting: is there a risk of bleed from head injury, or could a vascular event have caused the fall?
TFTs
Which HCPs should be in the MDT caring for an elderly patient who has fallen?
Doctors Nurses Physiotherapists OTs Dieticians
What equipment/interventions are available to reduce risk of falls at home, and to help a person should they fall?
Carer support at home Educating family Modifying home: decluttering, reducing trip hazards Stair lift Commode Hand rails A hospital bed Hoist Pendant alarms Fall detectors
List some complications that can occur after a fall.
Fracture: NOF, radial
Soft tissue injuries, pressure sores
Immobility: DVT, rhabdomyolysis
Incontinence: because of reduced mobility
Psychological: anxiety about falling again, low mood
Where exactly is a fracture of the NOF?
A fracture of the proximal femur up to 5cm below the greater trochanter
Causes of a fractured NOF?
Osteoporosis / osteopenia
Trauma, falls
Pathological fractures: bone mets or primary tumours
Where is pain felt in fractured NOF?
Hip
Groin
Knee
Examination findings in a patient with a fractured NOF?
Affected leg is shorter and abducted (away from midline)
Pain on palpation of greater trochanter
Pain when rotating hip
Complications of a fractured NOF?
Infection (after surgery)
Bleeding
Increased risk of thromboembolic events (PE, DVT)
Avascular necrosis of the femoral head
Management of osteoporosis?
Bisphosphonate: alendronate
Vitamin D and calcium
Denosumab (reduces osteoclast activity)
What is osteoporosis?
Reduced bone mineral density
Due to imbalance between remodelling and resorption
Risk factors for osteoporosis?
Smoking Early menopause Steroids Underweight Inactivity Alcohol
Investigations for osteoporosis?
DEXA scan
Signs of vit C deficiency?
Bruises
Bleeding gums
