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
