Falls Flashcards
What should you ask regarding what happened before the fall?
Aura
- How did you feel before?
- Warnings?
- Chest pain?
Environmental
- Did you trip over anything?
LoC
- Did you loose consciousness?
- How long for?
Witness
- Did anyone witness the episode? How did they describe it?
What should you ask regarding what happened during the fall?
Fall
- How did you fall?
- Bang head?
Seizure
- Fit?
- Describe?
- Whole body or only a part of it?
Continence
- Pass any urine?
- Soiling?
Tongue
- Bite
- Front or sides?
How may you manage someone who has had a fall due to…
- Poor mobility
- Postural hypotension
- Poor mobility
- OT and Social worker involvement
- Advise carefulness and taking things slowly
- Ensure safe home environment
- Strenght and balance exercise - Postural hypotension
- Review medications
- Do they need to be on all their tablets?
What should you ask regarding what happened after the fall?
Postictal
- How did you feel immediately after fall?
- Confused or drowsy?
- Aching muscles?
Todd’s Paralysis
- Any weakness after?
Previous episode
- Anything like this in the past?
- Describe in detail please
Cardio
- Do you suffer from chest pain? Do you get breathless often?
Eyesight
- Poor? Blurring?
- How do you get about
What conditions should you question about in PMH / FH?
Epilepsy
Arrhythmias and other CVD
Hypertension
What medications should you question about in DH?
BP drugs
Sedatives
Antidepressants
What questions should you ask in SH?
Other than normal questions (Drugs, Alcohol, Smoking)
DRIVING: Do you still drive?
- Effect of falls on life?
- Work / Employment? Effect of this on job?
- Home? Stairs? Chairlift? Modifications put in place?
What are some typical features or a typical sequence (before during after) of events of a falls history caused by a SEIZURE?
Partial or generalised
Simple or complex (impaired consciousness)
Before
- Aura may precede (visual, olfactory, sensory, dejavu)
- LoC
During
- LoC, fall, stiff limbs, jerk limbs violently, (10-20s)
- Biting of tongue and urinary/faecal incontinence
After
- Postictal drowsiness, myalgia, headache, amnesia
- Lasts up to 2-3 minutes
What are some typical features or a typical sequence (before during after) of events of a falls history caused by a VASOVAGAL SYNCOPE?
Before
- Strong emotion (fear), pain, prolonged standing
- Nausea, pallor, sweating
- Brief LoC of no more than 2 min
During
- Limb jerking is UNCOMMON, but may occur (no tonic-colonic sequence)
What are some typical features or a typical sequence (before during after) of events of a falls history caused by a POSTURAL HYPOTENSION?
Before
- On standing
- Headrush or unsteadiness
During
- Brief episode
- Few seconds
After
- Better after sitting down
What medications may contribute to POSTURAL HYPOTENSION related falls?
Antihypertensives
Antidepressants
What are some typical features or a typical sequence (before during after) of events of a falls history caused by a CAROTID SINUS SYNCOPE?
Before
- Turning of head
- Shaving
During
- Brief LoC
What are some typical features or a typical sequence (before during after) of events of a falls history caused by a AORTIC STENOSIS?
Before
- SOB on exertion
- Central crushing chest pain
Older patients generally
Senile calcification of aortic valve
What are some typical features or a typical sequence (before during after) of events of a falls history caused by POOR EYESIGHT OR MOBILITY?
Before
- Trip over rug or wire
- Poor balance or eyesight
- Achy joints
What investigations should be done on a falls patient?
Bedside, bloods and investigations
Bedside
- Full CVS exam
- Full Neuro exam
- Assess gait, balance, vision, cognition and risk of osteoporosis
- ECG (24h if suspected stoke adams)
Bloods
- FBC (anaemia? thiamine? B12?)
- U&E
- CRP
- CK (have they been on the floor for a long time?)
Investigations
- Echo (aortic stenosis, hypertrophic obstructive cardiomyopathy in young pt)
- CT / MRI of head if injured
