Falls

Question 1

Taking a falls Hx

Answer 1

• Introduce, patient details, consent
• PC
• HPC
  
  • What were you doing
  • Symptoms before falls: dizziness, palpations, chest pains, nausea, SOB
  • Syncope before during after
  • Do you remember putting your arms out to stop yourself
  • Amnesia
  • Incontinence
  • Witnesses - collateral history what do they say happened. Seizure?
  • How long were you down for?
  • Were you able to get yourself up?
  • When did help come and what did they do?
  • Did you sustain any injuries
  • Why do you think you fell
  • Coughs, colds precipitating illness?
• Falls Hx
  
  • Previous falls?
  • Causes?
  • Consequences?
• PMHx
  
  • Affectings balance
    
    • Meniere’s disease
  • Affecting gait/mobility
    
    • Arthritis
  • Affecting senses
    
    • Deafness, blindness
  • Affecting circulation
    
    • Hypertension
  • Affecting proprioception
    
    • DM
  • Affecting brains
    
    • Dementia
  • Continence/frequency/urgency
  • Osteoporsis
• DHx
  
  • Recent change in medication
  • Polypharmacy
  • Heart meds: antihypertensives, anti-platelet etc.
  • Sedating meds (benzos)
  • Allergies
• PSHx
  
  • Affecting thing in PMHx
• FHx
  
  • Falls, medical conditions mentioned in PMHx
• SHx
  
  • Mobility aids (at home)
  • Home set up bungalo etc.
  • Ability to care for self
  • Baseline mobility
  • Carers/accessible help
  • Smoking/drinking
  • Lack of exercise
• ICE

Question 2

Investigations to consider after a fall

Answer 2

1. Obs: BP, HR, RR, SATS, Temp, BM
2. Investigate any injuries e.g. CT head
3. Heart
   
   1. ECG, resp and cardio exam, supine standing BP, FBC
4. Infection
   
   1. Temp, blood cultures, urine dip, U&E
5. Endocrine
   
   1. TFT, BM
6. CNs
   
   1. CN, AMT/GCS, PNS, Capacity?
7. Physio/OT assessment of mobility

Question 3

Consequences of a long lie + investigations

Answer 3

• Hypothermia - temp
• Pressue ulcers - full body check
• Rhabdomyolysis - creatine kinase
• Hypostatic pneumonia - Resp exam, CXR, FBC
• Dehydration - U&Es

Question 4

Management of fall

Answer 4

• Investigations
• Treat any acute injuries
• Identify risk factors and treat
• Medication review
• MDT esp OT/Physio
• Fill out falls proforma

Question 5

Define and Interpret DEXA score

Answer 5

DEXA score is a diagnostic test for osteoporosis

• Normal = > -1
• Osteopenia = -1 - -2.5
• Osteoporsis = < -2.5

Question 6

Define and interpret FRAX score

Answer 6

Tool used to assess 10 year risk of hip fracture

Given as a percentage chance over 10 years