Falls Flashcards
morbidities caused by a long lie on the floor after a fall
hypothermia dehydration -> AKI rhabdomyolysis -> AKI DVT pneumonia pressure sore
what kind of patients are at highest risk of falls?
patients with delirium or cognitive impairment
what happens to vision as we get older?
smaller pupils
thicker lens so less light gets in
why do reaction times change as you get older?
central processing and cognition are worse
why is standing from a chair difficult in old people?
less muscle mass from sarcopenia so less quadriceps bulk
cardiovascular causes of falls
syncope
arrythmias
vascular eg postural hypotension or stroke (NOT TIA)
visual causes of falls
wet ARMD
glaucoma
cataracts
“i just go down…”
syncope
why should you look at clothes in someone who has fallen?
gives you an idea of the time/day that they fell eg pyjamas would mean it was at night
causes of syncope
arrhythmias eg heart block
postural hypotension
another term for postural hypotension
orthostatic hypotension
test for postural hypotension?
sit-stand BP
what would someone with aortic stenosis have before a fall?
chest pain
breathlessness
most common valvular cause of falls
aortic stenosis
postural HT is defined as a fall in __mmHg SBP and __mmHg DBP
> 20
>10
how would you do a sit-stand BP
take lying BP (lie for 5 mins)
take BP immediately when standing PLUS 3 mins after
why do old people get postural hypotension
skeletal muscle pumps less effective so less venous return
medication eg BP drugs
possible slowing of the ANS eg MS
“high-stepping gait”
cervical myelopathy
3 causes of a wide based gait
peripheral neuropathy
cerebellar ataxia
lumbar stenosis
patients with parkinsons get postural hypotension T or F
T
BPPV is confirmed by what manoeuvre?
dix -hallpike
“brown tinge to vision”
cataracts
what class of antiarrythmics cause falls?
class 1A
3 history questions to screen for falls?
- have you had 2 or more falls in the last year
- have you presented acutely with a fall
- do you have problems with walking and balance
what do you want to get from a fall history
what happened before and after
impact/consequence of it
account from a witness
medication list
what examinations would you want to do in a patient with falls?
GALS neurological exam CVS exam visual acuity incontinence assessment look at shoes
how would you screen for fracture risk?
do a qFRACTURE score
check vitamin D levels
being on over _ medications is a risk factor for falls
4
