Falls Flashcards
Factors that increases one’s risk of falling
Intrinsic to patient:
- Muscle strength
- Stable joints
- Sensory modalities: proprioception, vision, eye sight
- Functional CNS and PNS
Extrinsic:
- Environmental: light, obstacles, wind, grip of floor, supporting rails.
Factors that increases the severity of a fall
Osteoporosis
- More likely to fracture
System impairments:
Fewer saving mechanism (i.e bleeding)
- Secondary injury post fall, especially if left on the floor too long): dehydration, pneumonia
- Psychological effects
History for falls- HPC structure
Broken down into - Before - During - After fall
HPC fall- Before
How they were feeling on the day of the fall.
Where they were: at home, with anyone?, weather?
What they were doing.
Any warning symptoms before fall:
- Chest pain
- SOB
- Lightheaded/ dizziness
- Headache
- Aura/ blurred vision
- Nausea, abdo pain
- Weakness in legs
Fall HPC- during fall
Why they fell?
- Trip/ slip?
- Loss of consciousness
How they fell
- Body parts hitting the ground, areas affected
- Hit head?
Anyone witness the fall?
Incontinence/ biting of tongue
Fall HPC- after fall
Memory of the fall?
If they were able to get up?
How long they were on the floor?
Any help to get up?
Any new symptoms after fall:
- Pain in joint/ limb
- Weakness in limbs/ face
- Speech
- Balance affected?
- Cognition
- Vision
History- PMH
Cardiac
- Things that can cause syncope: valvular disease, arrhythmia, orthostatic hypotension, previous MI.
Resp
- COPD
- Previous PE?
Neuro
- Epilepsy
- Previous stroke?
- Peripheral neuropathy
- Parkinson’s
- Dementia
MSK
- Arthritis
- Previous fractures
General
- Diabetes
- Anaemia
- Visual/ hearing impairment
History- DH
Antihypertensives
- Beta-blockers: bisoprolol, atenolol
- ACEi: ramipril
- ARB: lorsatan
- Diuretics: furosemide, bumetinide
- Alpha blockers: doxazosin
- Ca2+ blocker: amlodipine
Anticonvulsants:
- Gabapentin
- Phenytoin
Sedatives:
- Benzos: diazepam, lorazapam
Hypoglycaemics:
- Sulphonylurea: gliceride
Anti-psychotics:
- Haloperidol
Opiates
Allergies
History- SH
Living arrangements
- Live alone?
- What type of building
- Any additional rails?
- Far away from members/ support?
Mobility
- Any aids: frames, walking stick, wheelchair
- Walking up and down steps?
Alcohol, smoking, drugs
Dependency
- Fine getting dressed?
- Cooking meals
- Using the toilet?
Eating?
- Can suggest nutritional deficiencies
History- FH
Cardiac problems
- MIs at young age
Cancers
Stroke
Epilepsy
MSK: arthritis
Examination structure
General
CVS
RESP
Gastro
Neuro
MSK
History- SR
General:
- Fatigue
- Weight loss
CVS
- Chest pain
- Palpitations
- Dizziness/ lightheaded
RESP
- SOB
- Chest pain
- Cough
Neuro
- Weakness
- LOC
- Headache
- Vision/ hearing/ sensation changes
- Balance/ vertigo
GI
- Abdo pain
- Nausea
- Bowels
GU
- Dysuria
- Increased urinary frequency
- Urinary retention
- Incontinence
MSK
- Joint pain
- Back pain
- Muscle weakness
Examination- General
Looks well?
- Pale, clammy
- Sweating?
- SOB
- Jaundice, cyanotic
Examination- CVS
Pulse
- Arrhythmia
- Bardycardia
BP
- Hypotension
- Check lying and standing BP
Auscultation
- Murmurs
Conjuctival pallor
- Anaemia
Carotids
- Bruit
Examination- Resp
Cyanosis?
Raised JVP?
SOB? Increased RR
Auscultation: crackles, wheeze, air entry
Percussion
- Dullness/ hyper-resonance
Examination- Abdo
Palpation
- Tenderness
- Rigid?
- Organomegaly
Examination- Neuro
CN
- Visual acuity
- Eye movement
- Facial/ shoulder weakness
- Altered sensation: smell, hearing, taste, feeling
Neuro
- Tone
- Power
- Co-ordination
- Reflexes
- Sensation
Examination- MSK
GALS
- Gait
- Joint movement
Get up and go test
Signs of injury/ fracture
Investigations
Bloods ECG X-ray of affect limb Chest X ray CT head ECho (murmur) Cognition: AMSE, MMSE Head-up tilt table testing - Unexplained syncope
Blood investigations (7)
FBC
- Anaemia
- Infection
CRP
- Infection
- Fracture
LFT
- ALP increased in fracture
- Liver failure/ Alcohol abuse
U+Es
- Electrolyte imbalance
- Dehydration
- Rhabdomyolosis
- Ca2+, B12, Folate, phosphate
Troponin
- MI
Glucose
Bone profile
Imaging investigation
Chest X-ray
- Pneumonia
- Fractures
Head CT
- History of head trauma
- Rule out stroke
Echo
- If murmur is heard
Factors to reduce fall frequency
Drug review
Treat orthostatic hypotension
Physiotherapy
Occupational therapist
Vision correction
Reducing stressors
Factors to prevent adverse effects of fall
Screen and treat osteoporosis
Alarms
Supervision
Treat infection/ dehydration/ delirium
Occupational therapist
