Falls Flashcards
Why are falls important?
occur in 30% of community dwellers over 65 or 40% of community dwellers over 80. One fall related death every hour. Accidental injuries cause more death than sepsis in adults
What are some of the consequences of falls
Injury (50%)- soft tissue, fracture, subdural etc Rhabdomyolsis Loss of confidence Inability to cope Reduced QOL Carer stress Institutionalisation Terminal decline
What causes falls
Athritis, sarcopenia, feet defomities MSK
Anti hypertensives, sedatives, bev DRUGS
Stroke,parkinsonsm,dimentia,deliriumNEURO
Visual impairment, visial innantetnion SENSORY
Postural hypotension, arrhytmia, HF CARDIO
Rushing to the toilet INCONTINENCE
What clues given in a falls history could indicate what the problem is?
No memory if collpase- cardio or neuro Clear history- sensory, eyes or nerves Palpitations before fall- Cardiac When turning/distracted- postural instability Syncope on exertion -aortic stenosis
What other features should be checked for during an examination
Memory Systematic enquiry Urinary symptoms Walking changes Drugs (inc. alcohol) if you find one cause, keep going. usually multiple issues in geriatrics
What is assessed on examination?
head to toe assessment: cranial nerves, neglect, cerebellar signs bradykinesia, rigidity Pulse BP, heart sounds, HF Respiratory disease, kyphosis, abdominal examination and PR check feet for sensation, deformities rombergs and gait
What are some very specific causes of falls
Ataxia- cerebellar damage, b12 deficiency, chronic alcoholism, strokes
arthralgic state- arthritis
Heamiplegic- stroke
Small steps, shuffling- vascular parkisons
High stepping- peripheral neuropathy
What should you assess if someone falls?
Glucose Seizure Head injury C-spine injury Flail chest Abdominal injury pelvic injury limb fracture
Do i need a CT?
Yes if GCS<13 If still confused after 2 hours Focal neurology Signs of skull fracture Basal skull fracture, CSF leak, Bruising around the eyes Seizure Vomiting Anticoagulation
