Falls Flashcards
Before the fall
Open Q- talk me through what happened exactly
What time of day was it?
Clarify- was it a fall or a sudden collapse/fit
Aura- how did you feel immediately before the episode eg. Any warning signs something may happen?
Screen for serious causes- chest pain/ SOB/ palpitations
Prior illness- have you been unwell recently?
Environmental- did you trip over something/ slip? Footwear? Do you use a mobility aid?
What do you think happened?
During the fall
Fall- how did you fall exactly? Eg. Hit your head or injure yourself elsewhere
LOC- do you remember what happened/ how long LOC?
Witness- did anybody see you fall? How did they describe it?
After the fall
Injury- how did you feel after the fall? Did you hurt yourself? Can you walk? How did you get help and could you get up?
Previous falls- is this your first? What has happened previously?
Eyesight- how is your eyesight? Do you normally manage okay?
Systems review
FWARNJL- fever/weight loss/appetite/ rashes/ night sweats/ joints/ lumps
Resp/CVS- recent cough/ SOB/ chest pain
GUT- dysuria/ polyuria/ haematuria
GIT- abdominal pain/ bowels/ blood
Endocrine- first presentation of diabetes (polyuria etc.) with hypoglycaemia
Neurology- any Sx
Patients perspective
Effect on life
Feelings
Ideas- what do you think is happening
Concerns- ie. what may have caused the fall?
Expectations
Background
PMH
DH- any changes recently? Ask about anti hypertensives, sedatives, diuretics etc., allergies
FH- any conditions run in the family?
SH- home situation. Are you managing at home? How is mobility in general? Walking aids or home modifications? Stairs? Any carers/ family and friends who help out? Smoking and drinking and red drug use
Points to consider
- distinguish a fall and a collapse (collapse requires a more detailed history)
- assess the damage the fall has done eg. Head or trauma elsewhere
- risk factors for osteoporosis (menopause, age etc. Make it more likely to suffer a fracture if they fall again)
Mechanical fall
No red flags and good recollection of the fall
If LOC the witness says this was due to fall itself
History of similar falls (usually elderly and frail)
Poor eyesight, mobility, cognition
May trip over loose carpets, wires, objects on floor etc.
Postural hypotension
Often after pt. moves from sitting/lying to standing
Very brief episode following a head rush or unsteadiness
Anti cholinergic meds such as TCA, anti hypertensives (esp. with recent changes)
Investigations
Full cardio resp and neuro exam MSK
Cognition
Assess gait, balance, vision, cognition, and osteoporosis risk
Bloods- BM,FBC, UE, Inflammatory markers (underlying condition), bone profile & vitD (osteoporosis?), TFT B12 folate (peripheral neuropathy)
ECG
Lying and standing BP
Management
Avoid precipitants (get up slowly and carefully)
Social workers (assess safety of home) and OTs/ physios (strength and balance training)- exercise
Refer to falls clinic
Review medication
Mention osteoporosis risk
Peripheral neuropathy
Think in the diabetic patient who has had a fall- they may not have adequate sensation in their feet
Bone health assessment
FRAX score
Calcium
Vitamin D
DEXA scan
