Falls and syncope Flashcards
1
Q
Falls workup
A
Obs and examination, ask about anticoag Neuro exam if head injury ECG, echo Bloods- urea, FBC, UE, maybe trop, LFT, clotting, CK, TFT Urine dip Lying standing BP- drop over 20 is sig Thorough secondary survey, esp neck pain XR if suspect frac- esp pelvis, chest CT head if head inj in over 65 Check what meds they are on EEG if seiz MRI if susp neuro dis Med review
2
Q
Falls history Qs
A
Cause of fall Memory of it, or witness LOC, amnesia Pre syncope- dizziness, nausea, vision change Chest pain, palpitations Recent illness, PMH, sensory impairment, cognition Medication changes Head injury, headache Home environment Mobility before and after Previous fall Post ictal Bite tongue Incontinence during fall Seizure like activity Fever
3
Q
Syncopal
A
Cardiac- arrhythmia, structural cardiac or pulm dis
Neural- Vasovagal, situational, carotid sinus hypersensitivity
Postural hypotension- often due to meds
Medication
Cerebrovascular
4
Q
non syncopal
A
ENVIRONMENT MSK problems Metabolic- hypoglycaemia, hypoxia, hypocapnia Seizure Intoxication TIA Psychogenic ANS eg PD
5
Q
Syncope causes
A
Vasovagal- ANS trigger Hypotension- dehyd, DM, meds, bleeding Cardiac- IHD, angina, MI, myop, arrhythmia Anaemia Electrolyte Sepsis Neuro and cerebrovasc Drugs- eg PD orthostatic hypot Alc and substance abuse Reflex anoxic seiz in kids Psychogenic eg anx
6
Q
Fall RFs
A
Cognitive impair
Sensory impair
Mobil impair
Balance prob
Frail and comorb- arth, DM, incontin, CVA, PD
Polypharmacy
Poor get up and go test- sit to stand w/o arms, walk 3m, then back and sit. Over 12sec is high risk.
More than 4 steps to turn 180 deg when stood
Previous fall
7
Q
prevention
A
OT and physio, home intervention Strength and balance training Vision assessment Medication review Comorb mx eg CVS, DM, MSK
