Falls History Flashcards

1
Q

Outline the structure of a history of presenting complaint for patients who have fallen

A

WHO

WHAT

WHEN

WHERE

WHY

HOW

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2
Q

WHO

A
  • Did anyone witness the fall?
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3
Q

WHAT

A

BEFORE

  • Did anything happen/was there a warning beforehand?
  • Any dizziness?
  • Any palpitations?

DURING

  • Incontinence or tongue biting? (seizure activity)
  • Loss of consciousness?
  • Pale or flushes? –> vasovagal attack
  • Did the patient hit their head?
  • Which part of their body had first contact with the ground?

AFTER

  • What happened after the fall?
  • Was the patient able to get off the floor?
  • How long did it take?
  • How long were they on the floor for?
  • Were they able to resume normal activities?
  • Confusion after the event? (head injury)
  • Weakness or speech difficulty? (stroke / TIA)
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4
Q

WHEN

A

What time of the day did they fall?

What were they doing?

  • Looking up (vertebrobasilar insufficiency)
  • Getting up (postural hypotension)
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5
Q

WHERE

A

Did they fall at home or outdoors?

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6
Q

WHY?

A

Why do they think they fell?

e.g. tripped over a rug

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7
Q

HOW?

A

How many times have you fallen in the last 6 months?

Can assess severity

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8
Q

Perform a systems review relevant to the falls history

A

PSYCHIATRIC: mood

NEUROLOGICAL: loss of consciousness, seizures, motor or sensory disturbance

CARDIOVASCULAR: chest pain or palpitations

RESPIRATORY: shortness of breath or cough

GENITOURINARY: incontinence, dysuria, urgency

GASTROINTESTINAL: abdominal pain, diarrhoea, cramps

MSK: joint pain or weakness

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9
Q

Perform a PMHx inquiry relevant to the falls history

A

PSYCHIATRIC: depression

NEUROLOGICAL: TIA, stroke, dementia, Parkinson’s, peripheral neuropathy

CARDIOVASCULAR: arrhythmia, CVD

RESPIRATORY: COPD

GENITOURINARY: UTI, incontinence

GASTROINTESTINAL: diverticular disease, chronic diarrhoea, alcoholic liver disease

MSK: chronic pain, arthritis, fractures

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10
Q

Social history relevant to falls history

A
  • Alcohol intake
  • Support at home (family, friends)
  • Mobility aids
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11
Q

Name 5 medications that increase fall risk, and why

A
  • Beta-blockers (bradycardia)
  • Diabetic medications (hypoglycaemia)
  • Antihypertensives (hypotension)
  • Diuretics (dehydration / hypotension)
  • Benzodiazapenes (sedation)
  • Antidepressants (sedation)
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12
Q

What would you be looking for in the GENERAL INSPECTION of a patient who has fallen?

A

Alert and oriented?

‘Get up and go’ test: Ask the patient to get up from the chair/bed and walk three metres then turn around and sit down again. The patient should be permitted to use their walking aid.

  • Helps evaluate deficits and functional capacity
  • Directs more targeted intervention
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13
Q

What would you be looking for in the CVD EXAM of a patient who has fallen?

A

Pulse: may have irregularities such as AF or bradycardia

Blood pressure – hypotension

Bruits over carotid arteries (e.g. aortic stenosis, carotid stenosis)

Murmurs: aortic stenosis/regurgitation, mitral stenosis

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14
Q

What would you be looking for in the RESPIRATORY EXAM of a patient who has fallen?

A

Inspection: increased work of breathing

Auscultation: coarse crackles (e.g. pneumonia)

Percussion: dullness (e.g. pleural effusion)

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15
Q

What would you be looking for in the NEUROLOGICAL EXAM of a patient who has fallen?

A

Cranial nerve examination: stroke or visual impairment

Power: weakness (e.g. stroke, disuse atrophy)

Tone: increased in stroke

Reflexes: absent (e.g. diabetic neuropathy), hyperreflexia (e.g. upper motor neuron pathology)

Sensation: may be reduced secondary to upper or lower motor neuron pathology

Co-ordination: may be impaired (e.g. chronic alcohol misuse leading to cerebellar degeneration)

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16
Q

What would you be looking for in the GASTROINTESTINAL EXAM of a patient who has fallen?

A

Organomegaly

Tenderness

17
Q

What would you be looking for in the MSK EXAM of a patient who has fallen?

A

Tenderness or bruising where they’ve fallen

18
Q

What are 5 useful bedside investigations for the assessment of falls?

A

ECG: cardiac precipitants of the fall

Supine & standing BP: orthostatic hypotension

Urine dipstick: hyperglycaemia, UTI, rhabdo

Cognitive screening: FAB, MMSE, 4AT

BGL: hyper or hypoglycaemia

19
Q

Which bloods should be ordered, and why?

A

CBE: anaemia, infection

EUC: dehydration, rhabdo, electrolyte abnormalitieis

LFTs: chronic alcohol use

Bone profile: calcium abnormalities in malignancy, over-supplementation

20
Q

Which imaging tests should be ordered, and why?

A

CXR: pneumonia

AP PELVIS and LATERAL HIP: if FNOF suspected

CT HEAD: stroke

ECHO: valvular HD