Falls + Postural hypotension

Question 1

Causes of falls?

Answer 1

MINC
MSK - Fracture, osteoporosis

Iatrogenic -
High ACB (amitryptilline, clozapine),
Low BP (ace-i, bb, ccb),
benzodiazepines

Neuro -
TIA/Stroke
seizure,
Parkinsonism
Cerebellar

CV -
Syncope
post hypo

Question 2

What is assessed in a patient who has fallen?

Answer 2

Circumstances (before/during/after)
ADL
Frailty
Fall risk

Question 3

what are ADLs?
examples?

Answer 3

Activities of Daily Living
self care - Barthel index
-dressing
-bathing
-toilet
-grooming
-eating

Question 4

What is an IADL?
examples?

Answer 4

Instrumental activities of daily living
Household maintenance - Lawton + Brody scale
-grocery shop
-driving
-housework
-using telephone
-handling finances

Question 5

How is ADL assessed?
what are the scores out of and what do they mean?

Answer 5

Barthel Index /100
eg. feeding, bathing, toilet, dressing
<90 mild, <60 severe dependency, <20 = total dependency

Question 6

How is frailty assessed?
what are the scores out of and what do they mean?

Answer 6

Rockwood frailty score 0-9
1-4 = mild
5-6 = moderate
7-9 = severe frailty, dependent

Question 7

What is used to assess falls risk?

Answer 7

FRAT tool
(falls risk assessment tool)

Question 8

Dx for falls?

Answer 8

Bloods (FBC, U+E, eGFR, CK, Bone profile, B12+folate, Vit D)
Lying/standing BP + ECG
Chest xray + CT head (rule out pneumothorax + head injury)
+ urine dip, MMSE, DEXA

Question 9

Tx for falls?

Answer 9

Exercises (PT)
House assess - hazards = PT/OT
Medication review
Eye check

Question 10

Complications of falls?

Answer 10

SDH
Haematoma
Pneumothorax
Fractures
Rhabdomyolysis

Question 11

What is rhabdomyolysis?
RF?

Answer 11

HIGH muscle breakdown after trauma

RF: Long lie (>1hr), NMS, Anabolic steroids, hyperthermia

Question 12

Rhabdomyolysis
Sx?
Dx?
Tx?

Answer 12

Coca Cola urine + muscle pain

High CK in blood, high myoglobin (causes Coca Cola urine)

IV fluids, IV Na2CO3 (prevent AKI)

Question 13

What is the definition of postural hypotension?

Answer 13

20+ mmHg SYSTOLIC or 10+ mmHg DIASTOLIC drop in BP after standing from sitting

Not resolved in less than 3 mins

Question 14

RF for postural hypotension?

Answer 14

Increased age
CVD

Question 15

Pathology of postural hypotension?

Answer 15

Impaired neuro-cardiac baroreceptor reflex - blood pooling in legs should increase CV BP but in increased age = Low BV plasticity

Question 16

Sx of postural hypotension?

Answer 16

Lightheadedness (+ syncope) after standing from sitting +/- dizzy, palpitation

Question 17

Causes of postural hypotension?

Answer 17

CV = HF, MI, AF
Neuro = parkinsons
Iatrogenic = Low BP meds
Other = Addisons

Question 18

Dx of postural hypotension?

Answer 18

Lying/standing BP
ECG
R/O other causes (eg. bloods)

Question 19

% of 70y/o affected by postural hypotension?

Answer 19

30%

Question 20

Tx of postural hypotension?
Conservative

Answer 20

Drink more water
stand slowly
review meds

Question 21

Tx of postural hypotension?
Medical

Answer 21

off licence use:

Midodrine (NAd replacement)

Fludrocortisone (mineral corticoid)

Question 22

SE for midodrine and fludrocortisone?

Answer 22

Midodrine - retention

Fludro - oedema