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Geriatrics > Falls + Syncope > Flashcards

Falls + Syncope Flashcards

1
Q

what drugs produce most ADRs

A

anticholinergics and sedatives

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2
Q

aetiology of falls?

A
  • intrinsic factors
    • gait & balance problems - vertigo/ postural instability
    • visual problems
    • syncope
    • acute illness
    • chronic disease
    • cognitive disorder
    • vit D deficiency
  • situational
    • medications
      • antidepressants
      • anticholinergics
      • antipsychotics
      • benzodiazapenes
      • diuretics
      • anti-hypertensives
    • alcohol
  • extrinsic
    • inappropriate footwear
    • enviornmental factors ie uneven paving
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3
Q

most common causes of falls + confusion?

A
  • Anaemia
  • UTI
  • Hyponatraemia
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4
Q

causes of syncope?

A
  • Neurally-mediated
    • vasovagal syncope
    • situational syncope
    • carotid sinus hypersensitivity
  • Orthostatic (postural) hypotension
    • autonomic failure
    • volume depletion
    • drugs
    • hormonal
  • Cardiac arrhythmias
  • Structural cardiac or cardiopulmonary disease
    • valvular disease
    • HOCM
    • MI
  • CVA
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5
Q

define orthostatic (postural) hypotension

A

a drop in

  • systolic BP of at least 20mmHg and /or
  • diastolic BP of at least 10mmHg

within 3 mins of standing from lying

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6
Q

causes of postural hypotension?

A
  • autonomic failure
    • DM
    • Systemic amyloidosis
    • Parkinson’s
    • certain drugs ie tricyclic antidepressants
    • shy-drager syndrome
  • drugs
    • myocardial contractility /vascular responsiveness impaired
      • nitrates, ca channel blockers, alpha blockers
  • hypovolaemia
  • hormonal responsiveness faulty
    • addison’s
    • hypopituitarism
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7
Q

Ix for postural hypotension

A
  1. posture test

attach cuff & measure BP when supine and again once pt has stood up, at 1 min and 3 mins

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8
Q

Mx of postural hypotension

A
  • conservative
    • squatting
    • elastic compression stockings
    • head-up tilt of the bed at night (increases renin release)
  • medical
    • 1st line –> fludrocortisone
    • 2nd line–> sympathomimetic
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9
Q

complications of postural hypotension

A
  • falls
  • syncope
  • generalised seizures
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10
Q

what is delirium?

A

rapid onset of fluctuating confusion, disturbed awareness and inattention

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11
Q

features of delirium

A
  • disturbed consciousness
    • hypoactive/hyperactive/mixed
  • change in cognition
    • memory/perceptual/language/illusions/hallucinations
  • disturbance of sleep wake cycle
  • altered mobility
  • emotional disturbance
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12
Q

causes of delirium

A

Pain

Infection

Nutrition

Constipation

Hydration /hypoxia

Sleep

Medication- withdrawal as well as toxin buildup

Environment / electrolyte imbalance

… often a combination of all these things

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13
Q

Ix of delirium

A
  • 4AT- delirium screening
  • SQUID
    • single question in delirium - “do you think pt has been more confused in last 3 days’
  • Bloods
  • ECG
  • Urine sample & culture if +ve
  • CXR
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14
Q

some drugs that cause low Na?

A
  • thiazide diuretics
  • fluoxetine
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15
Q

Mx of delirium

A
  • Time bundle
  • Treat cause
  • Explain diagnosis
  • Re-orinetate and reassure
  • encourage early mobility & self-care
  • ensure continuity of care
  • avoid catheterisation/venflons
  • stop bad drugs
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16
Q

what are pressure sores?

A

aka pressure ulcers

  • localised injury to skin and/or underlying tissue from pressure
  • most commonly over bony eminences
17
Q

risk factors for pressure sores

A
  • elderly
  • immobility
  • sensory impairment ie DM
  • past hx of ulcers
18
Q

features of pressure sores

A
  • non-blanchable erythema
  • localised skin changes
  • wound of varying severity on anatomical site
  • localised tenderness & warmth around wound areas
19
Q

stages of pressure sores

A
20
Q

common sites of pressure sores?

A
  • back of head /ears
  • shoulder
  • elbow
  • lower back and buttocks
  • inner knees
  • heel
21
Q

Mx of pressure sores

A
  • stage 1
    • pressure relief ie repositioning
    • skin care
    • good hygiene
  • stage 2
    • pressure relief
    • skincare
    • application of appropriate dressing
    • analgesia
  • for deep ulcers- stage 3 or 4:
    • debridement to remove necrotic tissue
    • dressing
    • analgesia

if signs of local infection–> topical Abx

wound culture to identify causative organisms

22
Q

complications of pressure sores?

A
  • sepsis
  • cellulitis
  • osteomyelitis

Geriatrics (1 decks)

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