Functional decline and falls Flashcards
Pressure sores Reduced mobility Falls
Patient presents to A&E with a fall. Which bloods should you send for?
FBC, U+E, haematinics, bone, vit D
Patient presents to A&E with a fall. Which investigations/exams/reviews do you want to carry out?
ECG, L+S BP, AMT4, vision, med review, bone health
What are categories of causes of falls?
- mental health
- vision defects
- MSK
- Neuro
- CVS
- Environment
Which of the following is not typically a cause of a fall: incontinence, polypharmacy, or hyperglycaemia?
hyperglycaemia (hypo=risk for falls), incontinence-> rushing to bathroom
What are the autonomic symptoms of hypoglycaemia?
trembling, sweating, hunger, anxiety, palpitations, nausea, tingling
What are the neuroglycopaenia symptoms of hypoglycaemia?
confusion, weakness, drowsiness, headaches, dizziness, visual changes, speech changes
Which questions make up the AMT?
- what year is it
- How old are you
- what is your dob?
- where are you?
What are symptoms of mild hypoglycaemia?
non-specific symptoms, generally feeling unwell (nauseous)- check BM
What are symptoms of moderate hypoglycaemia?
confusion, disorientation, aggression
What are symptoms of severe hypoglycaemia?
seizure, unconscious, very aggressive
What is the treatment for mild hypo?
15-20g fast-acting CHO e.g. luocozade 170 ml, pure fruit juice 150-200 ml, glucotabs, followed by long-acting CHO e.g. two biscuits, slice of bread
What is the treatment for moderate hypo?
if cooperative, same treatment as mild, escalate to i mg IM of glucagon
What is the treatment for severe hypo?
IV glucose or IM glucagon
List examples of drugs that can cause falls
drugs that cause postural hypotension: nitrates, ACEi, diuretics, L-dopa, SSRIs
Benzos, opiates, oral hypoglycaemia agents
What is the definition of postural hypotension?
fall in systolic BP of at least 20mmHg (30 in HTN) and/or fall in diastolic BP at least 10mmHg within 3 min of standing.
What is the management of postural hypotension?
med r/v, slow from lying to standing, small frequent meals, raise head of bed, mineralcorticoid
Which blood test is important to do in patient who has been lying down for a long time?
creatinine! risk of rhabdo. Muscle can start to break down during this time frame, and this rhabdomyolysis leads to release of haem which is nephrotoxic and can cause an acute kidney injury. Rhabdomyolysis is assessed by measuring creatine kinase (CK) - a raised level suggests the patient requires IV fluids to increase urinary flow rates and reduce the risk that the kidneys become damaged by intratubular cast formation.
How are the descending motor tracts divided?
pyramidal and extrapyramidal http://freeosmosis.com/learn/Pyramidal_and_extrapyramidal_tracts?section=Physiology
What is the function of pyramidal tracts?
voluntary movement, carry motor fibres from the cerebral cortex to the spinal cord and brainstem. Pyramidal tract lesions can occur from any type of damage to the brain or spinal cord, for example a stroke.
What is the function of extrapyramidal tracts?
responsible for involuntary control of the muscles, including posture and balance adjustments. They descend from the brainstem to the spinal cord. Damage to the extrapyramidal tracts results in dyskinesias and disorders of involuntary movement. Parkinson’s disease is an example of this
What are four classical features of idiopathic parkinson’s disease?
TRAP Tremor (asymmetric and resting) Rigidity Akinesia Postural instability
Name examples of exclusion criteria for parkinsonian syndrome
MPTP exposure, fam hx, babinski sign, unilateral features, negative response to levodopa
What is the diagnostic criteria for parkinson’s?
bradykinesia + 1
- muscular rigidity
- 4-6 Hz rest tremor
- primary instability not caused by primary visual, vestibular, cerebellar, or proprioceptive dysfunction
Name four non-motor symptoms of parkinson’s?
constipation, sleep disorders, depression, anxiety, erectile dysfunction, urinary frequency/incotinence/nocturia, altered sense of smell
