HCoLL Flashcards
Taking a falls Hx
- Introduce, patient details, consent
- PC
- HPC
- What were you doing
- Symptoms before falls: dizziness, palpations, chest pains, nausea, SOB
- Syncope before during after
- Do you remember putting your arms out to stop yourself
- Amnesia
- Incontinence
- Witnesses - collateral history what do they say happened. Seizure?
- How long were you down for?
- Were you able to get yourself up?
- When did help come and what did they do?
- Did you sustain any injuries
- Why do you think you fell
- Coughs, colds precipitating illness?
- Falls Hx
- Previous falls?
- Causes?
- Consequences?
- PMHx
- Affectings balance
- Meniere’s disease
- Affecting gait/mobility
- Arthritis
- Affecting senses
- Deafness, blindness
- Affecting circulation
- Hypertension
- Affecting proprioception
- DM
- Affecting brains
- Dementia
- Continence/frequency/urgency
- Osteoporsis
- Affectings balance
- DHx
- Recent change in medication
- Polypharmacy
- Heart meds: antihypertensives, anti-platelet etc.
- Sedating meds (benzos)
- Allergies
- PSHx
- Affecting thing in PMHx
- FHx
- Falls, medical conditions mentioned in PMHx
- SHx
- Mobility aids (at home)
- Home set up bungalo etc.
- Ability to care for self
- Baseline mobility
- Carers/accessible help
- Smoking/drinking
- Lack of exercise
- ICE
Investigations to consider after a fall
- Obs: BP, HR, RR, SATS, Temp, BM
- Investigate any injuries e.g. CT head
- Heart
- ECG, resp and cardio exam, supine standing BP, FBC
- Infection
- Temp, blood cultures, urine dip, U&E
- Endocrine
- TFT, BM
- CNs
- CN, AMT/GCS, PNS, Capacity?
- Physio/OT assessment of mobility
Consequences of a long lie + investigations
- Hypothermia - temp
- Pressue ulcers - full body check
- Rhabdomyolysis - creatine kinase
- Hypostatic pneumonia - Resp exam, CXR, FBC
- Dehydration - U&Es
Management of fall
- Investigations
- Treat any acute injuries
- Identify risk factors and treat
- Medication review
- MDT esp OT/Physio
- Fill out falls proforma
AMT questions
- Age
- Time to nearest hour
- Give address and test
- Year
- Location
- Recognise 2 people (nurse and doctor)
- Date of birth
- When did WW1 begin
- Name of PM
- Count back 20-1
History in delirium
May be collateral
PC
HPC
- Classic sx: memory, awareness, attention, disordered thinking, hallucinations, altered sleep
- Should be acute
- Should be fluctuating
PMH
- Previous diagnosis of dementia
- Cardiac/resp issues (stroke, hypoxia)
- Infections
- Bowels - constipation
- DM
- Pain
- Previous delirium
PSHx
- Post - op
DH - VERY IMPORTANT
- Recent change
- Recreational
- OTC
- Other peoples
FHx
- Cognitive impairment e.g. dementia, delirium
SHx
- Change in environment
- Sleep
- Smoking and alcohol
- Nutrition - are they eating?
- Other SHx stuff: home set up, mobility, carers,
AMT (more than 8 unlikely delirium)
- Age
- Time to the nearest hour
- Location
- Remember address
- Date of birth
- Current PM
- Start of WW1
- Current year
- Ask previous address
- Identify two people e.g. nurse doctor
- Count 20-1
Risk
- To themselves
- From others
- To others
- To property
Delirium DDs
Lewy body dementia (as it also fluctuates)
Step down in vascular dementia
Decompensation of existing dementia
Disorder of alertness
Disorder of communication
Post ictal confusion
Primary psych disorder
Confusion bloods and reason for each
FBC - infection, anaemia
CRP
U&E - dehydration, hyper/po natraemia, kalaemia,
LFT - liver failure
INR - intracranial bleeding
TFT - hypo/er thyroid
Calcium - hypercalcaemia
B12 folate - anaemia + deficiency
Glucose - hyper/o glycaemia
Investigations in delirium
Obs
- HR, BP, SATS, Temp
Imaging
- CT head, CXR
Confusion bloods
Urine dip
Blood cultures if sepsis suspected
Management of delirium
Treat any causes found
Treat symptoms
Support
- Fluids +/- electrolytes
- Nutrition
- Calm environment with clock
- Avoid drugs if possible
Make a solid discharge plan as 1 episode means they are likely to happen again. Involve carers and family
