ICA3 - Managing Falls

Question 1

5 factors around a fall

Who
What 
Where
When 
How

Answer 1

1. ) Who? - age, ethnicity etc.
   - if someone else witnessed the fall, then a collateral history must be taken
2. ) What? - before, during, after
   - before: prior symptoms, trip or slip?
   - during: loss of consciousness?
   - after: confusion or neurological symptoms, regain of consciousness
3. ) Where?
4. ) When? - what were they doing at the time?
5. ) How? - how long were they on the floor?
   - how many times have they fallen in the last 6 months?
   - any serious injuries?

Question 2

3 broad categories of syncope

Reflex Syncope
Orthostatic Hypotension
Cardiac Syncope

Answer 2

1. ) Reflex Syncope - disorder of autonomic regulation of postural tone
   - activation of medulla –> ↓sympa and ↑parasympa
   - ↓HR, ↓CO, ↓BP leads to reduced cerebral perfusion
   - examples: vasovagal (simple faint), situational (e.g. coughing or straining), carotid sinus massage
2. ) Orthostatic Hypotension - occurs after standing from a sitting or lying position
   - syncope occurs if ↓BP is severe enough (>20mmHg)
3. ) Cardiac Syncope - cardiac disease/abnormality
   - electrical: bradycardias or tachycardia
   - structural: aortic stenosis
   - coronary: MI/IHD

Question 3

Explanation of how orthostatic hypotension causes syncope

Blood Pooling
Baroreceptor Reflex
Reduced Baroreceptor Reflex Sensitivity

Answer 3

1. ) Blood Pooling - standing up causes 500-800ml of blood to pool in the legs causing a fall in EDV
   - this leads to a ↓SV, causing a ↓CO so ↓aBP
2. ) Baroreceptor Reflex - normally compensates for ↓CO
   - CNIX informs the medulla of the fall in BP
   - medulla ↓CNX and ↑sympathetic chain
   - this leads to ↑HR, ↑contractility to increase CO
3. ) Reduced Baroreceptor Reflex Sensitivity - leads to a fall in CO causing a decrease in cerebral perfusion
   - causes: age, hypertension, dehydration, medication (e.g. anti-hypertensives)

Question 4

Non-Syncopal Falls

Answer 4

A fall where the cause is not a syncope e.g. trips and slips

A fall with a loss of consciousness after a head trauma is still not a syncopal fall