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Y3 geriatrics > immobility and falls > Flashcards

immobility and falls Flashcards

1
Q

what are the causes of falls

A 
MSK 
drugs 
neurological 
sensory 
CVS
being generally unwell 
incontinence
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2
Q

MSK causes of falls

A

arthritis of weight bearing joints

sarcopaenia

deformities of feet

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3
Q

drugs that can cause falls

A 
anti-HT - not needed with increasing age due to weight loss
beta blockers - reduced BP and HR
sedatives
anticholinergics
alcohol 
opioids

lots more

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4
Q

neurological causes of falls

A 
stroke - old or new
parkinsonism 
dementia 
delirium, ataxia - seizure, TIA
other neurological conditions
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5
Q

sensory causes of falls

A

visual impairment
inattention
hearing

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6
Q

CVS causes of falls

A

postural hypotension

arrhythmia

heart failure

aortic stenosis

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7
Q

how do drugs cause falls

A

decrease:
BP
HR
awareness

increase: 
UO
sedation
hallucinations 
prolonged qTC
dizziness
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8
Q

MDT and falls clinic

A

nurse - eye test, ECG, lying and standing BP, incontinence, MMSE

physio - full assessment of gait and balance

doctor - hx and examination, bone health and osteoporosis screening

MDT treatment plan made

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9
Q

hx in falls

A

PC/HPC - detail of the fall

  • what were you doing
  • who with
  • what happened before, during, after
  • how did you get back up
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10
Q

when to consider different causes of falls

A

collapse w/ no memory - syncope or cognition

clear hx of trip - sensory (eyes, nerves)

palpitations preceding fall and no trip - cardiac

on turning - postural instability

near misses - unsteady on standing

syncope on exertion - aortic stenosis

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11
Q

systematic enquiry for falls

A

very important

  • memory, ideally ask relative also
  • urinary sx
  • has walking changed recently

drugs

  • everything incl OTC
  • alcohol
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12
Q

examination following a fall

A

head and arms

  • CNs (except smell), check glasses
  • check neglect
  • cerebellar signs
  • bradykinesia, rigidity - signs of PD

HR, BP, heart sounds - signs of heart failure and resp disease

kyphosis

abdo exam (+ PR is prostate)

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13
Q

examination of legs following a fall

A

feet - footwear, toenails

  • check sensation, vibration sense and proprioception - usually glove and stocking not dermatomal
  • co-ordination

put shoes and socks back on and stand patient up

  • romberg’s
  • assess gait
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14
Q

different gaits and associated pathology

A 
ataxic - cerebellar damage 
arthralgia - arthritis
hemiplegic - stroke
small steps, shuffling - vascular, parkinsonism 
high stepping - peripheral neuropathy
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15
Q

falls assessment in A and E - hx

A

ABCDE assessment, assess and treat any injury

how did they fall, did they trip over and what did they trip over

long lie - check CK for rhabdomyolysis, consider pneumonia and skin injury

any other falls

any cognitive impairment

any syncope

any features of seizure

are they drunk

talk to relative and paramedics

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16
Q

falls assessment in A and E - examination and investigations

A

acutely unwell - bloods

examination:
- neurological, chest, CVS, abdo
- legs, gait
- hx
- full set of obs, L+S BP

investigations:
- ECG for all
- bloods for all (except RGHs) - B12, folate, CK, TFT
- BG
- delirium using 4AT
- consider CT head if fall w/ head injury/neuro signs/anti-coagulated

17
Q

questions to consider when assessing a falls patient

A

are they injured

are they unwell

are there any reversible causes you can immediately correct - DRUGS!

are they safe to go home

  • can they get to the toilet alone
  • can they get drinks/food alone (between carer visits)
  • can they walk now
  • can they summon help if needed
18
Q

immediate assessment for serious injuries following an inpatient fall

A 
head injury, EDH
seizure
C spine injury 
flail chest 
abdo injury 
pelvic injury 
limb fracture
19
Q

when to consider CT for a head injury

A

yes immediately if:

  • GCS <13
  • still confused after 2hrs (or not back to baseline)
  • focal neurology
  • signs of skull fracture
  • basal skull fracture - CSF leak, eye bruising
  • seizure
  • vomiting
  • anti-coagulation
20
Q

when to consider x-ray following inpatient fall

A

if pain on moving joint have a low threshold of x-ray

no deformity but pain on weight bearing - low threshold to x-ray

21
Q

what can cause inpatient falls

A 
all the same as outpatients and 
- postural hypotention due to illness or hypotension
- new medication
low BG
- getting more ill
- DELIRIUM
- de-conditioning 
- call bell out of reach 
- inappropriate footwear
22
Q

what to do following a fall in hospital

A

repeat fall risk assessment
datix
call family
prevent further fall

23
Q

fall prevention care plan

A

ensure vision, mobility aids and call bell are in reach

consider bed rails

regular obs

tell people

  • if you move things, put them back - don’t leave the patient at risk of falls

Y3 geriatrics (7 decks)

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