immobility and falls Flashcards
what are the causes of falls
MSK drugs neurological sensory CVS being generally unwell incontinence
MSK causes of falls
arthritis of weight bearing joints
sarcopaenia
deformities of feet
drugs that can cause falls
anti-HT - not needed with increasing age due to weight loss beta blockers - reduced BP and HR sedatives anticholinergics alcohol opioids
lots more
neurological causes of falls
stroke - old or new parkinsonism dementia delirium, ataxia - seizure, TIA other neurological conditions
sensory causes of falls
visual impairment
inattention
hearing
CVS causes of falls
postural hypotension
arrhythmia
heart failure
aortic stenosis
how do drugs cause falls
decrease:
BP
HR
awareness
increase: UO sedation hallucinations prolonged qTC dizziness
MDT and falls clinic
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
hx in falls
PC/HPC - detail of the fall
- what were you doing
- who with
- what happened before, during, after
- how did you get back up
when to consider different causes of falls
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
systematic enquiry for falls
very important
- memory, ideally ask relative also
- urinary sx
- has walking changed recently
drugs
- everything incl OTC
- alcohol
examination following a fall
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)
examination of legs following a fall
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
different gaits and associated pathology
ataxic - cerebellar damage arthralgia - arthritis hemiplegic - stroke small steps, shuffling - vascular, parkinsonism high stepping - peripheral neuropathy
falls assessment in A and E - hx
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
falls assessment in A and E - examination and investigations
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
questions to consider when assessing a falls patient
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
immediate assessment for serious injuries following an inpatient fall
head injury, EDH seizure C spine injury flail chest abdo injury pelvic injury limb fracture
when to consider CT for a head injury
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
when to consider x-ray following inpatient fall
if pain on moving joint have a low threshold of x-ray
no deformity but pain on weight bearing - low threshold to x-ray
what can cause inpatient falls
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
what to do following a fall in hospital
repeat fall risk assessment
datix
call family
prevent further fall
fall prevention care plan
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
