Immobility and Falls Flashcards
What are the potential outcomes after a fall?
Injury (soft tissue, fracture, SAH) Rhabdomyolysis (increased CK) Loss of confidence/ fear of falling Dependency/ QOL decreased Carer stress Institutionalisation Terminal decline
What are the risks factors for falls?
Muscle weakness History of falls Gait deficit Balance deficit Use of assistive device Visual deficit Arthritis Impaired ADL Depression Cognitive impairment >80yrs
What are the intrinsic factors that cause patients to fall?
Gait and balance problems (postural instability, vertigo) Syncope (cardiac, vagal) Chronic disease (Neurological, MSK) Visual problems Acute illness Cognitive disorder Vitamin D deficiency
What are the situational factors that cause patients to fall?
Medications
Alcohol
Urgency of micturition
What are some examples of drugs that cause patients to fall?
Antidepressants Antipsychotics Anticholinergics/antimuscarinics Benzodiazepines Anti-hypertensives Diuretics
What are the extrinsic factors that cause patients to fall?
Inappropriate footwear
Environmental hazards (uneven paving, carpets,walking aids, stairs)
Poor lighting
What investigations can be used to assess gait and balance?
Sitting to standing ability Transfers Static standing balance Romberg test Dynamic standing balance Gait Tinetti gait and balance scale Berg balance scale
What can cause vertigo?
Labrynthitis Acute ear infection Benign paroxsymal positional vertigo Meniere's Cerebellar/brainstem pathology
What are the main causes of syncope?
Neurally-mediated (reflex) Orthostatic hypotension Cardiac arrhythmias Structural cardiac or cardiopulmonary disease Cerebrovascular
What can cause a neurally-mediated syncope?
Vasovagal syncope (common faint) Carotid sinus hypersensitivity Acute haemorrhage Post-exercise Cough, sneeze Micturition/post micturition Gastrointestinal stimulation
What can cause an orthostatic hypotension syncope?
Primary autonomic failure syndromes (multiple system atrophy, Parkinson’s)
Secondary autonomic failure syndromes (Diabetic neuropathy, Amyloid neuropathy)
Drug and alcohol induced orthostatic syncope
Haemorrhage
Diarrhoea
Addison’s disease
What can cause a cardiac arrhythmia syncope?
Sinus node dysfunction
Atrioventricular conduction system disease
Paroxsymal supraventricular and ventricular tachycardias
Inherited syndromes (long QT, Brugada syndrome)
Implanted device (pacemaker, ICD)
Drug-induced proarrhythmias
What can cause a structural cardiac or cardiopulmonary disease syncope?
Cardiac valvular disease (aortic stenosis)
Acute MI/ ischaemia
Obstructive cardiomyopathy
Atrial myxoma
Acute aortic dissection
Pericardial disease/tamponade
Pulmonary embolus/ pulmonary hypertension
What questions should be asked in a collateral history for syncope?
Event circumstances
Posture immediately before syncope
Appearance
Presence/absence of movement during event
Tongue-biting
Duration of event
Presence/absence of confusion in recovery period
Unilateral weakness during recovery period
When investigating syncope, what should be looked for on a 12 lead ECG?
Inappropriate persistent bradycardia
Long (>450ms) or short (<350ms) QT intervals
Abnormal T wave inversion
