Immobility and falls Flashcards
how do drugs cause falls
decrease: blood pressure, heart rate, awareness
increase: urine output, sedation, hallucinations, dizziness, QT interval
Culprit drugs
antihypertensive beta blocker sedative anticholinegerics opiods alcohol
falls clinic is a full multi DT
Nurse, physiotherapist, doctor
history
collapse no memory: syncope or cognition
clear history of trip:: think sensory (eyes, nerves)
Palpitations preceding fall: think cardiac
on turning: think postural instability
near misses: unsteady on standing
syncope on exertion: think aortic stenosis
Very important
memory
urinary symptoms
has walking changed recently
Drugs
everything especially over the counter antihistamines
alcohol
examination
check neglect cerebellar signs 'bradykinesia, rigidity-PD kyphosis sensation, vibration, proprioception coordination romberg's gait
Gait
Ataxic-cerebellar damage arthralgia- arthritis hemiplegic- stroke small steps, shuffling- parkinsonism high stepping- peripheral neuropathy
check long lie
CK levels for rhabdomyolysis,
pneumonia and skin injury common
Bloods
all, check B12, folate, CK, TFTs
Hospital falls immediate assessment for serious injuries
Head injury seizure c spine injury flail chest abdominal injury pelvic injury limb fracture
CT for head injury
Low GCS <13 still confused after 2 hrs focal neurology signs of skull fracture basal skull fractures seizure vomiting anti coagulations
caused of falls in patients
DELIRIUM
call bell out of reach
low blood glucose
post fall
repeat risk assessment
