LO3- Falls Flashcards
How should you structure a falls history?
Before
During
After
What should you ask about before the fall?
Did you feel any lightheadedness or dizziness
Did you feel like you were going to fall
Any chest pain or palpitations
What were you doing at the time
What should you ask about during the fall?
Conscious or LOC Tongue biting Incontinence Bleeding Which part of you made contact with the ground first Did you hit your head Any injuries
It’s very helpful to get a collateral history from someone who say the patient fall
What should you ask about after a fall?
How long were you on the ground for? Who found you? Did you have any pain or bleeding? Were you able to get yourself up again? Symptoms since
What are some causes of falls?
Mechanical- tripping, osteoarthritis, instability, loose clothing, poorly fitting shoes
Neurological- seizure (associated tongue biting and incontinence), bleeding, B12 and folate deficiency, stroke
Cardiac- Syncope (AS, Arrhythmia, Palpitations), Hypotension, Bleeding, Postural drop
Frailty and sarcopenia
Infection causing lightheadedness
Medications- beta blockers, anti-hypertensives, sedatives
ENT- BPPV, Meniere’s disease
Visual impairment
List in enormous
What is helpful to ask patients after a fall?
Why do you think you fell?
What is important to assess the prognosis and risk of further falls?
How many times have you fallen in the last 12 months.
What medications might cause falls?
Beta blockers Antihypertensives Sedatives Diuretics Hypoglycaemia is a cause so it may be worth checking glycaemic control
Polypharmacy itself is a risk factor for falls
What simple test could be done to assess falls risk? Describe how it is done?
Timed get up and go test
Patient gets up from the chair and walks to a point three metres away. They are allowed a practice run. Turn and walk back to the chair and sit down
It it takes for than 14 seconds it indicates a greater risk of fall. Stay close to the patient and offer support if they need it.
Where is the best place to refer at risk patients following a fall?
Falls clinic
What features would indicate that seizure is more likely?
Tongue biting Urinary incontinence Jerking of the limbs Post-ictal confusion Preceding aura Sensory abnormalities
What features would indicate that syncope is more likely?
Happened during exertion Palpitations Chest pain Dizziness/lightheadedness Lack of dread of knowing they were going to fall Not remembering falling itself
