Managing falls Flashcards
Give some differentials for falls
- Stroke
- Syncope
- Infection e.g. UTI, sepsis, cellulitis
- Ion imbalance
- Loads of possible causes
What are the intrinsic risk factors for falls?
- Demographic
- General health and functioning
- Medical conditions
- MSK and neuro
- Sensory
- Gait and balance
- Cognitive
- Psychological
What are the extrinsic risk factors for falls?
- Environmental hazards
- Risk-taking
- Transfer manoeuvres
What are the environmental risk factor for falls?
- Poor stairway design
- Inadequate lighting
- Clutter
- Slippery surfaces
- Unsecure mats/rugs
- Non-skid surfaces in bathrooms
What needs to be done in a falls assessment?
- History: presenting complaint, system review, PMH, medication, social
- Examination
- Investigations
What questions do we need to ask when finding out the ‘who’ part of history taking?
- Did anyone witness the fall?
- If yes - take collateral history
What questions do we need to ask when finding out the ‘when’ part of history taking?
- When did the fall occur?
- If at night, is vision an issue?
- What were they doing at the time?
- Looking up? Just got up from a chair/bed? Just been to the toilet?
What questions do we need to ask when finding out the ‘where’ part of history taking?
- In the house?
- At the shops?
- If at home, which room? Any trip hazards? Flashing lights?
What questions should we ask to find out what happened before the fall?
- Any symptoms prior to the fall (light headedness/dizziness)
- Chest pain
- Did they trip or fall?
What questions should we ask to find out what happened during the fall?
- Loss of consciousness (especially in unwitnessed falls)
- Incontinence, tongue biting, shaking
- Any injuries?
What questions should we ask to find out what happened after the fall?
- Did they regain consciousness quickly?
- Were they able to get up without help?
- Any confusion or neurological conditions?
What questions should we ask to find out the how part of a fall?
- How many times has the patient fallen over in the last 6 months
Which systems need to be reviewed following a fall?
- Cardiovascular
- Respiratory
- Neurological
- Genitourinary
- Gastrointestinal
- Musculoskeletal
What questions do we need to ask to investigate cardiovascular causes of a fall?
- Chest pain
- Palpitations
- Light-headedness, dizziness, clammy
What questions do we need to ask to investigate respiratory causes of a fall?
- Shortness of breath
- Cough - is it dry or wet? (if wet, what colour)
- Haemoptysis
- Wheezing
- Background of COPD/Asthma
What questions do we need to ask to investigate the neurological causes of a fall?
- Dementia
- Photophobia
- Neck pain
- Pins and needles/changes in sensation
What questions do we need to ask to investigate genitourinary causes of a fall?
- Dysuria
- Frequency of urination
- Colour
- Frothy/bloody urine
- Dehydrated
What questions do we need to ask to investigate gastrointestinal causes of a fall?
- Vomiting/diarrhoea
- Pain
- Constipation
What questions do we need to ask to investigate musculoskeletal causes of a fall?
- Normally steady on feet
- MSK pain
- Feeling any cracks or popping
- Full range of motion
- Recent joint swelling/erythema
What is a syncopal fall?
- Transient loss of consciousness due to reduced cerebral blood flow
What is a non-syncopal fall?
- Fall with or without loss of consciousness, not due to cerebral hypoperfusion
What are the four categories of syncope?
- Neurocardiogenic
- Orthostatic hypotension
- Cardiac arrhythmia
- Structural cardio-pulmonary
What are some causes of neurocardiogenic syncope?
- Vasovagal
- Carotid sinus
- Situational e.g. cough, micturition, defaecation, swallow
What are some causes of orthostatic hypotension syncope?
- Drug induced
- ANS failure
- Volume depletion
What are some causes of cardiac arrhythmia syncope?
- Bradycardia due to sick sinus or AV block
- Tachycardia due to ventricular tachycardia, supraventricular tachycardia
- Inherited
What are some causes of structural cardio-pulmonary syncope?
- Acute myocardial infarction
- Aortic stenosis
- Hypertrophic Obstructive Cardiomyopathy
- Pulmonary hypertension
What are some causes of non-syncopal falls without impairment of consciousness?
- Fall
- Psychogenic
- TIA/stroke
What are some causes of non-syncopal falls with partial or complete loss of consciousness?
- Epilepsy
- Metabolic (hypoglycaemia, hypoxia, hypercapnia)
- Intoxications
Outline the baroreceptor reflex?
- Decrease in arterial pressure
- Leads to decreased baroreceptor firing
- Leads to increased sympathetic activity and decreased vagal activity
- Increased cardiac output and increased systemic vascular resistance
- Negative feedback
Which systems should be examined following a fall?
- CVS
- Respiratory
- GI
- MSK
- Neurological
Which bedside investigations should be done following a fall?
- Bladder scan
- Urine dip
- Culture and sensitivity test
- Lying and standing BP
- ECG
Which bloods should be done following a fall?
- CRP
- FBC
- U&Es
- VBG/ABG
- LFT
- Bone
- Creatine kinase
What imaging should be done following a fall?
- Echo
- CT
- X-ray
Which procedures should be done following a fall?
Tilt table
What in a patient’s history suggests rhabdomyolysis?
- Dark urine
- If they’ve been on the floor for a while
What is released into the bloodstream due to rhabdomyolysis?
- Myoglobin
- This is toxic to the kidneys and can cause AKI
- Pre-renal cause
Which different healthcare workers make up the MDT for fall patients?
- Discharge team
- Senses
- Occupational therapists
- Nursing staff
- Tertiary care
- Physiotherapists
- Falls clinic
