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ICA > Managing falls > Flashcards

Managing falls Flashcards

1
Q

Give some differentials for falls

A
  • Stroke
  • Syncope
  • Infection e.g. UTI, sepsis, cellulitis
  • Ion imbalance
  • Loads of possible causes
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2
Q

What are the intrinsic risk factors for falls?

A
  • Demographic
  • General health and functioning
  • Medical conditions
  • MSK and neuro
  • Sensory
  • Gait and balance
  • Cognitive
  • Psychological
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3
Q

What are the extrinsic risk factors for falls?

A
  • Environmental hazards
  • Risk-taking
  • Transfer manoeuvres
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4
Q

What are the environmental risk factor for falls?

A
  • Poor stairway design
  • Inadequate lighting
  • Clutter
  • Slippery surfaces
  • Unsecure mats/rugs
  • Non-skid surfaces in bathrooms
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5
Q

What needs to be done in a falls assessment?

A
  • History: presenting complaint, system review, PMH, medication, social
  • Examination
  • Investigations
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6
Q

What questions do we need to ask when finding out the ‘who’ part of history taking?

A
  • Did anyone witness the fall?
  • If yes - take collateral history
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7
Q

What questions do we need to ask when finding out the ‘when’ part of history taking?

A
  • 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?
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8
Q

What questions do we need to ask when finding out the ‘where’ part of history taking?

A
  • In the house?
  • At the shops?
  • If at home, which room? Any trip hazards? Flashing lights?
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9
Q

What questions should we ask to find out what happened before the fall?

A
  • Any symptoms prior to the fall (light headedness/dizziness)
  • Chest pain
  • Did they trip or fall?
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10
Q

What questions should we ask to find out what happened during the fall?

A
  • Loss of consciousness (especially in unwitnessed falls)
  • Incontinence, tongue biting, shaking
  • Any injuries?
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11
Q

What questions should we ask to find out what happened after the fall?

A
  • Did they regain consciousness quickly?
  • Were they able to get up without help?
  • Any confusion or neurological conditions?
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12
Q

What questions should we ask to find out the how part of a fall?

A
  • How many times has the patient fallen over in the last 6 months
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13
Q

Which systems need to be reviewed following a fall?

A
  • Cardiovascular
  • Respiratory
  • Neurological
  • Genitourinary
  • Gastrointestinal
  • Musculoskeletal
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14
Q

What questions do we need to ask to investigate cardiovascular causes of a fall?

A
  • Chest pain
  • Palpitations
  • Light-headedness, dizziness, clammy
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15
Q

What questions do we need to ask to investigate respiratory causes of a fall?

A
  • Shortness of breath
  • Cough - is it dry or wet? (if wet, what colour)
  • Haemoptysis
  • Wheezing
  • Background of COPD/Asthma
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16
Q

What questions do we need to ask to investigate the neurological causes of a fall?

A
  • Dementia
  • Photophobia
  • Neck pain
  • Pins and needles/changes in sensation
17
Q

What questions do we need to ask to investigate genitourinary causes of a fall?

A
  • Dysuria
  • Frequency of urination
  • Colour
  • Frothy/bloody urine
  • Dehydrated
18
Q

What questions do we need to ask to investigate gastrointestinal causes of a fall?

A
  • Vomiting/diarrhoea
  • Pain
  • Constipation
19
Q

What questions do we need to ask to investigate musculoskeletal causes of a fall?

A
  • Normally steady on feet
  • MSK pain
  • Feeling any cracks or popping
  • Full range of motion
  • Recent joint swelling/erythema
20
Q

What is a syncopal fall?

A
  • Transient loss of consciousness due to reduced cerebral blood flow
21
Q

What is a non-syncopal fall?

A
  • Fall with or without loss of consciousness, not due to cerebral hypoperfusion
22
Q

What are the four categories of syncope?

A
  • Neurocardiogenic
  • Orthostatic hypotension
  • Cardiac arrhythmia
  • Structural cardio-pulmonary
23
Q

What are some causes of neurocardiogenic syncope?

A
  • Vasovagal
  • Carotid sinus
  • Situational e.g. cough, micturition, defaecation, swallow
24
Q

What are some causes of orthostatic hypotension syncope?

A
  • Drug induced
  • ANS failure
  • Volume depletion
25
Q

What are some causes of cardiac arrhythmia syncope?

A
  • Bradycardia due to sick sinus or AV block
  • Tachycardia due to ventricular tachycardia, supraventricular tachycardia
  • Inherited
26
Q

What are some causes of structural cardio-pulmonary syncope?

A
  • Acute myocardial infarction
  • Aortic stenosis
  • Hypertrophic Obstructive Cardiomyopathy
  • Pulmonary hypertension
27
Q

What are some causes of non-syncopal falls without impairment of consciousness?

A
  • Fall
  • Psychogenic
  • TIA/stroke
28
Q

What are some causes of non-syncopal falls with partial or complete loss of consciousness?

A
  • Epilepsy
  • Metabolic (hypoglycaemia, hypoxia, hypercapnia)
  • Intoxications
29
Q

Outline the baroreceptor reflex?

A
  • 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
30
Q

Which systems should be examined following a fall?

A
  • CVS
  • Respiratory
  • GI
  • MSK
  • Neurological
31
Q

Which bedside investigations should be done following a fall?

A
  • Bladder scan
  • Urine dip
  • Culture and sensitivity test
  • Lying and standing BP
  • ECG
32
Q

Which bloods should be done following a fall?

A
  • CRP
  • FBC
  • U&Es
  • VBG/ABG
  • LFT
  • Bone
  • Creatine kinase
33
Q

What imaging should be done following a fall?

A
  • Echo
  • CT
  • X-ray
34
Q

Which procedures should be done following a fall?

A

Tilt table

35
Q

What in a patient’s history suggests rhabdomyolysis?

A
  • Dark urine
  • If they’ve been on the floor for a while
36
Q

What is released into the bloodstream due to rhabdomyolysis?

A
  • Myoglobin
  • This is toxic to the kidneys and can cause AKI
  • Pre-renal cause
37
Q

Which different healthcare workers make up the MDT for fall patients?

A
  • Discharge team
  • Senses
  • Occupational therapists
  • Nursing staff
  • Tertiary care
  • Physiotherapists
  • Falls clinic

ICA (5 decks)

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