Managing Falls Flashcards
Identify a few differential diagnosis for a fall.
- Trip.
- UTI.
- Oedema.
- Osteoarthritis.
- Aortic Stenosis.
- Cellulitis.
- MI.
- Glaucoma.
- Diabetes Mellitus.
- Stroke.
What factors help determine the diagnosis of a cause of a fall?
- Who: was there a witness, if yes get a collateral history.
- When: night/day.
- Where: outside/inside/ occur through lights.
- What: before: symptoms, chest pain, slip, during: X consciousness, incontiencne, shock, after: quick regain/confusion.
What is syncope?
Transient loss of consciousness characterised by fast onset and spontaneous recovery.
Result of decrease perfusion pressure of the brain.
Self limiting.
What are the symptoms of pre-syncope?
- Light headless,
- Sweating,
- Pallor,
- Blurred vision.
What are the 3 categories of syncope?
- Reflex Syncope.
- Orthostatic Hypotension.
- Cardiac/Cardiopulmonary Disease.
What are seizures?
Generalised tonic-clinic seizures, a cause of loss of consciousness. Not syncope and can be subtle.
What is Reflex Syncope?
Disorder of the autonomic regulation of postural tone. The medulla is activated leading to decreased sympathetic output and stimulation of the parasympathetic nervous system. Decreased CO (HR) and BP, decreased cerebral perfusion.
When can come someone get reflex syncope?
- Vasovagal prolonged standing, stress.
- Situational syncope: coughing.
- Carotid sinus massage.
What is Orthostatic Hypotension?
Symptoms arise after standing from a sitting/lying position.
BP drop severe enough syncope (drop of 20mmHg).
What is the pathophysiology of Orthostatic Hypotension?
Standing up causes 500-800ml blood to pool in legs, EDV decreases, reduction in cardiac stretch, reduced SV and thus CO. Managed by the baroreceptor reflex which if cannot compensate will lead to syncope.
What can cause the Baroreceptor Reflex to fail?
- Baroreceptors become less sensitive as we age, especially due to increased hypertension also.
- Medications such as anti-hypertensives can impair the response and venous return.
- Dehydration.
What is Cardiac Syncope?
Syncope caused by cardiac disease/abnormality.
What are the 3 causes of Cardiac Syncope?
- Electrical: Brady/tachycardia.
- Structural: Aortic Stenosis or Hypertrophic Obstructive Cardiomyopathy.
- Coronary: MI/HD.
Why can Aortic Stenosis cause Cardiac Syncope?
Narrowing of the AV means blood has to push harder, it can thus fail to adequately perfuse the brain e.g. in exercise and thus cause CS.
What are non-syncopal falls?
Falls not caused by syncope,e.g. a fall from head trauma.
It can be the end result of someone with an illness like an infection.
