Managing Falls Flashcards
Why are falls important?
Falls make up a huge amount of A&E attendances
30% of one 65s and 50% of over 80s fall at least one a year, some several times a week.
Falls are a abuse of reduced quality of life, loss of confidence and independence and ultimately mortality.
What things are important to find out from a history taken regarding the fall?
Who? - anyone else there
When? - time of day, what doing
Where? - House (room)? Shops?
What? - before (symptoms before, chest pain, trip/slip), during (loss of consciousness, incontinence, younger biting, injuries), after (regain consciousness quickly, get up without help, confusion or neurological symptoms)
How? -long on the floor, fallen before, serious injuries
What is the most important thing to work out when taking a falls history?
Did they loose consciousness?
What is syncope?
A transient loss of consciousness characterised by fast onset and spontaneous recovery.
Caused by a reduced perfusion pressure to the brain
Syncope is usually self limiting being horizontal with dox low blood pressure
Beware of people who have been help in an upright position
What are pre-syncope symptoms?
Light headed ness
Sweating
Pallor
Blurred vision
What are seizures
Not a syncope
What are the three broad categories of syncope?
Reflex syncope
Orthostatic hypotension
Cardiac / cardiopulmonary disease
What is reflex syncope?
Disorders f autonomic regulation of postural tone.
Activation of part of medulla leads to decrease in sympathetic output and increase and parasympathetic.
Fall in CO (reduce HR) and BP leads to reduced cerebral perfusion
What are soem examples of reflex syncope?
Vasovagal
What is orhostatic hypotension?
Symptoms occur after standing from a. Sitting or lying position.
Can cause syncope if drop in BP is severe enough
Normally defined as a drop of 20mg or more with pre-syncopated symptoms on standing.
What is the problem with standing (why cause syncope)?
Standing up..
Why does the baroreceptor reflex sometimes fail?
Baroreceptors become less sensitive with age.
Also become less sensitive with hypertension.
Medications such as anti-hypertensives can impair this response or venous return
Dehydration -lower blood volume.
What is cardiac syncope?
Syncope caused by a cardiac disease or abnormality.
Can be electrical (rhythm), structural or coronary cause.
What are some causes of cardiac syncope?
Electrical:
Structural:
Coronary: MI, IHD
What is aortic stenosis?
Narrowing of the aortic valve
Harder to push blood through the aortic valve
If heart has to work harder, e.g. exercise can fail to adequately perfume brain.
If AS with syncope, then patient has a mean survival of 2-5 years.
What are the features of cardiac syncope?
Exertional syncope
Family history of cardiac disease or sudden cardiac death
Preceding chest pain or palpitations
Past medical history of heart disease
Abnormal ECG
What is a non-syncopal fall?
A fall in which the cause is not syncope
A fall with a loss of consciousness following a head trauma is still a non-syncopal fall.
Inc. trips and slips
Often the full can be the end result of inter current illness, such as an infection
How are falls multifactorial?
E.g. osteoarthritis and diabetic neuropathy and infection.
Why is a drug history important when talking to patients who have had a fall?
Polypharmacy
New meds?
Anti-hypertensives / anti-arrhythmias? -Long term?
Any drugs that induce drowsiness? -new analgesia, benzodiazepine, antidepressants, antipsychotics
Recent medication review?
Why is a social history important?
Who do they live with? Any help at home? Who pays? Family close by? Any stairs? Any walking aids? Drink alcohol? Smoke cigarettes?
What investigations do you do for falls?
LSBP (live standing BP_
ECG
FBC and U&E
CK if long lie.
Symptom guided: X-Ray Echo 24 hour tape CT
What is rhabdomyolysis?
Rhabdomyolysis May result from any traumatic or medical injury to the sarcolemma.
Release of intracellular ion, myoglobin, CK and rates into the circulation
Canlead to electrolyte disturbances, DIC, renal failure and multi-organ failure.
Serum CK 5 times upper limit of normal
Common complication of a fall with a “long lie”
What happens after having a fall?
Basic advice
OT assessment
Social work / PCC assessment
Opticians / audiologist
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