Case 3 - Fall and acute confusion Flashcards
1
Q
Common causes of falls
A
- Slips/trips
- Cardiac - postural hypotension, arrhytmia, stroke, HF
- Abnormal electrolytes
- UTI
- Medications - sedatives, anti-hypertensives, opitaes
- Hypoglycaemia
2
Q
Investigations to assess cause for fall
A
- ECG
- Lying and standing BP (immediate, 3 and 5 minutes)
- CT head - stroke?
- Urine dip and MSU
- U&Es, LFTs, FBC, CRP
- Echo?
3
Q
Examination for falls
A
- Cardio exam - inc ECG and lying and standing BP
- Neurological exam - CN and PNS
- MSK exam
- Assessment of mobility - how mobilise and gait
4
Q
Multidisciplinary teams involved in discharge of someone at risk of falls
A
- Social worker
- Occupational theraptist
- Physiotherapist
- Dieticians
- Specialist discharge nurse
- Pharmacists
- GP
5
Q
Common consequences of falling
A
- Fractures/sprains
- Loss of confidence/independence
- Head trauma
- Long term pain
- Reduced QOL
6
Q
Common drugs increasing falls risk
A
- Antihypertensives
- Sedatives eg diazepam and Z drugs eg Zopiclone
- Thiazide diuretics
- Opiates
- Antidepressants
- Benzodiazepines
- Antiepileptics
- Antipsychotics eg haloperidol
7
Q
Common causes of acute confusion
A
- Infection
- Hypoxia
- Electrolyte imbalance
- Drugs eg opiates
- Urinary retention
- Constipation
- Uncontrolled pain
8
Q
Examinations for acutely confused pt
A
- Neurological exam
- Psychological tests inc screening for depression etc
- Abdo, Cardiac and Resp - exclude common causes
9
Q
Investigations for acute confusion
A
- Urine dip and MSU
- U&E, LFTs, FBC, CRP
- Bladder scan - retention
- ECG
- Abdo X-ray - constipated
- CXR - infection?
10
Q
Management of pt with acute confusion
A
- Supoortive care
- Orientate time and place
- Optimise other conditions
- Haloperidol if risk to themselves or others - not recommended in parkinsons and LBD
11
Q
A
12
Q
History for fall
A
- What were they doing?
- What did they look like on the floor?
- Collateral?
- How did it happen?
- Feeling before fall?
- Dizziness/light headed?
- Lose conc?
- Cardiac symptoms?
- Weak anywhere?
- Happened before?
- Near misses?
- Medications - sedatives? antiHTN? anticholinergics, hypoglycaemics, opiates
- Normal mobilisation techniques
13
Q
What disease is important to assess for in someone who has fallen?
A
- Osteoporosis risk
- If fracture large bones with minimal trauma, commence osteoporosis treatment if over age 75
14
Q
Osteoporosis investigations
A
Offer a dual-energy X-ray absorptiometry (DXA) scan, then bone-sparing drug treatment if the T-score is -2.5 or lower.
15
Q
Bone sparing drug treatment
A
- Bisphosphonate eg alendronate (alendronic acid)
- Vitamin D - even if calcium levels are adequate, just depends on dose
- Calcium if intake inadequate
