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Integration for Clinical Application > 2.2 Managing Falls > Flashcards

2.2 Managing Falls Flashcards

1
Q

What do falls cause in the elderly?

A

Reduced QoL
Loss of confidence and independence
Mortality

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2
Q

Give some differentials for causes of falls

A

Trip
UTI
Stroke
Osteoarthritis
MI
Medicine side effects
Polypharmacy

(Bascially anything just be able to name a few)

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3
Q

What are the 3 types of risk factors for falls?

A

Intrinsic- patient
Extrinsic
Environmental

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4
Q

What are some examples of intrinsic risk factors for falls?

A

Demographic
General health and functioning
Medical conditions
MSK + Neuro
Sensory
Gait and Balance
Cognitive, pyschological

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5
Q

What are some examples of extrinsic risk factors for falls?

A

Environmental hazards
Risk-raking
Transfer manoeuvres

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6
Q

What are some examples of environmental risk factors for falls?

A

Poor stairway design
Inadequate lighting
Clutter
Slippery falls
Unsecure mats/rugs
Non-skid surfaces in bathtubs

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7
Q

What is involved in a falls assessment?

A

History- presenting complaint, system review, pmh, medication, social
Examination
Investigations

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8
Q

What is involved in the history taking of a fall?

A

Who - did anyone see the fall? take collateral history if yes

When did the fall occur? Night? What were they doing at the time?

Where - Inside? outside? Trip hazards?

What - Before, during and after

How - how many falls have they had in the last 6 months?

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9
Q

What else needs to be considered in taking a fall history?

A

Before - Symptoms prior to fall? chest pain? did they trip or fall?

During - Loss of conciousness? incontinence, tongue biting, shaking? Any injuries?

After - Did they regain consciousness quickly? Were they able to get up without help? Any confusion or neurological symptoms?

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10
Q

List each system covered in a system review during a history

A

CVS
Respiratory
Neuro
GU
GI
MSK

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11
Q

CVS system review questions

A

Chest pain?
Palpitations?
Dizzy?
Clammy?

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12
Q

Respiratory system review questions

A

Cough, was it productive?
Haemoptysis?
Dyspnoea?
Wheeze?
COPD/asthma?

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13
Q

Neuro system review questions

A

Slurred speech?
Weakness/numbness?
Headaches?
Photphobia?
Neck pain?

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14
Q

GU system review questions

A

Discharge?
Dysuria?
Frequency?
Nocturia?
Colour of urine?

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15
Q

GI system review questions

A

Vomiting?
Diarrhoea?
Constipated?
Abdominal pain?

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16
Q

MSK system review questions

A

Pain?
Full range of motion?
Swelling of joints?

17
Q

What are the two types of falls?

A

Syncope- transient loss of consciousness due to reduced cerebral blood flow

Non-syncope- with or without loss of consciousness, not due to cerebral hypoperfusion

18
Q

What are the 4 different types of syncope falls?

A

Neurocardiogenic
-Vasovagal
-Carotid sinus
-Situational e.g. cough, micturition

Orthostatic hypotension
-Drug induced
-ANS failure
-Volume depletion

Cardiac arrhythmia
-Bradycardia (sick sinus or AV block)
-Tachycardia (VT or SVT)

Structural cardio-pulmonary
-Aortic stenosis
-Pulmonary hypertension

19
Q

How is BP controlled?

A

Baroreceptor reflex

Done it 9million times should know it by now

20
Q

What change in blood pressure is suggestive of postural hypotension?

A

Change of 20mmHg from sitting to standing

21
Q

What are the causes of non-syncope related falls?

A

Without Impairment of consciousness
- Fall
- Psychogenic
- TIA/Stroke

With partial or complete loss of consciousness
- Epilepsy
- Metabolic (hypoglycaemia, hypoxia, hypocapnia)
- Intoxications

22
Q

What social history questions do we need to ask for a fall history?

A

Are they living alone?
Any carers?
Walking aids?
Any stairs, bungalow?
Smoking or drinking?

23
Q

What investigations should be done for a fall?

A

Start by doing all examinations

Bedside
Bladder Scan
Urine dip,
(MC&S)
Lying/Standing
BP
ECG

Bloods
VBG
Blood Glucose
FBC, U&Es,
LFTs, Bone, CRP,
CK

Imaging
ECHO
CT
X-ray

Procedures
Tilt table

24
Q

What in a history can suggest rhabdomyolysis?

A

Long lie, raised CK, dark urine/ tea coloured

25
Q

Why do you develop rhabdomyolysis in long lie?

A

Pressure on muscle leading to ischaemia causing muscle breakdown

26
Q

Why does rhabdomyolysis cause AKIs?

A

Myoglobin released into the blood stream which is toxic to the kidneys

Intrinsic AKI

27
Q

Who is involved in managing a fall patient?

A

MDT approach

Physiotherapist
Tertiary care
Nursing staff
Occupational therapist
Senses
Discharge team

Integration for Clinical Application (16 decks)

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