Falls and syncope Flashcards Preview

acute care > Falls and syncope > Flashcards

Flashcards in Falls and syncope Deck (7)
Loading flashcards...
1

Falls workup

Obs and examination, ask about anticoag
Neuro exam if head injury
ECG, echo
Bloods- urea, FBC, UE, maybe trop, LFT, clotting, CK, TFT
Urine dip
Lying standing BP- drop over 20 is sig
Thorough secondary survey, esp neck pain
XR if suspect frac- esp pelvis, chest
CT head if head inj in over 65
Check what meds they are on
EEG if seiz
MRI if susp neuro dis
Med review

2

Falls history Qs

Cause of fall
Memory of it, or witness
LOC, amnesia
Pre syncope- dizziness, nausea, vision change
Chest pain, palpitations
Recent illness, PMH, sensory impairment, cognition
Medication changes
Head injury, headache
Home environment
Mobility before and after
Previous fall
Post ictal
Bite tongue
Incontinence during fall
Seizure like activity
Fever

3

Syncopal

Cardiac- arrhythmia, structural cardiac or pulm dis
Neural- Vasovagal, situational, carotid sinus hypersensitivity
Postural hypotension- often due to meds
Medication
Cerebrovascular

4

non syncopal

ENVIRONMENT
MSK problems
Metabolic- hypoglycaemia, hypoxia, hypocapnia
Seizure
Intoxication
TIA
Psychogenic
ANS eg PD

5

Syncope causes

Vasovagal- ANS trigger
Hypotension- dehyd, DM, meds, bleeding
Cardiac- IHD, angina, MI, myop, arrhythmia
Anaemia
Electrolyte
Sepsis
Neuro and cerebrovasc
Drugs- eg PD orthostatic hypot
Alc and substance abuse
Reflex anoxic seiz in kids
Psychogenic eg anx

6

Fall RFs

Cognitive impair
Sensory impair
Mobil impair
Balance prob
Frail and comorb- arth, DM, incontin, CVA, PD
Polypharmacy
Poor get up and go test- sit to stand w/o arms, walk 3m, then back and sit. Over 12sec is high risk.
More than 4 steps to turn 180 deg when stood
Previous fall

7

prevention

OT and physio, home intervention
Strength and balance training
Vision assessment
Medication review
Comorb mx eg CVS, DM, MSK