Falls + Postural hypotension Flashcards
(22 cards)
Causes of falls?
MINC
MSK - Fracture, osteoporosis
Iatrogenic -
High ACB (amitryptilline, clozapine),
Low BP (ace-i, bb, ccb),
benzodiazepines
Neuro -
TIA/Stroke
seizure,
Parkinsonism
Cerebellar
CV -
Syncope
post hypo
What is assessed in a patient who has fallen?
Circumstances (before/during/after)
ADL
Frailty
Fall risk
what are ADLs?
examples?
Activities of Daily Living
self care - Barthel index
-dressing
-bathing
-toilet
-grooming
-eating
What is an IADL?
examples?
Instrumental activities of daily living
Household maintenance - Lawton + Brody scale
-grocery shop
-driving
-housework
-using telephone
-handling finances
How is ADL assessed?
what are the scores out of and what do they mean?
Barthel Index /100
eg. feeding, bathing, toilet, dressing
<90 mild, <60 severe dependency, <20 = total dependency
How is frailty assessed?
what are the scores out of and what do they mean?
Rockwood frailty score 0-9
1-4 = mild
5-6 = moderate
7-9 = severe frailty, dependent
What is used to assess falls risk?
FRAT tool
(falls risk assessment tool)
Dx for falls?
Bloods (FBC, U+E, eGFR, CK, Bone profile, B12+folate, Vit D)
Lying/standing BP + ECG
Chest xray + CT head (rule out pneumothorax + head injury)
+ urine dip, MMSE, DEXA
Tx for falls?
Exercises (PT)
House assess - hazards = PT/OT
Medication review
Eye check
Complications of falls?
SDH
Haematoma
Pneumothorax
Fractures
Rhabdomyolysis
What is rhabdomyolysis?
RF?
HIGH muscle breakdown after trauma
RF: Long lie (>1hr), NMS, Anabolic steroids, hyperthermia
Rhabdomyolysis
Sx?
Dx?
Tx?
Coca Cola urine + muscle pain
High CK in blood, high myoglobin (causes Coca Cola urine)
IV fluids, IV Na2CO3 (prevent AKI)
What is the definition of postural hypotension?
20+ mmHg SYSTOLIC or 10+ mmHg DIASTOLIC drop in BP after standing from sitting
Not resolved in less than 3 mins
RF for postural hypotension?
Increased age
CVD
Pathology of postural hypotension?
Impaired neuro-cardiac baroreceptor reflex - blood pooling in legs should increase CV BP but in increased age = Low BV plasticity
Sx of postural hypotension?
Lightheadedness (+ syncope) after standing from sitting +/- dizzy, palpitation
Causes of postural hypotension?
CV = HF, MI, AF
Neuro = parkinsons
Iatrogenic = Low BP meds
Other = Addisons
Dx of postural hypotension?
Lying/standing BP
ECG
R/O other causes (eg. bloods)
% of 70y/o affected by postural hypotension?
30%
Tx of postural hypotension?
Conservative
Drink more water
stand slowly
review meds
Tx of postural hypotension?
Medical
off licence use:
Midodrine (NAd replacement)
Fludrocortisone (mineral corticoid)
SE for midodrine and fludrocortisone?
Midodrine - retention
Fludro - oedema
