Immobility and Falls Flashcards Preview

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Flashcards in Immobility and Falls Deck (26)
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1
Q

What are the potential outcomes after a fall?

A
Injury (soft tissue, fracture, SAH) 
Rhabdomyolysis (increased CK)
Loss of confidence/ fear of falling 
Dependency/ QOL decreased 
Carer stress
Institutionalisation 
Terminal decline
2
Q

What are the risks factors for falls?

A
Muscle weakness 
History of falls 
Gait deficit 
Balance deficit 
Use of assistive device 
Visual deficit 
Arthritis 
Impaired ADL 
Depression 
Cognitive impairment 
>80yrs
3
Q

What are the intrinsic factors that cause patients to fall?

A
Gait and balance problems (postural instability, vertigo) 
Syncope (cardiac, vagal)
Chronic disease (Neurological, MSK) 
Visual problems 
Acute illness 
Cognitive disorder 
Vitamin D deficiency
4
Q

What are the situational factors that cause patients to fall?

A

Medications
Alcohol
Urgency of micturition

5
Q

What are some examples of drugs that cause patients to fall?

A
Antidepressants 
Antipsychotics 
Anticholinergics/antimuscarinics 
Benzodiazepines 
Anti-hypertensives 
Diuretics
6
Q

What are the extrinsic factors that cause patients to fall?

A

Inappropriate footwear
Environmental hazards (uneven paving, carpets,walking aids, stairs)
Poor lighting

7
Q

What investigations can be used to assess gait and balance?

A
Sitting to standing ability 
Transfers 
Static standing balance 
Romberg test 
Dynamic standing balance 
Gait 
Tinetti gait and balance scale 
Berg balance scale
8
Q

What can cause vertigo?

A
Labrynthitis 
Acute ear infection 
Benign paroxsymal positional vertigo 
Meniere's
Cerebellar/brainstem pathology
9
Q

What are the main causes of syncope?

A
Neurally-mediated (reflex) 
Orthostatic hypotension 
Cardiac arrhythmias
Structural cardiac or cardiopulmonary disease
Cerebrovascular
10
Q

What can cause a neurally-mediated syncope?

A
Vasovagal syncope (common faint) 
Carotid sinus hypersensitivity 
Acute haemorrhage 
Post-exercise 
Cough, sneeze 
Micturition/post micturition 
Gastrointestinal stimulation
11
Q

What can cause an orthostatic hypotension syncope?

A

Primary autonomic failure syndromes (multiple system atrophy, Parkinson’s)
Secondary autonomic failure syndromes (Diabetic neuropathy, Amyloid neuropathy)
Drug and alcohol induced orthostatic syncope
Haemorrhage
Diarrhoea
Addison’s disease

12
Q

What can cause a cardiac arrhythmia syncope?

A

Sinus node dysfunction
Atrioventricular conduction system disease
Paroxsymal supraventricular and ventricular tachycardias
Inherited syndromes (long QT, Brugada syndrome)
Implanted device (pacemaker, ICD)
Drug-induced proarrhythmias

13
Q

What can cause a structural cardiac or cardiopulmonary disease syncope?

A

Cardiac valvular disease (aortic stenosis)
Acute MI/ ischaemia
Obstructive cardiomyopathy
Atrial myxoma
Acute aortic dissection
Pericardial disease/tamponade
Pulmonary embolus/ pulmonary hypertension

14
Q

What questions should be asked in a collateral history for syncope?

A

Event circumstances
Posture immediately before syncope
Appearance
Presence/absence of movement during event
Tongue-biting
Duration of event
Presence/absence of confusion in recovery period
Unilateral weakness during recovery period

15
Q

When investigating syncope, what should be looked for on a 12 lead ECG?

A

Inappropriate persistent bradycardia
Long (>450ms) or short (<350ms) QT intervals
Abnormal T wave inversion

16
Q

When investigating syncope, what are considered as red flags?

A
ECG abnormality 
Heart failure 
Onset with exertion 
Family history of sudden cardiac death <40yrs and/or an inherited cardiac condition 
New or unexplained breathlessness 
Heart murmur
17
Q

What symtoms of an episode would make you consider a seizure?

A
1 or more of:
Bitten tongue 
Head-turning to 1 side during episode 
No memory of abnormal behaviour 
Unusual posturing 
Prolonged simultaneous limb-jerking 
Confusion after event 
Prodromal deja vu or jamais vu
18
Q

What further tests can be used to determine the reason for syncope episode?

A
Electrocardiogram 
Telemetry 
Cardiac enzymes 
CT 
Postural BP 
Echocardiogram 
EEG 
Carotid USS 
MRI 
Cardiac stress test
19
Q

What cognitive disorders could led to syncope episode?

A

Dementia
Delirium
Depression/anxiety

20
Q

What can be used to assess the risk of osteoporosis?

A

FRAX or QFRACTURE tool

DEXA scanning

21
Q

What are the most common sites of fracture in osteoporosis?

A

Hip
Wrist
Vertebrae

22
Q

What are the treatment options for osteoporosis?

A

Calcium/vitamin D supplement
Bisphosphonates
Teriparatide
Denosumab

23
Q

What are the physical complications of immobility?

A
Muscle wasting 
Muscle contractures 
Pressure sores 
Deep venous thrombosis 
Constipation/ incontinence 
Hypothermia 
Hypostatic pneumonia 
Osteoporosis
24
Q

What are the psychological complications of immobility?

A

Depression

Loss of confidence

25
Q

What are the social complications of immobility?

A

Isolation

Institutionalisation

26
Q

What are the risk factors of sarcopenia?

A
Diabetes/insulin resistance 
Elderly 
Chronic disease 
Lack of use 
Inflammation 
Nutritional deficiency 
Endocrine dysfunction