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Geriatrics > Immobility and falls > Flashcards

Immobility and falls Flashcards

1
Q

main disorders causing falls? - neurological

A
  • Stroke, old or new
  • Parkinsonism
  • Dementia
  • Delirium, Ataxia (Seizure, TIA)
    Other neurological conditions
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2
Q

main disorders causing falls?- drugs

A

Anti hypertensives
Sedatives, alcohol
And lots of others

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3
Q

main disorders causing falls? - sensory

A

Visual impairment
Inattention
(Hearing)

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4
Q

main disorders causing falls? - cardiovascular (4)

A
  • Postural hypotension
  • Arrythmia
  • Heart failure
  • Aortic Stenosis
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5
Q

main disorders causing falls? - musculoskeletal

A
  • Arthritis of weight bearing joints
  • Sarocopenia
  • Deformities of feet
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6
Q

how do drugs cause falls - what do they decrease

A

Blood pressure
Heart rate
Awareness

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7
Q

how do drugs cause falls - what do they increase

A
  • Urine output
  • Sedation
  • Hallucinations
  • qTC
  • Dizziness
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8
Q

Culprit drugs that can cause falls?

A
  • Antihypertensive
  • Beta blocker
  • Sedatives
  • Anticholingerics
  • Opioids
  • Alcohol
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9
Q

full MDT - what will nurse carry out

A

Eye test, ECG, Lying and standing BP, incontinence questionarrie. MMSE

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10
Q

full MDT - what will physio carry out

A

Full assessment of gait and balance

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11
Q

full MDT - what will doctor carry out

A

Through history and examination, consider bone health and osteoporosis screening. (45 minutes +)

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12
Q

syncope on excretion - what could this be?

A

aortic stenosis

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13
Q

Collapse with no memory ? think..?

A

syncope or cognition

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14
Q

Clear history of trip – think ?

A

sensory (eyes, nerves)

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15
Q

Palpitations preceding fall and no trip - think ?

A

cardiac

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16
Q

Falling on Turning - think?

A

postural instability

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17
Q

Any ‘near misses’- think?

A

unsteady on standing

- have they nearly fallen

18
Q

Systematic enquiry - what MUST you ask (3)

A
  • Memory – Ideally ask a relative too
  • Urinary symptoms (they won’t tell you if you don’t ask)
  • Has walking changed recently
19
Q

Systematic enquiry - drugs

A
  • Especially over the counter antihistamines…

- Especially alcohol

20
Q

Examination steps - first

A
  • assess walking

- Get patient on couch - can they take their shoes off

21
Q

Examination steps - head and arms

A
  • Cranial nerves, apart from smell.
  • Check glasses
  • Check neglect,
  • Cerebellar signs
  • Bradykineasia, ridigidity – signs of PD
22
Q

Examination - cardiac

A

Pulse, (BP) Heart sounds. Signs of heart failure and respiratory disease

23
Q

on examination look out for?

A

Kyphosis

24
Q

what examination may you carry out?

A

Abdominal examination (+PR if prostate)

25
Q

examinations - legs - what should you remember

A
  • Look at feet (footwear, toenails).
  • Check sensation, vibration sense, and proprioception – remember usually glove and stocking not dermatomal
  • Co-ordination
26
Q

how to asses them standing up?

A
  • Romberg’s

- Assess gait

27
Q

ataxic gate?

A

cerebellar damage

28
Q

Arthralgia gait?

A

Arthritis

29
Q

Hemiplegic gait?

A

old stroke (stiff leg)

30
Q

Small steps, shuffling (gait)?

A

(Vascular) parkinsonism

31
Q

High stepping gait caused by?

A

Peripheral neuropathy

32
Q

non injured fallers are often?

A

left at home by paramedics and referred to community falls pathways- including falls clinic

33
Q

non- injured falling patients in A&E are often

A
  • Tired
  • Injured
  • In pain
  • Unable to stand due to injury (so can’t assess gait)
  • Systemically unwell
  • Will need MDT assessment later
34
Q

important things to check in a history ?

A
  • How did they fall? Did they trip over? - What did they trip over?
  • Long lie – check CK for rhabdomyolysis. - Pneumonia and skin injury common as well.
  • Any other falls.
  • Any cognitive impairment
  • Any incontinence
  • Any syncope
  • Any features of seizure (rare but happens)
  • Are they drunk
  • Look at ambulance sheet –
  • Talk to relative
35
Q

A falls assessment in A+E - examination and investigations

A

if acute - do bloods

  • Do a neurological examination as well as Chest / heart / abdomen (skip reflexes!)
  • legs can they walk
  • The best history you can get (include the ambulance sheet)
  • obs, L+S BP
  • ECG
  • Bloods for all* check B12, folate, CK, TFTs
  • Check for delirium using 4AT
  • Consider CT head if fall with head injury and neurological signs or anticoagulated
36
Q

Questions to ask yourself?

A

ARE THEY INJURED

  • sick?
  • Is she safe to go home (+ community falls service)?
  • Can she go to the toilet on her own?
  • Can she get a cup of tea between carer visits?
  • Can she walk in A+E ?
  • Can she summon help (would she have a long lie)?
37
Q

what must you test for

A

glucose

ABCDE

38
Q

Immediate assessmentfor serious injuries?

A
  • Head injury and extra dural
  • Seizure
  • C Spine injury
  • Flail chest
  • Abdominal injury
  • Pelvic injury
  • Limb fracture
39
Q

when to do a CT head?

A
  • Low GCS <13
  • Still confused after 2 hours (or not back to baseline cognitive state)
  • Focal neurology
  • Signs of skull fracture
  • Basal skull fracture – CSF leak, bruising around eyes,
  • Seizure
  • Vomiting
  • Anti-coagualtion
40
Q

when to x-ray

A
  • if they can’t move joint
  • if there is a pain in joint
  • If no deformity but pain on weight bearing have low threshold to x ray
  • People can walk on fractured hips (I don’t know how either!)
41
Q

What caused the fall in inpatients ?

A
  • Patient getting postural hypotension (or just hypotension) due to illness
  • Or new medication
  • Low blood glucose
  • Or getting sicker
  • DELIRIUM
  • De-conditoning
  • Call bell out of reach, no appropriate footwear

Geriatrics (10 decks)

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