You are working as a double Technician crewed ambulance and are called to a 76-year-old female who has pressed her care-line button after a fall. The call has been in for some time and at scene you find the patient still on the floor next to her bed. She lives on her own but has no family nearby.
She is alert, conversant, and is very apologetic for ‘wasting your time’. You explain you are going to do a few checks first before you get her up on her feet. You are happy there are no abnormalities in your primary and a simple secondary survey to find external injury and she complains of no pain. Her observations completed are: 88 HR, 16 RR, 98% Sp02, 110/82 BP, 36.1 Temp and 7.2 blood sugar.
She remembers getting out of bed but is unsure how she got onto the floor. She states she has been feeling funny recently but has been unable to describe specific symptoms.
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There are numerous reasons for falls in older adults, what terms can we categorise these into?
You proceed to help the patient up off the floor and sit her on the bed. Again, she feels no pain when getting to her sitting position and is comfortable.
She has a past medical history of TIA and Hypertension. She is currently on Clopidogrel, Bisoprolol, Simvastatin and recently been put on Furosemide.
The patient is unable to tell you if she hit her head. Under the revised NICE head injury guidelines, should this patient be considered for head injury assessment at hospital regarding the medication she currently takes?
There are no signs of head injury, and the patient can’t feel any tenderness on her head, therefore, you deem the likelihood of head injury as low risk and move on. She states she would like to go to the toilet. You help her walk across her room but a few steps in she complains of dizziness then weakness. She falls into you, and you lower her to the ground as she has collapsed. You ask your colleague to get your defibrillator and equipment ready, but she quickly recovers when on the floor. What pathology would you suspect is behind this collapse?
The patient fully recovers shortly after and again is unable to remember the fall. As the patient can’t remember the fall, you are unable to classify this as a TLOC (transient loss of consciousness)?
According to the European society of cardiology, what four categories make up a TLOC diagnosis and can potentially help in the assessment of non-injury fallers?
What further assessments would you consider to further exclude potential reasons for a syncope?
What are some of the red flag features to observe for in a 12-lead ECG associated with syncope according to JRCALC guidelines? TICK ALL THAT APPLY
How do you complete a postural BP assessment?
Which of the following constitute as a postural drop when looking at your blood pressure readings?
You find the patient has a systolic BP drop of 26mmHg and therefore you have diagnosed postural hypotension. You have found no other abnormalities on your thorough assessment however the patient is unable to complete the stop and go test. You have determined no risk of ‘long lie’ risk factors. She has no family nearby. You think the cause is the recent furosemide prescription and little fluid replacement. What would be your likely plan for further assessment/treatment for this patient?
Asymptomatic postural hypotension can potentially be managed in primary care where appropriate services are available?
What factors are included in the diagnosis of an ‘uncomplicated faint’? TICK ALL THAT APPLY
According to European Society of Cardiology guidelines, what are some of the high-risk features associated with syncope? TICK ALL THAT APPLY
How much muscle mass can be lost in older adults with increased bed rest within the first week of hospitalisation and therefore should be a consideration of admitting a patient to hospital?
Older people who have contact with healthcare professionals for any reason should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the falls?
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