Last Updated on July 4, 2022
Introduction
• Elderly tends to present ‘fall’ as a consequence of underlying etiology, while healthy and younger age group tend to present with fall/trauma first as the etiology which may later be complicated by stroke e.g. due to intracranial bleed (ICB)
Age group | Etiology | Consequence |
Younger age group | Fall / Trauma | Stroke |
Elderly | Stroke | Fall |
Presentation
“74-year-old man with underlying DM, HTN and dyslipidaemia, presented to ED with wound at the forehead”
At Triage
Primary Triage
Key questions
• Age group?
• Any fall?
• Any slurred speech? Weakness? Facial asymmetry?
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Example:
Elderly + fall + slurred speech: allow skip secondary triage, assign patient to at least yellow zone for further assessment by doctor
History Taking
• What tine & date?
Prior to fall
• What the patient did prior to fall?
• How the fall occurs?
During fall
• Fall at which side? / Fall towards which direction?
• Which site first landing on the floor?
• Fall hitting the head? Which site of the head?
Post fall
• Any retrograde amnesia?
• Any loss of consciousness?
• Any abrasion / laceration wound? Any bleeding? Any ENT bleeding?
• Any head trauma? Any headache? Which site of the head?
• Any neck pain?
• Any upper limbs pain: Shoulder? Arm? Forearm? Wrist? Fingers?
• Any lower limbs pain: Knee? Calf? Ankle? foot? Toes?
• Able to ambulate?
Relevant history
Co-morbidities
e.g. DM, HTN, dyslipidaemia, IHD, atrial fibrillation
Medications
Who takes care of patient’s medication?
• Anticoagulant (e.g. Rivaroxaban, warfarin)
• Antiplatelet (e.g. aspirin, clopidogrel)
• Insulin or oral anti-diabetic agents
• anti-hypertensive
💡Notes
High risk of ICB post fall: elderly + on anticoagulant / antiplatelet
Causes of Fall
• Seizure (e.g. epilepsy)
• Alcoholics
Fall in elderly
• Stroke
• Acute coronary syndrome
• Hypoglycaemia
• Sepsis
• Pulmonary embolism
Complications of Fall
• Intracranial bleed (e.g. subdural haematoma)
Case Scenario
Example 1
67 years old man, presented with 4 hours of slurred speech
Patient has underlying HTN, DM, dyslipidaemia, and recent admission to hospital for pneumonia with atrial fibrillation, discharged with T Rivaroxaban