Categories
Emergency Medicine

Fall

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 groupEtiologyConsequence
Younger age groupFall / TraumaStroke
ElderlyStrokeFall

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

Take Home Message

1. Fall in different age group can have different etiology and different consequences
2. When patient presented with multiple problems, we give priority to manage the dominant one(s) first.

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