CARE OF THE ELDERLY
CARE OF THE ELDERLY
Embedded Files
FALLS
FALLS
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Take a focused history from a patient presenting with a fall
- Demonstrate a relevant and focused examination of a patient presenting with a fall
- Suggest differential diagnoses of patients presenting with a fall
- Understand some basic investigations for patients presenting with a fall
- Discuss the management of falls during on-call shifts
Explain structure of session
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Ysabelle Embury-YoungUploaded:
15th October 2019Last updated:
15th October 2019Resources needed for this session:
Resources needed for this session:
Pen, paper
Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination
25 minActivity 1: History Taking and Examination
Ask the student(s) to take a focused history including history of presenting complaint (encourage them to think about pre-/during-/and post- fall), past medical history, drug and allergy history, social history, family history and a thorough system review. Encourage them to take a collateral history from any witnesses/family, if possible.
Following this, ask the student(s) to perform a systematic A to E examination, followed by (or including) a focused system-based examination to include relevant respiratory, cardiovascular, neurological and musculoskeletal systems.
Activity 2: Diagnostic Reasoning and Case Based Discussion
10 minActivity 2: Diagnostic Reasoning and Case Based Discussion
Ask students to summarise the key points of history and examination.
Following this, consider:
- What are the possible differential diagnoses in this case?
- What investigations would you consider?
- How would you manage this patient?
Possible points of further discussion:
- Importance of drug history and anticoagulant use in falls
- Musculoskeletal examination/primary survey to identify traumatic injuries e.g. c-spine injuries, rib fractures, haemothorax, neck of femur fractures
- Importance of monitoring e.g. neurological observations
- Holistic approach to considering falls e.g. patient's home environment, cognition, hearing, visual impairment, environmental factors
Activity 3: Indications for Imaging
10 minActivity 3: Indications for Imaging
Consider the indications for CT head. Review the NICE Head Injury guidelines (CG176) - students can scan the QR code opposite to view on their phones.
Allow students to view the CT head if the patient they have seen has had one or alternatively use the example below. Ask students to identify key structures:
- skull/bone
- brain
- ventricles
- midline
- any obvious pathology
Discuss the differences between extra and subdural haemorrhages.
Activity 4: ECG Interpretation
5 minActivity 4: ECG Interpretation
Ask the student(s) to interpret the ECG of the patient. Briefly discuss common cardiac arrhythmias associated with syncope and falls.
Activity 5: Further Management
5 minActivity 5: Further Management
Find the local hospital guidelines for management of inpatient falls.
- Discuss additional considerations when managing patients who have fallen in hospital.
- Consider falls prevention strategies in hospitals - what measures are commonly put in place to minimise falls risk?
Summary and Feedback
5 minSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
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