Physical Exam for Falls
• Always establish your airway, breathing, and circulation.
• Assess the patient’s level of consciousness and mental status.
• Note the patient’s vital signs.
• All fallen elderly patients should be placed on a cardiac monitor, due to high rate and mortality of cardiac dysrhythmias resulting in falls.
• Do a secondary survey searching for traumatic injury.
• Focus specifically on head, neck, hips, and pelvis.
Direct special attention to areas of patient complaint. Fractures are the most common serious injury resulting from the fall. Extremity fractures compose the majority of fractures, followed by facial fractures, rib fractures, lumbar and thoracic vertebral fractures, cervical spine fractures, and fractures of the skull.
• Perform a careful neurologic evaluation.
• If possible, check for orthostatic blood pressure and pulse changes.
• Always check blood sugar for hypoglycemia.
Source: Terasita Hogan, MD, FACEP, Resurrection Medical Center, Chicago.