Search for Hidden Pathology of Falls

• Always ask if the patient felt weak or dizzy prior to the fall.

• Ask for pre-fall syncope that would indicate cardiac dysrhythmia, myocardial infarction, or cerebrovascular accident.

• Ask for post-fall loss of consciousness that could indicate intracranial trauma.

• Remember that retrograde amnesia for syncope is present in one-third of all syncope patients. That means one-third of all patients who have syncope do not remember fainting because their brains were not getting enough oxygen or glucose at that time to preserve awareness of the event.

• Question the patient about cardiac problems:

— chest pain;

— palpitations;

— shortness of breath or dyspnea on exertion;

— diaphoresis;

— history of myocardial infarction or cardiac dysrhythmias.

• Question the patient about neurologic problems:

— focal weakness or numbness;

— ataxia: prior trouble with walking or balance;

— aphasia: trouble with speech: slurring or forgetting words;

— trouble with activities of daily living.

• Can the patient comb hair, brush teeth, button buttons, and tie shoes? Answers to those questions will often reveal a serious underlying problem.

• Question the patient about volume loss:

— nausea, vomiting or diarrhea. Specifically ask about gastrointestinal bleeding;

— lack of fluid and food intake;

— orthostatic symptoms on sitting up or standing prior to this fall.

• Question the patient about generalized illness/weakness

— history of cancer;

— diabetes: Was he/she hypoglycemic? Check a glucose on all patients. Note use of insulin or oral agents and last meal.

— Check for infection: fever, cough, upper respiratory infection or flu symptoms, abdomi- nal pain, urinary symptoms.

• Question about acute abdomen:

— abdominal pain;

— possible aneurysm;

— ruptured viscus.

• Question the patient for use of drugs that could impair balance or awareness:

— sedatives or narcotic pain medications;

— antihistamines;

— antihypertensives;

— alcohol

• Question for loss of up-righting reflex:

— neuropathy;

— musculoskeletal problems (arthritis);

— vertigo;

— old cerebrovascular accidents;

— Parkinson’s disease;

— poor vision.