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;
— shortness of breath or dyspnea on exertion;
— 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;
• Question for loss of up-righting reflex:
— musculoskeletal problems (arthritis);
— old cerebrovascular accidents;
— Parkinson’s disease;
— poor vision.