JOURNAL TRANSCRIPT

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UHSM ED Pathway ELDERLY FALL / COLLAPSE

Patient name / Addressograph

Pathway for patients who require assessment in ED after a fall or collapse Note: - It can be used if the patient has also sustained a minor head injury - More than 30% of elderly people have amnesia for blackouts and so will report it as a fall - A rapid / recent change in caring needs indicates that there is an underlying medical problem Exclusions - under 70 years old - acute medical illness - multiple injuries (major trauma) Arrival time………………..Date…………………Triage Category………..…... Initiate from arrival

On arrival

30 minutes

60 minutes

HR

HR

HR

BP

BP

BP

RR

RR

RR

FBC, U&E, +/- INR

SpO2

Spo2

Spo2

ECG

Pupils

Pupils

Pupils

Contact GP for PMHx & DHx

GCS Eyes

/4

GCS Eyes

/4

GCS Eyes

/4

Verbal

/5

Verbal

/5

Verbal

/5

Motor

/6

Motor

/6

Motor

/6

Postural BPs Urinalysis & MSU

Consider CXR / Pelvis/Hip Xray

Requested

Done

TOTAL /15

TOTAL /15

TOTAL /15

MEWS

MEWS

MEWS

Patient name / INITIAL CLINICAL ASSESSMENT

Addressograph

HISTORY OF PRESENTING COMPLAINT Time of fall / collapse……………………………………….. History of Fall / Collapse

Memory of event? Yes No Precipitating event? Yes No Recent deterioration in health? Yes No History of falls? Yes No Change in caring needs in last week? Yes No

Symptoms of head Injury: Vomiting? Yes No LOC? Yes No Seizure? Yes No Post traumatic amnesia? Yes No Pre traumatic amnesia ?Yes No PAST MEDICAL HISTORY

Social History: Current care package:

Regular alcohol intake

Tetanus status

Patient name / Addressograph DRUG HISTORY DRUG

DOSE

FREQUENCY

Drug allergies

DRUG

Drug Intolerance

EXAMINATION CVS: RESP: GI:

HIP & PELVIS:

LIMBS:

MOBILITY ASSESSMENT:

DOSE

FREQUENCY

Patient name / Addressograph

NEUROLOGICAL ASSESSMENT GCS: Eyes………./4

Verbal ……../5

Motor……..6

PUPILS: Cranial Nerves:

Examine for Head Injury:

Haemotympanum Panda Eyes CSF rhinorrhoea Battle’s sign

RIGHT Yes No Yes No Yes No Yes No

LEFT Yes Yes Yes Yes

Neck Examination:

C-Spine Xray indicated?

Yes No

Peripheral Nerves / Limb Examination:

No No No No

Patient name/ Addressograph

REVIEW INVESTIGATION

RESULTS

ECG POSTURAL BP URINALYSIS BLOODS XRAYS Does the patient take medications that could cause them to fall? Betablockers Antiarrhythmics Diuretics

Yes No Yes No Yes No

Does the patient have a history of CCF Yes No CVA Yes No Previous falls Yes No

Heart disease Yes No Parkinsons disease Yes No Dizzy episodes Yes No

MANAGEMENT PLAN Does the patient need a CT Head? Yes No (see flow chart on next page Plan:

Admit medics if:  Acute medical illness  Symptomatic postural drop in BP ( and >20mmHg)  Acute abnormal ECG  Abnormal Bloods Discharge Home if: Patient well  All investigation results are normal  Refer them to the Falls Service on the attached proforma Admit to CDU for ICT assessment if: Unable to go home due to acute change in caring needs Patient well  Investigation results normal  Agreed by consultant in charge: Name & Signature……………………………………………..  Drug Kardex completed

INVESTIGATION OF POTENTIAL HEAD INJURY GCS< 13 (in ED) Post Traumatic seizure Focal neurological deficit >1 episode of vomiting GCS 13 0r 14 2hrs or more after injury

YES TO ANY

Suspected open or depressed skull fracture

IMMEDIATE CT SCAN Time requested ……………………… (complete part 2/ CDU pathway)

Sign of fracture of base of skull  Coagulopathy with loss of consciousness or amnesia ( history of bleeding, clotting disorder, current treatment with warfarin)

NO Age >65 and loss of consciousness or amnesia Dangerous mechanism of injury and loss of consciousness or amnesia Amnesia of events> 30 mins before impact

YES TO ANY

CT SCAN WITHIN 8 HOURS OF INJURY (complete part 2/ CDU pathway)

NO DISCHARGE Ensure that: Head injury advice leaflet given Verbal advice given Analgesia given Accompanied by a responsible adult If any concerns consider admission to CDU on minor head injury pathway

Note: if no beds on CDU patient to be admitted under General Surgery