• Scene – vitals, EKG, 12 Lead
• En route – IV, fluids, assessment, vitals
• Hospital – unk
• Response to treatment – dizziness was better upon arrival. BP came up a little and heart rate went down.
• Mark Shelton Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Hypotension
• Hypotension (primary or related to medication)
• Dehydration
• Arrhythmia
• CVA/stroke
• Myocardial infarction
• Medication overdose or non-compliance.
• Metabolic disturbance (electrolyte abnormality, eg hypokalemia).
• Patient states – I felt dizzy and had blurry vision. I sat down for a few minutes and then felt better, so I got up to get something to eat, and when I got in the kitchen my knees felt weak. My wife was able to help me to the floor.
• Caregiver states – I checked his BP and got a top number of 50 and a lower number of 40-something while he was seated in chair. He drinks Gatorade for the salt content.
• Physical findings – dizzy, blurry vision, hypotension, poor skin turgor.
• GCS – 15
• BP – initial 101/60; en route 124/81(after fluids).
• HR -102 then down to 77
• EKG – A-Fib
• CBG – n/a
The differential is large for a fall in the elderly population (see DDx). The paramedics gently and carefully supported this patient with sitting and then standing. It is important to note the he was lucid, able to carry on a conversation, and was not amnestic to the event. This appears to have been an assisted fall to the ground, rather than true syncope. Reviewing the patient’s medication and history can give the medic clues to the etiology behind the fall and the patient’s symptoms.
-Dr. David Spiro
• Always consider cervical spinal injury and immobilization when someone falls and hits their head
• It is important to think about both what may have caused the fall, as well as injuries that may have resulted from a fall
• Even seemingly mechanical falls should have a glucose, a stroke scale and an EKG checked
• Find out if they are on aspirin (salycilate), Plavix (clopidogrel), Coumadin (warfarin), Pradaxa (dabigatran), or other blood thinners, as these medications increase the risk of intracranial bleeds. Intracranial bleeds are one of the big concerns that could kill a patient.
• Keep in mind that the elderly are already at increased risk of intracranial injury with even minor mechanism, even if they’re not on blood thinners
• It is important to consider how long the patient was down for, what their functional status prior to the fall was, and what their body temperature is. Many older people fall and can’t get up for prolonged periods, resulting in hypothermia and muscle and skin breakdown from being down for so long.
• Whenever someone injures an extremity, check if they have strong distal pulses, motor strength, and sensation. If any of those details are missing, they need immediate evaluation at the hospital. If there is an obvious deformity, a cardboard splint can sometimes help with circulation/nervous/motor problems and pain control.
• Consider treating pain as appropriate per local protocol
• Falls in the elderly
• Failure to Thrive in Elderly Adults
• Gender: Male
• Age: 90 years
• Height: Not Available
• Temperature: Not Available
• Blood Pressure: 101/60
• Heart Rate: 102
• Respiratory Rate: 16
• Pulse Oximetry: 97% RA
Dizziness, blurred vision, assisted fall
• PHM: quadruple bypass, stents, knee replacements, a-fib.
• Allergies: PCN
• Dispatch info: dizzy, GLF, possible low blood pressure.
• Lives with wife. Nicely kept home, golfs about two times a week.
• Has occasional drink; non smoker.
• Warfarin
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